ENDOCRINOLOGY IN PREGNANCY: Influence of maternal vitamin D status on obstetric outcomes and the foetal skeleton
Eur J Endocrinol April 10, 2015 EJE-14-0826
Rebecca Moon, Nicholas Harvey and Cyrus Cooper cc at mrc.soton.ac.uk
R Moon, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
N Harvey, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
C Cooper, MRC Lifecourse Epidemiology Unit, University of Southampton, SOUTHAMPTON, United Kingdom
Overview Pregnancy and vitamin D has the following summary
|IU||Cumulative Benefit||Blood level||Cofactors||Calcium||$*/month|
|200|| Better bones for mom|
with 600 mg of Calcium
|6 ng/ml increase||Not needed||No effect||$0.10|
|400|| Less Rickets (but not zero with 400 IU)|
3X less adolescent Schizophrenia
Fewer child seizures
|20-30 ng/ml||Not needed||No effect||$0.20|
|2000|| 2X More likely to get pregnant naturally/IVF |
2X Fewer dental problems with pregnancy
8X less diabetes
4X fewer C-sections (>37 ng)
4X less preeclampsia (40 ng vs 10 ng)
5X less child asthma
2X fewer language problems age 5
|42 ng/ml||Desirable||< 750 mg||$1|
|4000|| 2X fewer pregnancy complications |
2X fewer pre-term births
|49 ng/ml|| Should have |
|< 750 mg||$3|
|6000||Probable: larger benefits for above items|
Just enough D for breastfed infant
More maternal and infant weight
|< 750 mg||$4|
The articles in Pregnancy AND Meta-analysis are here:
- Vitamin D treats Gestational Diabetes, decreases hospitalization and newborn complications – meta-analysis March 2019
- Birth size and weight increased by Vitamin D – meta-analysis Feb 2019
- Pregnancies helped by Vitamin D in many ways – 27th meta-analysis Jan 2019
- Vitamin D supplementation reduced SGA, fetal mortality, infant mortality – JAMA Meta – May 2018
- Gestational Diabetes 39 percent more likely if insufficient Vitamin D – Meta-analysis March 2018
- Preeclampsia reduced 2X by Vitamin D, by 5X if also add Calcium – meta-analysis Oct 2017
- Preeclampsia risk reduced 60 percent if supplement with Vitamin D (they ignored dose size) – meta-analysis Sept 2017
- Small for gestational age is 1.6 X more likely if mother was vitamin D deficient – meta-analysis Aug 2017
- Miscarriage 2 times more likely if low vitamin D – meta-analysis May 2017
- Fewer than half of pregnancies will get even 20 ng of vitamin D with 800 IU daily dose – meta-analysis May 2017
- Low Vitamin D results in adverse pregnancy and birth outcomes – Wagner meta-analysis March 2017
- Bacterial vaginosis in pregnancy increased prematurity risk by 60 percent - meta-analysis 1999
- Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017
- Vitamin D during pregnancy reduces risk of childhood asthma by 13 percent – meta-analysis Dec 2016
- Vitamin D helps during pregnancy – meta-analysis Feb 2016
- Preterm birth 30 percent more likely if low vitamin D – meta-analysis May 2016
- Preterm birth extended by 2 weeks with Omega-3 – Meta-analysis Nov 2015
- Gestational Diabetes Mellitus 1.5X more likely if low vitamin D – meta-analysis Oct 2015
- Infant wheezing 40 percent less likely if mother supplemented with vitamin D, vitamin E, or Zinc – meta-analysis Aug 2015
- Birth weight and length increased with high levels of vitamin D – meta-analysis March 2015
- Pregnancy and Vitamin D – meta-analysis April 2015
- More vitamin D needed during pregnancy – meta-analysis Oct 2014
- Preeclampsia rate cut in half by high level of vitamin D – meta-analysis March 2014
- Preeclampsia 2.7X more frequent if low vitamin D – meta-analysis Sept 2013
- 2X more preeclampsia when vitamin D less than 30 ng, etc. - meta-analysis March 2013
- 2X more likely to have preeclampsia if less than 20 ng of vitamin D – Meta-analysis Jan 2013
- Pregnancy and vitamin D meta-analysis – July 2012
- Low vitamin D increased probability of low birth weight by 60 percent – meta-analysis June 2012
- Gestational diabetes 60 percent more likely below 20 ng of vitamin D – meta-analysis Feb 2012
- Premature or low birth weight resulted in children 3X more likely to be anxious – meta-analysis May 2011
Vitamin D status is increasingly associated with wide ranging clinical outcomes. There is now a wealth of observational studies reporting on its associations with obstetric complications, including preeclampsia, gestational diabetes and mode and timing of delivery. The findings are inconsistent and currently there is a lack of data from high quality intervention studies to confirm a causal role for vitamin D in these outcomes. This is similarly true with regards to fetal development, including measures of fetal size and skeletal mineralisation.
Overall, there is an indication of possible benefits of vitamin D supplementation during pregnancy for
- offspring birthweight,
- calcium concentrations and bone mass, and for
- reduced maternal pre-eclampsia.
However, for none of these outcomes is the current evidence base conclusive, and the available data justify the instatement of high-quality randomised placebo controlled trials in a range of populations and health care settings to establish potential efficacy and safety of vitamin D supplementation to improve particular outcomes.
Received 1 October 2014, Accepted Preprint first posted online on 10 April 2015
Download the PDF from VitaminDWiki
Figure 1: Forest plot of the association between maternal vitamin D status and risk of preeclampsia (observational studies)
Table 1: Meta-analyses of maternal vitamin D status (intake and serum 25-hydroxyvitamin D level) and risk of pre-eclampsia
Table 2: Intervention studies of vitamin D supplementation (alone, and in combination with calcium supplementation) in pregnancy to reduce obstetric complications
- National Institute for Health and Clincial Excellence. Antenatal care (NICE Clinical Guideline 62). www.guidance.nice.org.uk/cg62, 2010.
- Paxton GA, Teale GR, Nowson CA, Mason RS, McGrath JJ, Thompson MJ, Siafarikas A, Rodda CP & Munns CF. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Med J Aust 2013 198 142-143.
- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH & Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. JClinEndocrinolMetab 2011 96 1911-1930.
- World Health Organisation. Guideline: Vitamin D supplementation in pregnant women. Geneva, 2012.
- Harvey N, Holroyd C, Ntani G, Javaid M, Cooper P, Moon R, Cole Z, Tinati T,
- Godfrey K, Dennison E, et al. Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess 2014 18.
- Jones KS, Assar S, Harnpanich D, Bouillon R, Lambrechts D, Prentice A & Schoenmakers I. 25(OH)D2 Half-Life Is Shorter Than 25(OH)D3 Half-Life and Is Influenced by DBP Concentration and Genotype. J Clin Endocrinol Metab 2014 99 3373-3381.
- Hollis BW & Wagner CL. Clinical review: The role of the parent compound vitamin D with respect to metabolism and function: Why clinical dose intervals can affect clinical outcomes. J Clin Endocrinol Metab 2013 98 4619-4628.
- Bikle D, S. Adams J & Christakos S. Vitamin D: Production, Metabolism, Mechanism of Action, and Clinical Requirements. In Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, pp 235-248: John Wiley & Sons, Inc., 2013.
- Kovacs CS. Calcium and Bone Metabolism in Pregnancy and Lactation*. The Journal of Clinical Endocrinology & Metabolism 2001 86 2344-2348.
- Cross NA, Hillman LS, Allen SH, Krause GF & Vieira NE. Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr 1995 61 514-523.
- Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE & King JC. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr 1998 67 693-701.
- More C, Bhattoa HP, Bettembuk P & Balogh A. The effects of pregnancy and lactation on hormonal status and biochemical markers of bone turnover. Eur J Obstet Gynecol Reprod Biol 2003 106 209-213.
- Ardawi MS, Nasrat HA & HS BAA. Calcium-regulating hormones and parathyroid hormone-related peptide in normal human pregnancy and postpartum: a longitudinal study. Eur J Endocrinol 1997 137 402-409.
- Zhang JY, Lucey AJ, Horgan R, Kenny LC & Kiely M. Impact of pregnancy on vitamin D status: a longitudinal study. Br J Nutr 2014 1-7.
- Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM & Cooper C. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. The Lancet 2006 367 36-43.
- McAree T, Jacobs B, Manickavasagar T, Sivalokanathan S, Brennan L, Bassett P, Rainbow S & Blair M. Vitamin D deficiency in pregnancy - still a public health issue. Matern Child Nutr 2013 9 23-30.
- Maghbooli Z, Hossein-Nezhad A, Shafaei AR, Karimi F, Madani FS & Larijani B. Vitamin D status in mothers and their newborns in Iran. BMC Pregnancy Childbirth 2007 7 1.
- Song SJ, Si S, Liu J, Chen X, Zhou L, Jia G, Liu G, Niu Y, Wu J, Zhang W, et al. Vitamin D status in Chinese pregnant women and their newborns in Beijing and their relationships to birth size. Public Health Nutr 2013 16 687-692.
- Markestad T, Aksnes L, Ulstein M & Aarskog D. 25-Hydroxyvitamin D and 1,25- dihydroxyvitamin D of D2 and D3 origin in maternal and umbilical cord serum after vitamin D2 supplementation in human pregnancy. Am J Clin Nutr 1984 40 10571063.
- Novakovic B, Galati JC, Chen A, Morley R, Craig JM & Saffery R. Maternal vitamin D predominates over genetic factors in determining neonatal circulating vitamin D concentrations. Am J Clin Nutr 2012 96 188-195.
- Brooke OG, Brown IR, Bone CD, Carter ND, Cleeve HJ, Maxwell JD, Robinson VP & Winder SM. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J 1980 280 751-754.
- Grant CC, Stewart AW, Scragg R, Milne T, Rowden J, Ekeroma A, Wall C, Mitchell EA, Crengle S, Trenholme A, et al. Vitamin D During Pregnancy and Infancy and Infant Serum 25-Hydroxyvitamin D Concentration. Pediatrics 2013.
- Mallet E, Gugi B, Brunelle P, Henocq A, Basuyau JP & Lemeur H. Vitamin D supplementation in pregnancy: a controlled trial of two methods. Obstet Gynecol 1986 68 300-304.
- Roth DE, Al Mahmud A, Raqib R, Akhtar E, Perumal N, Pezzack B & Baqui AH. Randomized placebo-controlled trial of high-dose prenatal third-trimester vitamin D3 supplementation in Bangladesh: the AViDD trial. Nutr J 2013 12 47.
- Yu CK, Sykes L, Sethi M, Teoh TG & Robinson S. Vitamin D deficiency and supplementation during pregnancy. Clin Endocrinol (Oxf) 2009 70 685-690.
- Wagner CL, McNeil RB, Johnson DD, Hulsey TC, Ebeling M, Robinson C, Hamilton SA & Hollis BW. Health characteristics and outcomes of two randomized vitamin D supplementation trials during pregnancy: a combined analysis. J Steroid Biochem Mol Biol 2013 136 313-320.
- Hollis BW, Johnson D, Hulsey TC, Ebeling M & Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011 26 2341-2357.
- Dawodu A, Saadi HF, Bekdache G, Javed Y, Altaye M & Hollis BW. Randomized controlled trial (RCT) of vitamin D supplementation in pregnancy in a population with endemic vitamin D deficiency. J Clin Endocrinol Metab 2013 98 2337-2346.
- Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L & Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev 2014 6 Cd001059.
- Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW & Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007 92 3517-3522.
- Baker AM, Haeri S, Camargo CA, Jr., Espinola JA & Stuebe AM. A nested case- control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clin Endocrinol Metab 2010 95 5105-5109.
- Bodnar LM, Simhan HN, Catov JM, Roberts JM, Platt RW, Diesel JC & Klebanoff MA. Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology 2014 25 207-214.
- Wei SQ, Audibert F, Hidiroglou N, Sarafin K, Julien P, Wu Y, Luo ZC & Fraser WD. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. Bjog 2012 119 832-839.
- Robinson CJ, Alanis MC, Wagner CL, Hollis BW & Johnson DD. Plasma 25- hydroxyvitamin D levels in early-onset severe preeclampsia. Am J Obstet Gynecol 2010 203 366.e361-366.
- Xu L, Lee M, Jeyabalan A & Roberts JM. The relationship of hypovitaminosis D and IL-6 in preeclampsia. Am J Obstet Gynecol 2014 210 149.e141-147.
- Abedi P, Mohaghegh Z, Afshary P & Latifi M. The relationship of serum vitamin D with pre-eclampsia in the Iranian women. Matern Child Nutr 2014 10 206-212.
- Scholl TO, Chen X & Stein TP. Vitamin D, secondary hyperparathyroidism, and preeclampsia. Am J Clin Nutr 2013 98 787-793.
- Haugen M, Brantsaeter AL, Trogstad L, Alexander J, Roth C, Magnus P & Meltzer HM. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology 2009 20 720-726.
- Shand AW, Nassar N, Von Dadelszen P, Innis SM & Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for preeclampsia. Bjog 2010 117 1593-1598.
- Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA & Thadhani R. First trimester vitamin D, vitamin D binding protein, and subsequent preeclampsia. Hypertension 2010 56 758-763.
- Seely EW, Wood RJ, Brown EM & Graves SW. Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia. J Clin Endocrinol Metab 1992 74 1436-1440.
- Fernandez-Alonso AM, Dionis-Sanchez EC, Chedraui P, Gonzalez-Salmeron MD & Perez-Lopez FR. First-trimester maternal serum 25-hydroxyvitamin D(3) status and pregnancy outcome. Int J Gynaecol Obstet 2012 116 6-9.
- Burris HH, Rifas-Shiman SL, Huh SY, Kleinman K, Litonjua AA, Oken E, Rich- Edwards JW, Camargo CA, Jr. & Gillman MW. Vitamin D status and hypertensive disorders in pregnancy. Ann Epidemiol 2014 24 399-403.e391.
- Zhou J, Su L, Liu M, Liu Y, Cao X, Wang Z & Xiao H. Associations between 25- hydroxyvitamin D levels and pregnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr 2014.
- Dalmar A, Raff H, Chauhan SP, Singh M & Siddiqui DS. Serum 25-hydroxyvitamin D, calcium, and calcium-regulating hormones in preeclamptics and controls during first day postpartum. Endocrine 2014.
- Yu CK, Ertl R, Skyfta E, Akolekar R & Nicolaides KH. Maternal serum vitamin D levels at 11-13 weeks of gestation in preeclampsia. J Hum Hypertens 2013 27 115118.
- Hypponen E, Cavadino A, Williams D, Fraser A, Vereczkey A, Fraser WD, Banhidy F, Lawlor D & Czeizel AE.
Vitamin D and pre-eclampsia: original data, systematic review and meta-analysis. Ann Nutr Metab 2013 63 331-340.
See VitaminDWiki Preeclampsia rate cut in half by high level of vitamin D – meta-analysis March 2014
- Thorne-Lyman A & Fawzi WW. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 2012 26 Suppl 1 75-90.
- Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M & Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013 346 f1169.
- Tabesh M, Salehi-Abargouei A, Tabesh M & Esmaillzadeh A. Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013 98 3165-3173.
- Wei SQ, Qi HP, Luo ZC & Fraser WD. Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013 26 889-899.
- Schneuer FJ, Roberts CL, Guilbert C, Simpson JM, Algert CS, Khambalia AZ, Tasevski V, Ashton AW, Morris JM & Nassar N. Effects of maternal serum 25- hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr 2014 99 287-295.
- Reeves IV, Bamji ZD, Rosario GB, Lewis KM, Young MA & Washington KN.
Vitamin D deficiency in pregnant women of ethnic minority: a potential contributor to preeclampsia. J Perinatol 2014.
- Xu L, Nicholson P, Wang Q, Alen M & Cheng S. Bone and muscle development during puberty in girls: a seven-year longitudinal study. J Bone Miner Res 2009 24 1693-1698.
- Bener A, Al-Hamaq AO & Saleh NM. Association between vitamin D insufficiency and adverse pregnancy outcome: global comparisons. Int J Womens Health 2013 5 523-531.
- Wetta LA, Biggio JR, Cliver S, Abramovici A, Barnes S & Tita AT. Is midtrimester vitamin D status associated with spontaneous preterm birth and preeclampsia? Am J Perinatol 2014 31 541-546.
- Ullah MI, Koch CA, Tamanna S, Rouf S & Shamsuddin L. Vitamin D deficiency and the risk of preeclampsia and eclampsia in Bangladesh. Horm Metab Res 2013 45 682-687.
- Robinson CJ, Wagner CL, Hollis BW, Baatz JE & Johnson DD.
Association of maternal vitamin D and placenta growth factor with the diagnosis of early onset severe preeclampsia. Am J Perinatol 2013 30 167-172.
- Anderson CM, Ralph J, Johnson L, Scheett A, Wright ML, Taylor JY, Ohm JE & Uthus E.
First trimester vitamin D status and placental epigenomics in preeclampsia among Northern Plains primiparas. Life Sci 2014.
- Maghbooli Z, Hossein-Nezhad A, Karimi F, Shafaei AR & Larijani B. Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008 24 27-32.
- Clifton-Bligh RJ, McElduff P & McElduff A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med 2008 25 678-684.
- Lacroix M, Battista MC, Doyon M, Houde G, Menard J, Ardilouze JL, Hivert MF & Perron P.
Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus. Acta Diabetol 2014.
- McManus R, Summers K, de Vrijer B, Cohen N, Thompson A & Giroux I.
Maternal, umbilical arterial and umbilical venous 25-hydroxyvitamin D and adipocytokine concentrations in pregnancies with and without gestational diabetes. Clin Endocrinol (Oxf) 2014 80 635-641.
- Cho GJ, Hong SC, Oh MJ & Kim HJ. Vitamin D deficiency in gestational diabetes mellitus and the role of the placenta. Am J Obstet Gynecol 2013 209 560.e561-568.
- Wang O, Nie M, Hu YY, Zhang K, Li W, Ping F, Liu JT, Chen LM & Xing XP. Association between vitamin D insufficiency and the risk for gestational diabetes mellitus in pregnant Chinese women. Biomed Environ Sci 2012 25 399-406.
- Farrant HJ, Krishnaveni GV, Hill JC, Boucher BJ, Fisher DJ, Noonan K, Osmond C, Veena SR & Fall CH.
Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr 2009 63 646-652.
- Whitelaw DC, Scally AJ, Tuffnell DJ, Davies TJ, Fraser WD, Bhopal RS, Wright J & Lawlor DA.
Associations of circulating calcium and 25-hydroxyvitamin D with glucose metabolism in pregnancy: a cross-sectional study in European and South Asian women. J Clin Endocrinol Metab 2014 99 938-946.
- Perez-Ferre N, Torrejon MJ, Fuentes M, Fernandez MD, Ramos A, Bordiu E, del Valle L, Rubio MA, Bedia AR, Montanez C, et al. Association of low serum 25- hydroxyvitamin D levels in pregnancy with glucose homeostasis and obstetric and newborn outcomes. Endocr Pract 2012 18 676-684.
- Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T & Simsek S.
Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med 2012 23 465-469.
- Parildar H, Dogruk Unal A, Aksan Desteli G, Cigerli O & Guvener Demirag N. Frequency of Vitamin D deficiency in pregnant diabetics at Baskent University Hospital, Istanbul. Pak J Med Sci 2013 29 15-20.
- Merewood A, Mehta SD, Chen TC, Bauchner H & Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab 2009 94 940-945.
- Scholl TO, Chen X & Stein P. Maternal vitamin D status and delivery by cesarean. Nutrients 2012 4 319-330.
- Savvidou MD, Makgoba M, Castro PT, Akolekar R & Nicolaides KH. First-trimester maternal serum vitamin D and mode of delivery. Br J Nutr 2012 108 1972-1975.
- Dunlop AL, Taylor RN, Tangpricha V, Fortunato S & Menon R. Maternal micronutrient status and preterm versus term birth for black and white US women. Reprod Sci 2012 19 939-948.
- Mehta S, Hunter DJ, Mugusi FM, Spiegelman D, Manji KP, Giovannucci EL, Hertzmark E, Msamanga GI & Fawzi WW. Perinatal outcomes, including mother-to- child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis 2009 200 1022-1030.
- Delmas PD, Glorieux FH, Delvin EE, Salle BL & Melki I. Perinatal serum bone Gla- protein and vitamin D metabolites in preterm and fullterm neonates. J Clin Endocrinol Metab 1987 65 588-591.
- Thorp JM, Camargo CA, McGee PL, Harper M, Klebanoff MA, Sorokin Y, Varner MW, Wapner RJ, Caritis SN, Iams JD, et al. Vitamin D status and recurrent preterm birth: a nested case-control study in high-risk women. Bjog 2012 119 1617-1623.
- Baker AM, Haeri S, Camargo CA, Jr., Stuebe AM & Boggess KA. A nested case- control study of first-trimester maternal vitamin D status and risk for spontaneous preterm birth. Am J Perinatol 2011 28 667-672.
- Bodnar LM, Rouse DJ, Momirova V, Peaceman AM, Sciscione A, Spong CY, Varner MW, Malone FD, Iams JD, Mercer BM, et al. Maternal 25-hydroxyvitamin d and preterm birth in twin gestations. Obstet Gynecol 2013 122 91-98.
- Bodnar LM, Klebanoff MA, Gernand AD, Platt RW, Parks WT, Catov JM & Simhan HN. Maternal vitamin D status and spontaneous preterm birth by placental histology in the US Collaborative Perinatal Project. Am J Epidemiol 2014 179 168-176.
- Hossain N, Khanani R, Hussain-Kanani F, Shah T, Arif S & Pal L. High prevalence of vitamin D deficiency in Pakistani mothers and their newborns. Int J Gynaecol Obstet 2011 112 229-233.
- Li N, Liu E, Guo J, Pan L, Li B, Wang P, Liu J, Wang Y, Liu G, Baccarelli AA, et al. Maternal prepregnancy body mass index and gestational weight gain on pregnancy outcomes. PLoS One 2013 8 e82310.
- Bautista-Castano I, Henriquez-Sanchez P, Aleman-Perez N, Garcia-Salvador JJ, Gonzalez-Quesada A, Garcia-Hernandez JA & Serra-Majem L. Maternal obesity in early pregnancy and risk of adverse outcomes. PLoS One 2013 8 e80410.
- Zhang S, Cardarelli K, Shim R, Ye J, Booker KL & Rust G. Racial disparities in economic and clinical outcomes of pregnancy among Medicaid recipients. Matern Child Health J 2013 17 1518-1525.
- Curtis EM, Moon RJ, Dennison EM & Harvey NC. Prenatal calcium and vitamin d intake, and bone mass in later life. Curr Osteoporos Rep 2014 12 194-204.
- Hossain N, Kanani FH, Ramzan S, Kausar R, Ayaz S, Khanani R & Pal L. Obstetric and neonatal outcomes of maternal vitamin D supplementation: Results of an open label randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. J Clin Endocrinol Metab 2014 jc20133491.
- Yap C, Cheung NW, Gunton JE, Athayde N, Munns CF, Duke A & McLean M. Vitamin d supplementation and the effects on glucose metabolism during pregnancy: a randomized controlled trial. Diabetes Care 2014 37 1837-1844.
- Kalra P, Das V, Agarwal A, Kumar M, Ramesh V, Bhatia E, Gupta S, Singh S,
- Saxena P & Bhatia V. Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the newborn and infant. Br J Nutr 2012 108 1052-1058.
- Marya RK, Rathee S & Manrow M. Effect of Calcium and Vitamin D Supplementation on Toxaemia of Pregnancy. Gynecol Obstet Invest 1987 24 38-42.
- NICE Clinical Guideline 63. Diabetes in Pregnancy. 2008.
- Soheilykhah S, Mojibian M, Moghadam MJ & Shojaoddiny-Ardekani A. The effect of different doses of vitamin D supplementation on insulin resistance during pregnancy. Gynecol Endocrinol 2013 29 396-399.
- Asemi Z, Hashemi T, Karamali M, Samimi M & Esmaillzadeh A. Effects of vitamin D supplementation on glucose metabolism, lipid concentrations, inflammation, and oxidative stress in gestational diabetes: a double-blind randomized controlled clinical trial. Am J Clin Nutr 2013 98 1425-1432.
- Innes AM, Seshia MM, Prasad C, Al SS, Friesen FR, Chudley AE, Reed M, Dilling LA, Haworth JC & Greenberg CR. Congenital rickets caused by maternal vitamin D deficiency. PaediatrChild Health 2002 7 455-458.
- Anatoliotaki M, Tsilimigaki A, Tsekoura T, Schinaki A, Stefanaki S & Nicolaidou P. Congenital rickets due to maternal vitamin D deficiency in a sunny island of Greece. Acta Paediatr 2003 92 389-391.
- Orbak Z, Karacan M, Doneray H & Karakelleoglu C. Congenital rickets presenting with hypocalcaemic seizures. West Indian MedJ 2007 56 364-367.
- Marya RK, Rathee S, Lata V & Mudgil S. Effects of vitamin D supplementation in pregnancy. Gynecol Obstet Invest 1981 12 155-161.
- Hashemipour S, Ziaee A, Javadi A, Movahed F, Elmizadeh K, Javadi EH & Lalooha F. Effect of treatment of vitamin D deficiency and insufficiency during pregnancy on fetal growth indices and maternal weight gain: a randomized clinical trial. Eur J Obstet Gynecol Reprod Biol 2014 172 15-19.
- Ioannou C, Javaid MK, Mahon P, Yaqub MK, Harvey NC, Godfrey KM, Noble JA, Cooper C & Papageorghiou AT. The effect of maternal vitamin D concentration on fetal bone. J Clin Endocrinol Metab 2012 97 E2070-2077.
- Mahon P, Harvey N, Crozier S, Inskip H, Robinson S, Arden N, Swaminathan R, Cooper C, Godfrey K & Group SWSS. Low maternal vitamin D status and fetal bone development: cohort study. J Bone Miner Res 2010 25 14-19.
- Namgung R, Tsang RC, Lee C, Han DG, Ho ML & Sierra RI. Low total body bone mineral content and high bone resorption in Korean winter-born versus summer-born newborn infants. JPediatr 1998 132 421-425.
- Namgung R & Tsang RC. Factors affecting newborn bone mineral content: in utero effects on newborn bone mineralization. Proc Nutr Soc 2000 59 55-63.
- Weiler H, Fitzpatrick-Wong S, Veitch R, Kovacs H, Schellenberg J, McCloy U & Yuen CK. Vitamin D deficiency and whole-body and femur bone mass relative to weight in healthy newborns. CMAJ 2005 172 757-761.
- Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Makitie O, Andersson S, Laitinen K & Lamberg-Allardt C. Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab 2010 95 1749-1757.
- Viljakainen HT, Korhonen T, Hytinantti T, Laitinen EK, Andersson S, Makitie O & Lamberg-Allardt C. Maternal vitamin D status affects bone growth in early childhood-- a prospective cohort study. Osteoporos Int 2011 22 883-891.
- Prentice A, Jarjou LM, Goldberg GR, Bennett J, Cole TJ & Schoenmakers I. Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants. Acta Paediatr 2009 98 1360-1362.
- Sayers A & Tobias JH. Estimated maternal ultraviolet B exposure levels in pregnancy influence skeletal development of the child. J Clin Endocrinol Metab 2009 94 765771.
- Lawlor DA, Wills AK, Fraser A, Sayers A, Fraser WD & Tobias JH. Association of maternal vitamin D status during pregnancy with bone-mineral content in offspring: a prospective cohort study. The Lancet 2013 381 2176-2183.
- Harvey NC, Javaid MK, Inskip HM, Godfrey KM & Cooper C. Maternal vitamin D status during pregnancy and bone-mineral content in offspring. Lancet 2013 382 766.
- Zhu K, Whitehouse AJ, Hart P, Kusel M, Mountain J, Lye S, Pennell C & Walsh JP.
Maternal Vitamin D Status During Pregnancy and Bone Mass in Offspring at 20 Years of Age: A Prospective Cohort Study. J Bone Miner Res 2013.
- Congdon P, Horsman A, Kirby PA, Dibble J & Bashir T. Mineral content of the forearms of babies born to Asian and white mothers. Br Med J (Clin Res Ed) 1983 286 1233-1235.
- Harvey NC, Javaid K, Bishop N, Kennedy S, Papageorghiou AT, Fraser R, Gandhi SV, Schoenmakers I, Prentice A & Cooper C. MAVIDOS Maternal Vitamin D Osteoporosis Study: study protocol for a randomized controlled trial. The MAVIDOS Study Group. Trials 2012 13 13.
- Harvey NC & Cooper C. Vitamin D: some perspective please. BMJ 2012 345 e4695.