Obstetrical & Gynecological Survey:
April 2010 - Volume 65 - Issue 4 - pp 273-284
CME Program: CME REVIEW ARTICLES 10, 11, AND 12: CME REVIEW ARTICLE 12
Bodnar, Lisa M. PhD, MPH, RD; Simhan, Hyagriv N. MD, MSCR
Continued Medical Education
In the United States, significant, intractable disparities exist in rates of major pregnancy outcomes between non-Hispanic black and non-Hispanic white women. A previously unexplored candidate influence on the black-white disparity in adverse birth outcomes is maternal vitamin D status.
This review summarizes the evidence relating maternal vitamin D to preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction, and addresses gaps in our understanding of the contribution of vitamin D to the intractable black-white disparity in these conditions. The literature reviewed highlights strong biologic plausibility of role for vitamin D in the pathophysiology of these poor pregnancy outcomes. Data also suggest that maternal vitamin D deficiency may increase the risk of preeclampsia and fetal growth restriction.
Less research has been done in support of relations with spontaneous preterm birth and gestational diabetes, and fetal and infant survival have rarely been studied. Few trials of vitamin D supplementation have been conducted in pregnant women with adequate power to test effects on birth outcomes. Importantly, black pregnant women have rarely been studied in vitamin D—birth outcomes research.
Although vitamin D is a promising candidate influence on black-white disparities in preeclampsia, spontaneous preterm birth, fetal growth restriction, and gestational diabetes, these associations require further study in large samples of black US women.
Because vitamin D deficiency is widespread and black-white disparities in pregnancy outcomes and infant survival have been resistant to previous interventions, research to test vitamin D as a causal factor is of major public health significance.
Target Audience: Obstetricians & Gynecologist, Family Physicians.
Learning Objectives: After completion of this educational activity, the reader will be able to appreciate risk factors for inadequate vitamin D status. Understand the basic aspects of vitamin D metabolism. Become aware of recent literature linking inadequate vitamin D status and adverse pregnancy outcomes such as preeclampsia and preterm birth.
In 2005, black mothers were 2.3 times as likely as white mothers to experience an
- intrauterine fetal death (11.1 vs. 4.8 fetal deaths at 20 weeks gestation or greater per 1000 live births) or
- death of their infant (13.5 vs. 5.8 deaths per 1000 live births) (1, 2).
Major causes of fetal and infant death also demonstrate striking racial disparities.
Compared with white women, black women are at
- 1.5- to 2.5-fold greater risk of delivering a preterm (<37 weeks gestation; 18.5% vs. 11.7%) or
- very preterm infant (<32 weeks gestation; 4.1% vs. 1.7%) as well as a term
- low birth weight infant (<2500 g birth weight at >37 weeks; 5.6% vs. 2.6%) (3).
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