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Vitamin D Supplementation during Pregnancy: An Evidence Analysis Center Systematic Review and Meta-Analysis

Published:October 25, 2019DOI:https://doi.org/10.1016/j.jand.2019.07.002

      Abstract

      Background

      Given the high rates of vitamin D deficiency among pregnant women and possible effects on offspring health, a systematic review on this topic was conducted to help inform future practice guidelines.

      Objective

      To evaluate associations between maternal vitamin D supplementation, maternal 25-hydroxyvitamin D (25(OH)D) concentrations, and health outcomes.

      Methods

      A PubMed literature search was conducted to identify studies that examined the health effects of vitamin D supplementation during pregnancy on maternal and infant health outcomes published from 2000 to 2016. Among 976 identified publications, 20 randomized clinical trials met the inclusion criteria. The initial search was extended to include five studies published between July 2016 and September 2018.

      Main outcome measures

      Maternal and infant 25(OH)D concentrations, gestational diabetes, preeclampsia or gestational hypertension, cesarean section, maternal parathyroid hormone and calcium concentrations, and infant gestational age, birth weight, and birth length.

      Statistical analyses

      Mean differences, odds ratios, and 95% CIs were calculated, only for the initial search, using separate random-effects meta-analyses for each outcome.

      Results

      Evidence was good or strong that maternal vitamin D supplementation significantly increased maternal (13 studies, n=18, mean difference, 14.1 ng/mL [35.2 nmol/L]; 95% CI=9.6-18.6 ng/mL [24.0-46.4 nmol/L]) and infant (nine studies, n=12; 9.7, 5.2, 14.2 ng/mL [24.2, 12.9, 35.5 nmol/L]) 25(OH)D concentrations, although heterogeneity was significant (I2=95.9% and I2=97.4, respectively, P<0.001). Evidence was fair that vitamin D supplementation significantly decreases maternal homeostatic model assessment-insulin resistance (five studies, n=7; −1.1, −1.5, −0.7) and increases infant birth weight (nine studies, n=11, 114.2, 63.4, 165.1 g), both had insignificant heterogeneity. A null effect of maternal supplementation on other maternal (preeclampsia, cesarean section) and infant (gestational age, birth length) outcomes was found.

      Conclusions

      Results show vitamin D supplementation during pregnancy improves maternal and infant 25(OH)D concentrations and may play a role in maternal insulin resistance and fetal growth. To further inform practice and policies on the amount of vitamin D, which supports a healthy pregnancy, high quality dose-response randomized clinical trials, which assess pregnancy-specific 25(OH)D thresholds, and appropriately powered clinical outcomes are needed.
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      Biography

      S. Gallo is an assistant professor, Nutrition and Food Studies, College of Health and Human Services, George Mason University, Fairfax, VA.

      Biography

      J. M. McDermid is an assistant professor, Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, Charlottesville.

      Biography

      R. I. Al-Nimr is the director, Nutrition in Medical Education Program, Clinical Instructor in Medicine & Medical Education, Geisel School of Medicine, Dartmouth College, Hanover, NH.

      Biography

      Hakeem is the principal, Raana Liaqat Ali Khan Government College of Home Economics, Karachi, Pakistan.

      Biography

      J. M. Moreschi is the regional extension educator, SNAP-Education, Northwest Region, Ottawa, IL.

      Biography

      M. Pari-Keener is a clinical dietitian, Outpatient Clinic, Department of Pediatrics, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn.

      Biography

      B. Stahnke is the WIC advisory team manager, Georgia Department of Health, Division of Health Promotion, Georgia WIC Program, Program Integrity and Strategy Unit, Atlanta.

      Biography

      C. Papoutsakis is the senior director, Nutrition and Dietetics Data Science Center, Research, International, and Scientific Affairs (RISA), Chicago, IL.

      Biography

      D. Handu is Research International & Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL.

      Biography

      F. W. Cheng is a nutrition researcher, EAL Business Operations, Academy of Nutrition and Dietetics, Chicago, IL.