Evidence of an Association Between Vitamin D Deficiency and Preterm Birth and Preeclampsia: A Critical Review

Abstract

Vitamin D deficiency has been associated with adverse pregnancy and birth outcomes such as increased risk for preterm birth and preeclampsia. This state of the science review analyzed recently published meta-analyses and relevant studies that have evaluated the association between vitamin D deficiency and preeclampsia or preterm birth. The results suggest that a positive association between vitamin D deficiency and preterm birth exists. However, the findings of the relationship between vitamin D deficiency and preeclampsia were inconclusive, possibly because of the need for supplementation to occur prior to placentation. This may be because of a lack of studies with ethnic minority populations, who are more likely to experience vitamin D deficiency, and inadequate supplementation doses used for treatment of vitamin D deficiency. Health care providers should screen pregnant women at risk for vitamin D deficiency and supplement women accordingly based on their vitamin D status. Lastly, well-designed and standardized clinical trials need to include large cohorts of minority pregnant women to establish the impact of vitamin D supplementation on improving preterm birth and preeclampsia risk in pregnancy.

Association between vitamin D plasma concentrations and VDR gene variants and the risk of premature birth

“…Otherwise, the VDR FokI variant was associated with decreased risk of preeclampsia in the dominant model in Iranian population [44]. Despite the evidence of an association between vitamin D deficiency and preterm birth and preeclampsia, data on the effect of vitamin D supplementation on preterm birth have not been consistent, probably due to the heterogeneity of studies regarding the differences in assay methodologies, definitions of vitamin D deficiency, timing of supplementation, and dose of supplementation [34]. A recent Cochrane review [39] showed evidence from 3725 pregnant women enrolled in 22 studies, suggesting that vitamin D supplementation alone during pregnancy potentially attenuates the risk of preeclampsia in comparison to placebo or no intervention.…”

“…A meta-analysis performed by Zhou et al (2017) [33] including 6 randomized controlled trials and 18 observational studies, the increased risk of prematurity was associated to deficiency (OR = 1.25; 95% IC = 1.13-1.38) more than maternal vitamin D insufficiency (OR = 1.09; 95% IC = 0.89-1.35). Recently, the association between maternal vitamin D deficiency and preterm birth was evaluated in a study by Woo et al [34] comprising studies from 2012 to 2018, being non conclusive despite analysis of research indicates that vitamin D deficiency is related to an increased risk for preterm birth [34].…”

“…A large body of evidence indicates that increased inflammatory response is a feature of systemic vascular dysfunction in this disorder, although its cause is not completely known [38,39]. Due to vitamin D anti-inflammatory effects, it may play a role in preeclampsia prevention [34,[40][41][42]. A recent study [43] pointed that downregulation of VDR expression and vitamin D deficiency may contribute to phenotypic changes of inflammatory patterns in maternal vasculature in preeclampsia.…”

“…It is important to note that there are several other pregnancy and neonatal complications associated with maternal vitamin D deficiency such as increased incidence of gestational diabetes mellitus, low birth weight, and possible epigenetic effects on offspring [34].…”

Gebelerde İlk Trimester Plazma D Vitamini Düzeyleri ile Gestasyonel Diyabet Arasında İlişki Var mı?

“…Fetal gelişim için ve gebelikteki preterm eylem, preeklampsi gibi komplikasyonlar için de D vitamininin önemli olduğu literatürdeki yayınlarda mevcuttur (5)(6)(7)(8)(9)(10). Bunun yanında D Vitamini eksikliğinin, pankreas beta hücrelerinde insülin salınımını azalttığı ve insülin direncine katkıda bulunarak erişkin dönem diyabet patogenezinde rol oynadığı literatürde bildirilmektedir (11)(12)(13).…”