Vitamin D deficiency increases the risk of bacterial vaginosis during pregnancy: Evidence from a meta-analysis based on observational studies

Abstract

BackgroundBacterial vaginosis (BV) is the most common microbiological syndrome in women of childbearing age, causing numerous adverse health issues in pregnant women. Several observational studies have discussed the association between vitamin D deficiency and the risk of BV during pregnancy, but the results were inconclusive. Therefore, this meta-analysis aimed to explore the association between vitamin D deficiency and BV risk in pregnant women.Materials and methodsWe searched four databases, including PubMed, Embase, Cochrane Library, and Web of Science, from their inception to July 2022. Pooled odds ratios (OR) with corresponding 95% confidence intervals (CI) were estimated using random effects models. Additionally, we conducted subgroup analyses to identify the potential sources of between-study heterogeneity. Sensitivity analysis was performed using the method of exclusion, one study at a time. Publication bias was examined using Egger’s test and funnel plot.ResultsA total of 14 studies from 13 articles including 4,793 participants were eligible for this meta-analysis. The outcome showed that vitamin D deficiency may increase the risk of BV during pregnancy by 54% (OR, 1.54; 95% CI, 1.25–1.91; P < 0.001). In subgroup analyses, positive associations were also found in studies that were: conducted in black women (OR, 1.56; 95% CI, 0.98–2.48; P = 0.060), focused on the first trimester of pregnancy (OR, 2.22; 95% CI, 1.35–3.64; P = 0.002), of high quality (OR, 3.05; 95% CI, 1.26–7.41; P = 0.014), and adjusted for confounders (OR, 1.28; 95% CI, 1.06–1.55; P = 0.012). Sensitivity analysis reported that BV risk during pregnancy resulting from vitamin D deficiency increased by 157% (OR, 2.57; 95% CI, 1.50–4.42; P = 0.001) when removing the first two high-weight studies. Publication bias was observed using Egger’s test (t = 3.43, P = 0.005) and a visual funnel plot.ConclusionThis meta-analysis showed that vitamin D deficiency is positively associated with the risk of BV during pregnancy. Further high-quality prospective cohort studies are needed to determine whether vitamin D intake reduces the prevalence of BV in pregnant women.

Effects of vitamin D in pregnancy on maternal and offspring health-related outcomes: An umbrella review of systematic review and meta-analyses

“…Following deduplication, 673 meta-analyses remained, which underwent title and abstract screening with 123 meta-analyses selected for full-text screening. Finally, 16 meta-analyses met the inclusion criteria for this umbrella review [15][16][17][18][22][23][24][25][26][27][28][29][30][31][32][33][34].…”

“…For maternal outcomes, a low level of vitamin D ( < 50 nmol/L), significantly increased the risk of preterm birth (OR = 1.28; 95% CI = 1.08-1.52; number of studies = 21; Table 2A) [32], miscarriage (OR = 1.60; 95% CI = 1.11-2.30; number of studies = 6; Table 2A) [29], and small-for-gestational-age infants (OR = 1.43; 95% CI = 1.08-1.91; number of studies = 19; Table 2B) [32]. Vitamin D deficiency also increased the risk of GDM (OR = 1.38; 95% CI = 1.22 -1.57; number of studies = 31) [28], recurrent miscarriage (OR = 4.02; 95% CI = 2.23-7.25; number of studies = 12) [23], and bacterial vaginosis (OR = 1.54; 95% CI = 1.25-1.91; number of studies = 14) (Table 2A) [16]. The highest level of vitamin D had a significant lower risk of preeclampsia compared with the lowest level (RR = 0.68; 95% CI = 0.55-0.85; number of studies = 29; Table 2A) [34].…”

“…To date, several meta-analyses have been conducted to investigate the associations between vitamin D status during pregnancy and maternal and offspring outcomes [15,16]. Additionally, many meta-analyses have examined the impact of vitamin D supplementation during pregnancy on these outcomes [17,18].…”

Diet Quality and Nutritional Risk Based on the FIGO Nutrition Checklist among Greek Pregnant Women: A Cross-Sectional Routine Antenatal Care Study

“…A systematic review [56] of women from Mediterranean countries, including pregnant women, revealed a 23-90% deficiency prevalence with possible adverse consequences for maternal and neonatal health. Low vitamin D levels have been associated with a greater risk for preeclampsia, GDM, and bacterial vaginosis [57][58][59], preterm birth [57,58,60,61], giving birth to small-for-gestational-age (SGA) [58,61] and LBW infants [58], maternal and infant infections [57], the need for caesarian deliveries [57,58], lower offspring scores in mental and developmental tests [61], and many more. Among the risk factors for low vitamin D concentrations are less time spent outdoors, the use of sunscreens, lower skin exposure due to clothing choices, or avoidance of exposure to UVB radiation [54].…”

Sun Exposure Score and Vitamin D Levels in Moroccan Women of Childbearing Age

“…Clinical studies have shown that vitamin D supplementation can lower androgen levels, lower anti-Mullerian hormone (AMH) levels [ 14 , 15 ], normalize the metabolic profile, and regularize periods in women with polycystic ovarian syndrome (PCOS) [ 16 , 17 ]. In fact, low serum 25(OH)D concentrations have been linked to problems of infertility [ 18 , 19 ], endometriosis [ 20 ], polycystic ovary syndrome (PCOS) [ 16 , 17 , 21 , 22 ], as well as adverse pregnancy outcomes, including spontaneous abortions [ 23 ], gestational diabetes [ 24 , 25 ], bacterial vaginosis [ 26 ], preeclampsia [ 27 , 28 ], neonatal hypocalcemia [ 29 ], prematurity, and low birth weight [ 30 ], as well as fetal and infant growth disorders [ 31 ].…”