Vitamin D in Pregnancy and Lactation in Humans

Abstract

Concerns exist about the adequacy of vitamin D in pregnant and lactating women. This review assesses the evidence that maternal vitamin D status influences maternal, fetal, and breast-fed infant bone health; maternal adverse outcomes (preeclampsia, gestational diabetes, obstructed labor, and infectious disease); fetal adverse outcomes (growth, gestational age, and developmental programming); and infant adverse outcomes. The evidence for all of these outcomes is contradictory (except for maternal infectious disease) and lacking causality; thus, it is inconclusive. The 2011 Dietary Reference Intakes for vitamin D and their implications for assessing vitamin D status are discussed. An estimated 5% to 29% of American pregnant women may have inadequate vitamin D status, with the higher prevalence in African Americans. Little is known about the prevalence of inadequacy in American lactating women. Research needs are also identified, especially the need for rigorous and well-designed randomized clinical trials to determine the role of vitamin D in nonbone health outcomes in pregnancy and lactation.

Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: The Generation R Study

“…Recent narrative reviews suggested that the prevalence of vitamin D deficiency during pregnancy can be alarmingly high (e.g. 84% (Brannon and Picciano, 2011) (also see review (Ponsonby et al, 2010)). …”

“…There is also preliminary evidence to suggest that vitamin D deficiency may be linked to a range of later adverse health outcomes in the offspring (Boucher, 1998, McGrath, 2001, Brannon and Picciano, 2011, Christesen et al, 2012, Thorne-Lyman and Fawzi, 2012, Zipitis and Akobeng, 2008, Ponsonby et al, 2010.…”

Maternal vitamin D status in Type 1 diabetic pregnancy: Impact on neonatal vitamin D status and association with maternal glycaemic control

“…Cord concentrations are lower than maternal concentrations, therefore, if the mother is deficient so too will be the foetus [9]. Despite the lack of change/decline in 25OHD levels, levels of the biologically active vitamin D metabolite, 1,25 dihydroxy vitamin D [1,25(OH) 2 D], are known to increase by 100% or more during pregnancy [7,10]. This rise begins at 10-12 weeks gestation and reaches a maximum in the third trimester [10].…”

“…Despite the lack of change/decline in 25OHD levels, levels of the biologically active vitamin D metabolite, 1,25 dihydroxy vitamin D [1,25(OH) 2 D], are known to increase by 100% or more during pregnancy [7,10]. This rise begins at 10-12 weeks gestation and reaches a maximum in the third trimester [10]. Increased synthesis of the active vitamin D form is due to the enhanced production of 1a-hydroxylase in the decidua and placenta, as well as an oestrogen-dependent increase in vitamin D binding protein [7].…”

Association between placental vitamin D receptor expression and cord blood vitamin D level and its effect on the birth weight of newborns

“…Several studies have linked maternal vitamin D status, as measured by circulating 25(OH)D, with placental function and fetal growth, pregnancy outcomes and offspring risk of chronic disease. [2][3][4] The mechanism by which vitamin D crosses the placenta is not yet clear. Recent literature reviews reported that the main mechanism is passive diffusion, as occurs with sex steroid hormones.…”