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Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review

European Journal of Clinical Nutrition volume 70, pages 979–986 (2016)Cite this article

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Abstract

Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.

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Authors and Affiliations

  1. First Department of Obstetrics and Gynecology, Unit of Reproductive Endocrinology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece

    S Karras, S A Paschou, P Anagnostis, B C Tarlatzis & D G Goulis

  2. Department of Endocrinology, Diabetes and Metabolism, Red Cross Hospital, Athens, Greece

    E Kandaraki

  3. Department of Geriatric Medicine, UPRES EA 4638, University Hospital, Angers, France

    C Annweiler

  4. Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada

    C Annweiler

  5. Medical University of South Carolina Children’s Hospital, Charleston, SC, USA

    B W Hollis

  6. Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA

    W B Grant

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  1. S Karras
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Correspondence to D G Goulis.

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Karras, S., Paschou, S., Kandaraki, E. et al. Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review. Eur J Clin Nutr 70, 979–986 (2016). https://doi.org/10.1038/ejcn.2016.12

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