Maternal Vitamin D Deficiency and the Risk of Small for Gestational Age: A Meta-analysis
-
Zhao HU
,
Lu TANG
,
Hui-Lan XU
Abstract
Background: Inconsistencies among studies still exist in regard to the associations between maternal vitamin D deficiency and the risk of small for gestational age.
Methods: We conducted a meta-analysis of observational studies to evaluate these associations. We searched electronic databases for literature published in PubMed, Medline, Web of Science, Embase and the Cochrane Library up to Dec 2016 using the following keywords: “vitamin D” or “cholecalciferol” or “25-OHD” or “25-hydroxyvitamin D” in combination with “small for gestational age” or “SGA” or “fetal outcome” or “pregnancy outcome”.
Results: Twelve studies involving 19,027 participants were included in this meta-analysis. Pregnant women with vitamin D deficiency (25-OHD levels<50 nmol/L) experienced an increased risk of SGA (odds ratio (OR) =1.41, 95% confidence interval (CI): 1.14, 1.75). The vitamin D concentration of the SGA group was lower than that of the non-SGA group (mean difference: -1.75 nmol/L, 95%CI:-3.23, -0.27).
Conclusion: Maternal vitamin D deficiency during pregnancy may be associated with an increased risk of SGA.
1. Holick MF (2007). Vitamin D deficiency. N Engl J Med, 357:266-281.
2. Bodnar LM, Simhan HN, Powers RW, et al (2007). High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr, 137:447-452.
3. Maghbooli Z,Hossein-Nezhad A,Karimi F, et al (2008). Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev, 24:27-32.
4. Zhang C, Qiu C, Hu FB, et al (2008). Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One, 3: e3753.
5. Makgoba M, Nelson SM, Savvidou M, et al (2011). First-trimester circulating 25-hydroxyvitamin D levels and development of gestational diabetes mellitus. Diabetes Care, 34:1091-1093.
6. Robinson CJ, Wagner CL, Hollis BW, et al (2011). Maternal vitamin D and fetal growth in early-onset severe preeclampsia. Am J Obstet Gynecol, 204(6):556.e1-4.
7. Hensel KJ, Randis TM, Gelber SE, et al (2011). Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis. Am J Obstet Gynecol, 204(1):41.e1-9.
8. Qin LL, Lu FG, Yang SH, et al (2016). Does Maternal Vitamin D Deficiency Increase the Risk of Preterm Birth: A Meta-Analysis of Observational Studies. Nutrients, 8(5): E301.
9. Merewood A, Mehta SD, Chen TC, et al (2009). Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab, 94(3):940-5.
10. O'Loan J, Eyles DW, Kesby J, et al (2007). Vitamin D deficiency during various stages of pregnancy in the rat; its impact on development and behaviour in adult offspring. Psychoneuroendocrinology, 32:227-234.
11. Strom M, Halldorsson TI, Hansen S, et al (2014). Vitamin D measured in maternal serum and offspring neurodevelopmental outcomes: a prospective study with long-term follow-up. Ann Nutr Metab, 64:254-261.
12. Slancheva B, Mumdzhiev H (2013). Small for gestational age newborns--definition, etiology and neonatal treatment. Akush Ginekol (Sofiia), 52:25-32.
13. Gaudineau A (2013). Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age. J Gynecol Obstet Biol Reprod (Paris), 42:895-910.
14. Hernandez MI, Mericq V (2011). Metabolic syndrome in children born small-for-gestational age. Arq Bras Endocrinol Metabol, 55:583-589.
15. Chen YH, Fu L, Hao JH, et al (2015). Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population. J Clin Endocrinol Metab, 100:1912-1919.
16. Leffelaar ER, Vrijkotte TG, van Eijsden M (2010). Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort. Br J Nutr, 104:108-117.
17. Zhou J, Su L, Liu M, et al (2014). Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr, 68:925-930.
18. Morgan C, Dodds L, Langille DB, et al (2016). Cord blood vitamin D status and neonatal outcomes in a birth cohort in Quebec, Canada. Arch Gynecol Obstet, 293:731-738.
19. Rodriguez A, Garcia-Esteban R, Basterretxea M, et al (2015). Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG, 122:1695-1704.
20. Aghajafari F, Nagulesapillai T, Ronksley PE, et al (2013). Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ, 346:f1169.
21. von Elm E, Altman DG, Egger M, et al (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg, 12:1495-1499.
22. Hozo SP,Djulbegovic BHozo I(2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 5:13.
23. Bodnar LM, Catov JM, Zmuda JM, et al (2010). Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr, 140:999-1006.
24. Burris HH, Rifas-Shiman SL, Camargo CA Jr, et al (2012). Plasma 25-hydroxyvitamin D during pregnancy and small-for-gestational age in black and white infants. Ann Epidemiol, 22:581-586.
25. Boyle VT, Thorstensen EB, Mourath D, et al (2016). The relationship between 25-hydroxyvitamin D concentration in early pregnancy and pregnancy outcomes in a large, prospective cohort. Br J Nutr, 116:1409-1415.
26. Fernandez-Alonso AM, Dionis-Sanchez EC, Chedraui P, et al (2012). First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome. Int J Gynaecol Obstet, 116:6-9.
27. Gernand AD, Simhan HN, Klebanoff MA, et al (2013). Maternal serum 25-hydroxyvitamin D and measures of newborn and placental weight in a U.S. multicenter cohort study. J Clin Endocrinol Metab, 98:398-404.
28. Gernand AD, Simhan HN, Caritis S, et al (2014). Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol, 123:40-48.
29. Ong YL, Quah PL, Tint MT, et al (2016). The association of maternal vitamin D status with infant birth outcomes, postnatal growth and adiposity in the first 2 years of life in a multi-ethnic Asian population: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study. Br J Nutr, 116:621-631.
30. Schneuer FJ, Roberts CL, Guilbert C, et al (2014). Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr, 99:287-295.
31. Weinert LS, Reichelt AJ, Schmitt LR, et al (2016). Vitamin D Deficiency Increases the Risk of Adverse Neonatal Outcomes in Gestational Diabetes. PLoS One, 11:e0164999.
32. Wei SQ, Qi HP, Luo ZC, et al (2013). Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 26:889-899.
33. Liu NQ, Hewison M (2012). Vitamin D, the placenta and pregnancy. Arch Biochem Biophys, 523:37-47.
34. Vieth R (2007). Vitamin D toxicity, policy, and science. J Bone Miner Res, 22 Suppl 2:V64-68.
35. Luderer HF, Nazarian RM, Zhu ED, et al (2013). Ligand-dependent actions of the vitamin D receptor are required for activation of TGF-beta signaling during the inflammatory response to cutaneous injury. Endocrinology, 154:16-24.
36. Cotechini T, Komisarenko M, Sperou A, et al (2014). Inflammation in rat pregnancy inhibits spiral artery remodeling leading to fetal growth restriction and features of preeclampsia. J Exp Med, 211:165-179.
37. Buxton IL (2004). Regulation of uterine function: a biochemical conundrum in the regulation of smooth muscle relaxation. Mol Pharmacol, 65:1051-1059.
38. Evans KN, Bulmer JN, Kilby MD, et al (2004). Vitamin D and placental-decidual function. J Soc Gynecol Investig, 11:263-271.
39. Liu NQ, Kaplan AT, Lagishetty V, et al (2011). Vitamin D and the regulation of placental inflammation. J Immunol, 186:5968-5974.
40. Galthen-Sorensen M, Andersen LB, Sperling L, et al (2014). Maternal 25-hydroxyvitamin D level and fetal bone growth assessed by ultrasound: a systematic review. Ultrasound Obstet Gynecol, 44:633-640.
41. Yap C, Cheung NW, Gunton JE, et al (2014). Vitamin D supplementation and the effects on glucose metabolism during pregnancy: a randomized controlled trial. Diabetes Care, 37:1837-1844.
42. Deplanque X, Wullens A, Norberciak L (2017). Prevalence and risk factors of vitamin D deficiency in healthy adults aged 18-65 yr in northern France. Rev Med Interne, 38(6):368-373.
43. Choi R, Kim S, Yoo H, et al (2015). High prevalence of vitamin D deficiency in pregnant Korean women: the first trimester and the winter season as risk factors for vitamin D deficiency. Nutrients, 7:3427-3448.
44. Perez-Lopez FR, Pasupuleti V, Mezones-Holguin E, et al (2015). Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril, 103:1278-88.e4.
45. Thorne-Lyman A, Fawzi WW (2012). Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol, 26 Suppl 1:75-90.
2. Bodnar LM, Simhan HN, Powers RW, et al (2007). High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr, 137:447-452.
3. Maghbooli Z,Hossein-Nezhad A,Karimi F, et al (2008). Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev, 24:27-32.
4. Zhang C, Qiu C, Hu FB, et al (2008). Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS One, 3: e3753.
5. Makgoba M, Nelson SM, Savvidou M, et al (2011). First-trimester circulating 25-hydroxyvitamin D levels and development of gestational diabetes mellitus. Diabetes Care, 34:1091-1093.
6. Robinson CJ, Wagner CL, Hollis BW, et al (2011). Maternal vitamin D and fetal growth in early-onset severe preeclampsia. Am J Obstet Gynecol, 204(6):556.e1-4.
7. Hensel KJ, Randis TM, Gelber SE, et al (2011). Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis. Am J Obstet Gynecol, 204(1):41.e1-9.
8. Qin LL, Lu FG, Yang SH, et al (2016). Does Maternal Vitamin D Deficiency Increase the Risk of Preterm Birth: A Meta-Analysis of Observational Studies. Nutrients, 8(5): E301.
9. Merewood A, Mehta SD, Chen TC, et al (2009). Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab, 94(3):940-5.
10. O'Loan J, Eyles DW, Kesby J, et al (2007). Vitamin D deficiency during various stages of pregnancy in the rat; its impact on development and behaviour in adult offspring. Psychoneuroendocrinology, 32:227-234.
11. Strom M, Halldorsson TI, Hansen S, et al (2014). Vitamin D measured in maternal serum and offspring neurodevelopmental outcomes: a prospective study with long-term follow-up. Ann Nutr Metab, 64:254-261.
12. Slancheva B, Mumdzhiev H (2013). Small for gestational age newborns--definition, etiology and neonatal treatment. Akush Ginekol (Sofiia), 52:25-32.
13. Gaudineau A (2013). Prevalence, risk factors, maternal and fetal morbidity and mortality of intrauterine growth restriction and small-for-gestational age. J Gynecol Obstet Biol Reprod (Paris), 42:895-910.
14. Hernandez MI, Mericq V (2011). Metabolic syndrome in children born small-for-gestational age. Arq Bras Endocrinol Metabol, 55:583-589.
15. Chen YH, Fu L, Hao JH, et al (2015). Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population. J Clin Endocrinol Metab, 100:1912-1919.
16. Leffelaar ER, Vrijkotte TG, van Eijsden M (2010). Maternal early pregnancy vitamin D status in relation to fetal and neonatal growth: results of the multi-ethnic Amsterdam Born Children and their Development cohort. Br J Nutr, 104:108-117.
17. Zhou J, Su L, Liu M, et al (2014). Associations between 25-hydroxyvitamin D levels and pregnancy outcomes: a prospective observational study in southern China. Eur J Clin Nutr, 68:925-930.
18. Morgan C, Dodds L, Langille DB, et al (2016). Cord blood vitamin D status and neonatal outcomes in a birth cohort in Quebec, Canada. Arch Gynecol Obstet, 293:731-738.
19. Rodriguez A, Garcia-Esteban R, Basterretxea M, et al (2015). Associations of maternal circulating 25-hydroxyvitamin D3 concentration with pregnancy and birth outcomes. BJOG, 122:1695-1704.
20. Aghajafari F, Nagulesapillai T, Ronksley PE, et al (2013). Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ, 346:f1169.
21. von Elm E, Altman DG, Egger M, et al (2014). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg, 12:1495-1499.
22. Hozo SP,Djulbegovic BHozo I(2005). Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 5:13.
23. Bodnar LM, Catov JM, Zmuda JM, et al (2010). Maternal serum 25-hydroxyvitamin D concentrations are associated with small-for-gestational age births in white women. J Nutr, 140:999-1006.
24. Burris HH, Rifas-Shiman SL, Camargo CA Jr, et al (2012). Plasma 25-hydroxyvitamin D during pregnancy and small-for-gestational age in black and white infants. Ann Epidemiol, 22:581-586.
25. Boyle VT, Thorstensen EB, Mourath D, et al (2016). The relationship between 25-hydroxyvitamin D concentration in early pregnancy and pregnancy outcomes in a large, prospective cohort. Br J Nutr, 116:1409-1415.
26. Fernandez-Alonso AM, Dionis-Sanchez EC, Chedraui P, et al (2012). First-trimester maternal serum 25-hydroxyvitamin D3 status and pregnancy outcome. Int J Gynaecol Obstet, 116:6-9.
27. Gernand AD, Simhan HN, Klebanoff MA, et al (2013). Maternal serum 25-hydroxyvitamin D and measures of newborn and placental weight in a U.S. multicenter cohort study. J Clin Endocrinol Metab, 98:398-404.
28. Gernand AD, Simhan HN, Caritis S, et al (2014). Maternal vitamin D status and small-for-gestational-age offspring in women at high risk for preeclampsia. Obstet Gynecol, 123:40-48.
29. Ong YL, Quah PL, Tint MT, et al (2016). The association of maternal vitamin D status with infant birth outcomes, postnatal growth and adiposity in the first 2 years of life in a multi-ethnic Asian population: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort study. Br J Nutr, 116:621-631.
30. Schneuer FJ, Roberts CL, Guilbert C, et al (2014). Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr, 99:287-295.
31. Weinert LS, Reichelt AJ, Schmitt LR, et al (2016). Vitamin D Deficiency Increases the Risk of Adverse Neonatal Outcomes in Gestational Diabetes. PLoS One, 11:e0164999.
32. Wei SQ, Qi HP, Luo ZC, et al (2013). Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med, 26:889-899.
33. Liu NQ, Hewison M (2012). Vitamin D, the placenta and pregnancy. Arch Biochem Biophys, 523:37-47.
34. Vieth R (2007). Vitamin D toxicity, policy, and science. J Bone Miner Res, 22 Suppl 2:V64-68.
35. Luderer HF, Nazarian RM, Zhu ED, et al (2013). Ligand-dependent actions of the vitamin D receptor are required for activation of TGF-beta signaling during the inflammatory response to cutaneous injury. Endocrinology, 154:16-24.
36. Cotechini T, Komisarenko M, Sperou A, et al (2014). Inflammation in rat pregnancy inhibits spiral artery remodeling leading to fetal growth restriction and features of preeclampsia. J Exp Med, 211:165-179.
37. Buxton IL (2004). Regulation of uterine function: a biochemical conundrum in the regulation of smooth muscle relaxation. Mol Pharmacol, 65:1051-1059.
38. Evans KN, Bulmer JN, Kilby MD, et al (2004). Vitamin D and placental-decidual function. J Soc Gynecol Investig, 11:263-271.
39. Liu NQ, Kaplan AT, Lagishetty V, et al (2011). Vitamin D and the regulation of placental inflammation. J Immunol, 186:5968-5974.
40. Galthen-Sorensen M, Andersen LB, Sperling L, et al (2014). Maternal 25-hydroxyvitamin D level and fetal bone growth assessed by ultrasound: a systematic review. Ultrasound Obstet Gynecol, 44:633-640.
41. Yap C, Cheung NW, Gunton JE, et al (2014). Vitamin D supplementation and the effects on glucose metabolism during pregnancy: a randomized controlled trial. Diabetes Care, 37:1837-1844.
42. Deplanque X, Wullens A, Norberciak L (2017). Prevalence and risk factors of vitamin D deficiency in healthy adults aged 18-65 yr in northern France. Rev Med Interne, 38(6):368-373.
43. Choi R, Kim S, Yoo H, et al (2015). High prevalence of vitamin D deficiency in pregnant Korean women: the first trimester and the winter season as risk factors for vitamin D deficiency. Nutrients, 7:3427-3448.
44. Perez-Lopez FR, Pasupuleti V, Mezones-Holguin E, et al (2015). Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertil Steril, 103:1278-88.e4.
45. Thorne-Lyman A, Fawzi WW (2012). Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol, 26 Suppl 1:75-90.
| Files | ||
| Issue | Vol 47 No 12 (2018) | |
| Section | Review Article(s) | |
| Keywords | ||
| Vitamin D Small for gestational age Pregnancy | ||
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How to Cite
1.
HU Z, TANG L, XU H-L. Maternal Vitamin D Deficiency and the Risk of Small for Gestational Age: A Meta-analysis. Iran J Public Health. 2018;47(12):1785-1795.
