Abstract
Pregnant women in Asia, the Middle East, Africa and Latin America are at risk of vitamin D deficiency (VDD) and prevalence throughout these regions are among the highest, globally. Maternal VDD has been associated with increased risk of a number of adverse maternal and neonatal health outcomes, yet research from developing countries is limited. We assessed the associations of maternal VDD during pregnancy with adverse health outcomes by synthesizing the literature from observational studies conducted in developing countries. Six electronic databases were searched for English-language studies published between 2000 and 2017. Thirteen studies from seven countries were included in the review. Prevalence of VDD ranged from 51.3% to 100%. Six studies assessed both maternal and neonatal outcomes, four studies assessed only maternal outcomes and three studies assessed only neonatal outcomes. Ten studies showed at least one significant association between VDD and adverse maternal and/or neonatal health outcomes including pre-eclampsia (n = 3), gestational diabetes mellitus (n = 1), postpartum depression (n = 1), emergency cesarean section delivery (n = 1), low birth weight babies (n = 4), small for gestational age (n = 2), stunting (n = 1). However most of these studies (n = 6) also showed no association with multiple health outcomes. Vitamin D assessment methods, criteria applied to define VDD, season and trimester in which studies were conducted varied considerably across studies. In conclusion, this study highlights the need to improve maternal vitamin D status in developing countries in an effort to support best maternal and child health outcomes across these regions. Future research should focus on more unified approaches to vitamin D assessment and preventative approaches that may be embedded into already existing antenatal care settings.
Highlights
Vitamin D deficiency (VDD), defined as 25 hydroxyvitamin D concentration (25OHD) below50 nmol/L (20 ng/mL) [1] is recognized as a global health problem, affecting around one billion people across all ethnicities and age groups worldwide [2]
Studies which included either short term and/or long term health complications which were associated with vitamin D deficiency (VDD) were eligible for inclusion
We elected to exclude case-control studies as they are inherently susceptible to selection bias, incidence rates of maternal VDD could not be obtained via such studies and actual relative risk is unable to be determined [28]
Summary
Vitamin D deficiency (VDD), defined as 25 hydroxyvitamin D concentration (25OHD) below50 nmol/L (20 ng/mL) [1] is recognized as a global health problem, affecting around one billion people across all ethnicities and age groups worldwide [2]. Vitamin D deficiency (VDD), defined as 25 hydroxyvitamin D concentration (25OHD) below. Vitamin D is produced endogenously following exposure of the skin to ultraviolet (UV) radiation, with only small proportions being derived from exogeneous dietary sources [5]. Despite sufficient and stable sunny conditions across equatorial countries [2,6,7], studies have reported high prevalence of VDD in pregnant and lactating women [6,8] and infants [6,9,10] in such areas, ranging from 26–95%. Women throughout Asia [12,13], the Middle East and Africa [13] have been consistently regarded as “high risk” for deficiency, with high prevalence being observed throughout these continents. Once ingested or produced by the body via sunlight exposure, vitamin D is transported to the liver for hydroxylation to
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