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Maternal and Pediatric Nutrition Highlights Review

Maternal vitamin D status during pregnancy: the Mediterranean reality

Abstract

Vitamin D status during pregnancy is linked to bone mineralization of developing fetus, which justifies targeting sufficient levels of vitamin D in pregnant women. Despite high level of sunshine in the Mediterranean regions, maternal hypovitaminosis D remain common in these countries. The aim of this narrative review was to provide potential explanations for this phenomenon in an effort to guide future public health policies and vitamin D intakes during pregnancy. We searched Medline for publications regarding hypovitaminosis D during pregnancy in the Mediterranean region. Available studies confirmed the high prevalence of hypovitaminosis D among pregnant women in the Mediterranean regions (50–65% in most studies), resulting in severe skeletal and nonskeletal health events among the offspring. Reasons for this may rely on maternal darker skin pigmentation, poor dietary vitamin D intake, veiled clothing and reduced sunshine exposure, health policies and increased prevalence of obesity. Public health organizations should be aware of this phenomenon and develop specific policies to prevent hypovitaminosis D and its adverse outcomes in maternal and neonatal health.

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References

  1. Karras SN, Anagnostis P, Bili E, Naughton D, Petroczi A, Papadopoulou F et al. Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era. Osteoporos Int 2013; 25: 795–805.

    Article  Google Scholar 

  2. Karras SN, Shah I, Petroczi A, Goulis DG, Bili H, Papadopoulou F et al. An observational study reveals that neonatal vitamin D is primarily determined by maternal contributions: Implications of a new assay on the roles of vitamin D forms. Nutr J 2013; 12: 77.

    Article  CAS  Google Scholar 

  3. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Guidelines for preventing and treating vitamin D deficiency and insufficiency revisited. J Clin Endocrinol Metab 2012; 97: 1153–1158.

    Article  CAS  Google Scholar 

  4. Institute of Medicine. Dietary Reference Intakes for Calcium and Vitamin D. Committee to Review Dietary Reference Intakes for Calcium and Vitamin D. National Academies Press, Institute of Medicine: Washington, DC, USA, 2011.

  5. Kovacs CS . Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Am J Clin Nutr 2008; 88: 520S–528SS.

    Article  CAS  Google Scholar 

  6. Specker B . Vitamin D requirements during pregnancy. Am J Clin Nutr 2004; 80(6 Suppl): 1740S–1747S.

    Article  CAS  Google Scholar 

  7. Durand D, Braithwaite GD, Barlet JP . The effect of 1 alpha-hydroxycholecalciferol on the placental transfer of calcium and phosphate in sheep. Br J Nutr 1983; 49: 475–480.

    Article  CAS  Google Scholar 

  8. Turner M, Barre PE, Benjamin A, Goltzman D, Gascon-Barré M . Does the maternal kidney contribute to the increased circulating 1,25-dihydroxyvitamin D concentrations during pregnancy? Miner Electrolyte Metab 1988; 14: 246–252.

    CAS  PubMed  Google Scholar 

  9. Kovacs CS . Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 2001; 86: 2344–2348.

    CAS  PubMed  Google Scholar 

  10. Pahuja DN, DeLuca HF . Stimulation of intestinal calcium transport and bone calcium mobilization by prolactin in vitamin D-deficient rats. Science 1981; 214: 1038–1039.

    Article  CAS  Google Scholar 

  11. Brommage R, Baxter DC, Gierke LW . Vitamin D-independent intestinal calcium and phosphorus absorption during preproduction. Am J Physiol 1990; 259: G631–G638.

    Article  CAS  Google Scholar 

  12. Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367: 36–43.

    Article  CAS  Google Scholar 

  13. Dawodu A, Absood G, Patel M, Agarwal M, Ezimokhai M, Abdulrazzaq Y et al. Serum 25-hydroxyvitamin D and calcium homeostasis in the United Arab Emirates mothers and neonates: a preliminary report. Middle East Paediatr 1997; 2: 9–12.

    Google Scholar 

  14. Sachan A, Gupta R, Das V, Agarwal A, Awasthi PK, Bhatia V . High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. Am J Clin Nutr 2005; 81: 1060–1064.

    Article  CAS  Google Scholar 

  15. Datta S, Alfaham M, Davies DP, Dunstan F, Woodhead S, Evans J et al. Vitamin D deficiency in pregnant women from a non- European ethnic minority population – an interventional study. BJOG 2002; 109: 905–908.

    CAS  Google Scholar 

  16. Judkins A, Eagleton C . Vitamin D deficiency in pregnant New Zealand women. N Z Med J 2006; 119: U2144.

    PubMed  Google Scholar 

  17. Ioannou C, Javaid MK, Mahon P, Yaqub MK, Harvey NC, Godfrey KM et al. The effect of maternal vitamin D concentration on fetal bone. J Clin Endocrinol Metab 2012; 97: E2070–E2077.

    Article  CAS  Google Scholar 

  18. Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Mäkitie O et al. Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab 2010; 95: 1749–1757.

    Article  CAS  Google Scholar 

  19. Lawlor DA, Wills AK, Fraser A, Sayers A, Fraser WD, Tobias JH . Association of maternal vitamin D status during pregnancy with bone-mineral content in offspring: a prospective cohort study. Lancet 2013; 381: 2176–2183.

    Article  CAS  Google Scholar 

  20. Zhu K, Whitehouse AJ, Hart P, Kusel M, Mountain J, Lye S et al. Maternal vitamin D status during pregnancy and bone mass in offspring at 20 years of age: a prospective cohort study. J Bone Miner Res 2013; e-pub ahead of print 5 November 2013; doi:10.1002/jbmr.2138.

  21. Kaushal M, Magon N . Vitamin D in pregnancy: a metabolic outlook. Indian J Endocrinol Metab 2013; 17: 76–82.

    Article  Google Scholar 

  22. Kovacs CS . Maternal vitamin D deficiency: fetal and neonatal implications. Semin Fetal Neonatal Med 2013; e-pub ahead of print 13 February 2013. pii: S1744-165X (13)00006-1.

  23. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C . Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2010; 202, 429.e1–e9.

    Article  Google Scholar 

  24. Clifton-Bligh RJ, McElduff P, McElduff A . Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med 2008; 25: 678–684.

    Article  CAS  Google Scholar 

  25. Maghbooli Z, Hossein-Nezhad A, Karimi F, Shafaei AR, Larijani B . Correlation between vitamin D3 deficiency and insulin resistance in pregnancy. Diabetes Metab Res Rev 2008; 24: 27–32.

    Article  CAS  Google Scholar 

  26. Poel YH, Hummel P, Lips P, Stam F, van der Ploeg T, Simsek S . Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Intern Med 2012; 23: 465–469.

    Article  CAS  Google Scholar 

  27. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM et al. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab 2007; 92: 3517–3522.

    Article  CAS  Google Scholar 

  28. Robinson CJ, Alanis MC, Wagner CL, Hollis BW, Johnson DD . Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Am J Obstet Gynecol 2010; 203: 366.e1–e6.

    Article  Google Scholar 

  29. Wei SQ, Audibert F, Hidiroglou N, Sarafin K, Julien P, Wu Y et al. Longitudinal vitamin D status in pregnancy and the risk of pre-eclampsia. BJOG 2012; 119: 832–839.

    Article  CAS  Google Scholar 

  30. Tabesh M, Salehi-Abargouei A, Tabesh M, Esmaillzadeh A . Maternal vitamin D status and risk of pre-eclampsia: a systematic review and meta-analysis. J Clin Endocrinol Metab 2013; 98: 3165–3173.

    Article  CAS  Google Scholar 

  31. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O'Beirne M, Rabi DM . Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 2013; 346: f1169.

    Article  Google Scholar 

  32. Wei SQ, Qi HP, Luo ZC, Fraser WD . Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013; 26: 889–899.

    Article  CAS  Google Scholar 

  33. Christesen HT, Elvander C, Lamont RF, Jørgensen JS . The impact of vitamin D in pregnancy on extraskeletal health in children: a systematic review. Acta Obstet Gynecol Scand 2012; 91: 1368–1380.

    Article  Google Scholar 

  34. Morales E, Guxens M, Llop S, Rodríguez-Bernal CL, Tardón A, Riaño I et al. Circulating 25-hydroxyvitamin D3 in pregnancy and infant neuropsychological development. Pediatrics 2012; 130: e913–e920.

    Article  Google Scholar 

  35. Pérez-López FR, Fernández-Alonso AM, Ferrando-Marco P, González-Salmerón MD, Dionis-Sánchez EC, Fiol-Ruiz G et al. First trimester serum 25-hydroxyvitamin D status and factors related to lower levels in gravids living in the Spanish Mediterranean coast. Reprod Sci 2011; 18: 730–736.

    Article  Google Scholar 

  36. Cadario F, Savastio S, Pozzi E, Capelli A, Dondi E, Gatto M et al. Vitamin D status in cord blood and newborns: ethnic differences. Ital J Pediatr 2013; 39: 35.

    Article  Google Scholar 

  37. Gaggero M, Mariani L, Guarino R, Patrucco G, Ballardini G, Boscardini L et al. Vitamin D at term of pregnancy and during lactation in white and black women living in Northern Italy. Minerva Ginecol 2010; 62: 91–96.

    CAS  PubMed  Google Scholar 

  38. Nicolaidou P, Hatzistamatiou Z, Papadopoulou A, Kaleyias J, Floropoulou E, Lagona E et al. Low vitamin D status in mother—newborn pairs in Greece. Calcif Tissue Int 2006; 78: 337–342.

    Article  CAS  Google Scholar 

  39. Halicioglu O, Aksit S, Koc F, Akman SA, Albudak E, Yaprak I et al. Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey. Paediatr Perinat Epidemiol 2012; 26: 53–60.

    Article  Google Scholar 

  40. Narchi H, Kochiyil J, Zayed R, Abdulrazzak W, Agarwal M . Maternal vitamin D status throughout and after pregnancy. J Obstet Gynaecol 2010; 30: 137.

    Article  CAS  Google Scholar 

  41. Holick MF . Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995; 61 (3 Suppl): 638S–645S.

    Article  CAS  Google Scholar 

  42. Van der Wielen RP, Loewik MR, van den Berg H, de Groot LC, Haller J, Moreiras O et al. Serum vitamin D concentrations among elderly people in Europe. Lancet 1995; 346: 207–210.

    Article  CAS  Google Scholar 

  43. Andersen LB, Abrahamsen B, Dalgård C, Kyhl HB, Beck-Nielsen SS, Frost-Nielsen M et al. Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population-based cohort study. Clin Endocrinol (Oxf) 2013; 79: 333–341.

    Article  CAS  Google Scholar 

  44. Laaksi IT, Rouhola J-PS, Ylikomi TJ, Auvinen A, Haataja RI, Pihlajamäki HK et al. Vitamin D fortification as public health policy:significant improvement in vitamin D status in young men. Eur J Clin Nutr 2006; 60: 1035–1038.

    Article  CAS  Google Scholar 

  45. Piirainen T, Laitinen K, Isolauri E . Impact of fortification of fluid milks and margarine with vitamin D on dietary intake and serum 25-hydroxyvitamin D concentration in 4-year-old children. Eur J Clin Nutr 2007; 61: 123–128.

    Article  CAS  Google Scholar 

  46. Bourre JM, Paquotte PM . Contributions (in 2005) of marine and fresh water products (finfish and shellfish, seafood, wild and farmed) to the French dietary intakes of vitamins D and B12, selenium, iodine and docosahexaenoic acid: impact on public health. Int J Food Sci Nutr 2008; 59: 491–501.

    Article  Google Scholar 

  47. Danish Institute for Food and Veterinary Research Vitamin D status in the Danish Population should be improved (in Danish with English summary) 2004 Available at: http://www.dfvf.dk/Default.aspx?ID=10082 (accessed September 2013).

  48. British Nutrition Foundation (www.nutrition.org.uk). Assessed September 2013,Vitamin section (page 4).

  49. Tzotzas T, Papadopoulou FG, Tziomalos K, Karras S, Gastaris K et al. Rising serum 25-hydroxy-vitamin D levels after weight loss in obese women correlate with improvement in insulin resistance. J Clin Endocrinol Metab 2010; 95: 4251–4257.

    Article  CAS  Google Scholar 

  50. Blum M, Dolnikowski G, Seyoum E, Harris SS, Booth SL, Peterson J et al. Vitamin D(3) in fat tissue. Endocrine 2008; 33 : 90–94.

    Article  CAS  Google Scholar 

  51. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF . Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000; 72: 690–693.

    Article  CAS  Google Scholar 

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Karras, S., Anagnostis, P., Annweiler, C. et al. Maternal vitamin D status during pregnancy: the Mediterranean reality. Eur J Clin Nutr 68, 864–869 (2014). https://doi.org/10.1038/ejcn.2014.80

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