Vitamin D in pregnancy: Where we are and where we should go
•While the role of vitamin D in skeletal development has been accepted for many years, the particular needs of pregnant women and newborn infants have been underserved.•National/international policy implementation is often slow or non-existent, causing gross inequalities in health care provision and...
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| Veröffentlicht in: | The Journal of steroid biochemistry and molecular biology 2020-07, Vol.201, p.105669-105669, Article 105669 |
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| container_title | The Journal of steroid biochemistry and molecular biology |
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| creator | Kiely, M.E. Wagner, C.L. Roth, D.E. |
| description | •While the role of vitamin D in skeletal development has been accepted for many years, the particular needs of pregnant women and newborn infants have been underserved.•National/international policy implementation is often slow or non-existent, causing gross inequalities in health care provision and poor outcomes for at risk mothers and babies, as shown by the wide variation in vitamin D status and prevalence of nutritional rickets within and between countries.•It would be reasonable and safe for public health authorities to take a population approach that aims to eliminate the prevalence of 25(OH)D |
| doi_str_mv | 10.1016/j.jsbmb.2020.105669 |
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Vitamin D deficiency has been widely reported among pregnant women and infants around the world. Women with low sun exposure, high BMI, low vitamin D intakes and socioeconomic disadvantage with poor quality diets are at greatest risk of vitamin D deficiency, leading to very low serum concentrations of 25-hydroxyvitamin D (25(OH)D) in their offspring and an increased risk of nutritional rickets. Many observational studies, supported by compelling in vitro and in vivo data, have generated evidence suggesting that low vitamin D status in pregnancy may also contribute to the risk of adverse perinatal outcomes including hypertensive disorders (e.g., preeclampsia), fetal growth restriction, and preterm birth. However, the few large randomized controlled trials (RCTs) conducted to date have generated conflicting evidence for a role of vitamin D supplementation in improving perinatal outcomes. Vitamin D supplementation policies during pregnancy and implementation of policies vary within and between jurisdictions. Regulatory authorities have cited insufficient evidence to establish pregnancy-specific targets for serum 25(OH)D concentrations or prenatal vitamin D intake that effectively reduce the risks of adverse perinatal and infant outcomes. This paper arises from a Debate on Vitamin D Requirements during Pregnancy, held at the 22nd Vitamin D Workshop, 2019. From varied perspectives, our objectives were to evaluate the evidence for: vitamin D metabolism in pregnancy and the prevalence of gestational vitamin D deficiency worldwide; the translation of laboratory research findings to clinical studies on the role of vitamin D in perinatal health; the challenges of designing and conducting clinical trials to establish prenatal vitamin D requirements; and results to date of major large RCTs of prenatal vitamin D supplementation. Lastly, we explored potential next steps towards generating robust clinical data in this field to address both public health protection and patient care.</description><identifier>ISSN: 0960-0760</identifier><identifier>EISSN: 1879-1220</identifier><identifier>DOI: 10.1016/j.jsbmb.2020.105669</identifier><identifier>PMID: 32302652</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>25-Hydroxyvitamin D ; Clinical trials ; Dietary supplements ; Fetuses ; Infants ; Nutrient deficiency ; Perinatal health ; Pre-eclampsia ; Preeclampsia ; Pregnancy ; Premature birth ; Prenatal experience ; Public health ; Rickets ; Vitamin D ; Vitamin D requirements ; Vitamin D status ; Vitamin deficiency</subject><ispartof>The Journal of steroid biochemistry and molecular biology, 2020-07, Vol.201, p.105669-105669, Article 105669</ispartof><rights>2020 Elsevier Ltd</rights><rights>Copyright © 2020 Elsevier Ltd. 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Vitamin D deficiency has been widely reported among pregnant women and infants around the world. Women with low sun exposure, high BMI, low vitamin D intakes and socioeconomic disadvantage with poor quality diets are at greatest risk of vitamin D deficiency, leading to very low serum concentrations of 25-hydroxyvitamin D (25(OH)D) in their offspring and an increased risk of nutritional rickets. Many observational studies, supported by compelling in vitro and in vivo data, have generated evidence suggesting that low vitamin D status in pregnancy may also contribute to the risk of adverse perinatal outcomes including hypertensive disorders (e.g., preeclampsia), fetal growth restriction, and preterm birth. However, the few large randomized controlled trials (RCTs) conducted to date have generated conflicting evidence for a role of vitamin D supplementation in improving perinatal outcomes. Vitamin D supplementation policies during pregnancy and implementation of policies vary within and between jurisdictions. Regulatory authorities have cited insufficient evidence to establish pregnancy-specific targets for serum 25(OH)D concentrations or prenatal vitamin D intake that effectively reduce the risks of adverse perinatal and infant outcomes. This paper arises from a Debate on Vitamin D Requirements during Pregnancy, held at the 22nd Vitamin D Workshop, 2019. From varied perspectives, our objectives were to evaluate the evidence for: vitamin D metabolism in pregnancy and the prevalence of gestational vitamin D deficiency worldwide; the translation of laboratory research findings to clinical studies on the role of vitamin D in perinatal health; the challenges of designing and conducting clinical trials to establish prenatal vitamin D requirements; and results to date of major large RCTs of prenatal vitamin D supplementation. Lastly, we explored potential next steps towards generating robust clinical data in this field to address both public health protection and patient care.</description><subject>25-Hydroxyvitamin D</subject><subject>Clinical trials</subject><subject>Dietary supplements</subject><subject>Fetuses</subject><subject>Infants</subject><subject>Nutrient deficiency</subject><subject>Perinatal health</subject><subject>Pre-eclampsia</subject><subject>Preeclampsia</subject><subject>Pregnancy</subject><subject>Premature birth</subject><subject>Prenatal experience</subject><subject>Public health</subject><subject>Rickets</subject><subject>Vitamin D</subject><subject>Vitamin D requirements</subject><subject>Vitamin D status</subject><subject>Vitamin deficiency</subject><issn>0960-0760</issn><issn>1879-1220</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kEtLw0AQgBdRbK3-AkECXryk7iPZzSoepD6h4MXHcdlspm1Ck9TdxNJ_78a0HjwIwwwM3zz4EDoleEww4ZfFuHBpmY4ppl0n5lzuoSFJhAwJpXgfDbHkOMSC4wE6cq7AGDNGxCEaMMow5TEdouv3vNFlXgV3gU8rC_NKV2ZzFXwswEKwhkD7oqssWO8ablG3yyyY18foYKaXDk62dYTeHu5fJ0_h9OXxeXI7DU3EaBMywUiS0ozjmdCG6TRKZAaM6DSJUyk4JdrwhMRES80hymIjDAYfGoMgkWEjdNHvXdn6swXXqDJ3BpZLXUHdOkWZJFKQWHCPnv9Bi7q1lf9O0SiKpOyyp1hPGVs7Z2GmVjYvtd0oglXnVhXqx63q3KrerZ862-5u0xKy35mdTA_c9AB4GV85WOVMDpWBLLdgGpXV-b8HvgGe04hu</recordid><startdate>20200701</startdate><enddate>20200701</enddate><creator>Kiely, M.E.</creator><creator>Wagner, C.L.</creator><creator>Roth, D.E.</creator><general>Elsevier Ltd</general><general>Elsevier BV</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7TM</scope><scope>7U9</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope></search><sort><creationdate>20200701</creationdate><title>Vitamin D in pregnancy: Where we are and where we should go</title><author>Kiely, M.E. ; Wagner, C.L. ; Roth, D.E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c432t-37318b2d60f7ac3ab489de31ab85b97621ac68151a9a6e4d5c7c0ec0ea0e714c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>25-Hydroxyvitamin D</topic><topic>Clinical trials</topic><topic>Dietary supplements</topic><topic>Fetuses</topic><topic>Infants</topic><topic>Nutrient deficiency</topic><topic>Perinatal health</topic><topic>Pre-eclampsia</topic><topic>Preeclampsia</topic><topic>Pregnancy</topic><topic>Premature birth</topic><topic>Prenatal experience</topic><topic>Public health</topic><topic>Rickets</topic><topic>Vitamin D</topic><topic>Vitamin D requirements</topic><topic>Vitamin D status</topic><topic>Vitamin deficiency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kiely, M.E.</creatorcontrib><creatorcontrib>Wagner, C.L.</creatorcontrib><creatorcontrib>Roth, D.E.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of steroid biochemistry and molecular biology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kiely, M.E.</au><au>Wagner, C.L.</au><au>Roth, D.E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vitamin D in pregnancy: Where we are and where we should go</atitle><jtitle>The Journal of steroid biochemistry and molecular biology</jtitle><addtitle>J Steroid Biochem Mol Biol</addtitle><date>2020-07-01</date><risdate>2020</risdate><volume>201</volume><spage>105669</spage><epage>105669</epage><pages>105669-105669</pages><artnum>105669</artnum><issn>0960-0760</issn><eissn>1879-1220</eissn><abstract>•While the role of vitamin D in skeletal development has been accepted for many years, the particular needs of pregnant women and newborn infants have been underserved.•National/international policy implementation is often slow or non-existent, causing gross inequalities in health care provision and poor outcomes for at risk mothers and babies, as shown by the wide variation in vitamin D status and prevalence of nutritional rickets within and between countries.•It would be reasonable and safe for public health authorities to take a population approach that aims to eliminate the prevalence of 25(OH)D <30 nmol/L and facilitate achievement of a personal target of 50 nmol/L, which would also benefit women of reproductive age.•Fortification of a variety of staple foods with vitamin D and scale-up of use of antenatal multiple micronutrient supplements containing modest amounts of vitamin D will likely achieve this aim.•A large-scale RCT of prenatal vitamin D supplementation that goes beyond the scope of any previous or ongoing RCT with multi-country collaboration, early first trimester or preconception enrolment, factorial design with calcium, and designed and powered for uncommon maternal outcomes and longer-term child health outcomes including nutritional rickets is required.
Vitamin D deficiency has been widely reported among pregnant women and infants around the world. Women with low sun exposure, high BMI, low vitamin D intakes and socioeconomic disadvantage with poor quality diets are at greatest risk of vitamin D deficiency, leading to very low serum concentrations of 25-hydroxyvitamin D (25(OH)D) in their offspring and an increased risk of nutritional rickets. Many observational studies, supported by compelling in vitro and in vivo data, have generated evidence suggesting that low vitamin D status in pregnancy may also contribute to the risk of adverse perinatal outcomes including hypertensive disorders (e.g., preeclampsia), fetal growth restriction, and preterm birth. However, the few large randomized controlled trials (RCTs) conducted to date have generated conflicting evidence for a role of vitamin D supplementation in improving perinatal outcomes. Vitamin D supplementation policies during pregnancy and implementation of policies vary within and between jurisdictions. Regulatory authorities have cited insufficient evidence to establish pregnancy-specific targets for serum 25(OH)D concentrations or prenatal vitamin D intake that effectively reduce the risks of adverse perinatal and infant outcomes. This paper arises from a Debate on Vitamin D Requirements during Pregnancy, held at the 22nd Vitamin D Workshop, 2019. From varied perspectives, our objectives were to evaluate the evidence for: vitamin D metabolism in pregnancy and the prevalence of gestational vitamin D deficiency worldwide; the translation of laboratory research findings to clinical studies on the role of vitamin D in perinatal health; the challenges of designing and conducting clinical trials to establish prenatal vitamin D requirements; and results to date of major large RCTs of prenatal vitamin D supplementation. Lastly, we explored potential next steps towards generating robust clinical data in this field to address both public health protection and patient care.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32302652</pmid><doi>10.1016/j.jsbmb.2020.105669</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | The Journal of steroid biochemistry and molecular biology, 2020-07, Vol.201, p.105669-105669, Article 105669 |
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| language | eng |
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| source | Elsevier ScienceDirect Journals |
| subjects | 25-Hydroxyvitamin D Clinical trials Dietary supplements Fetuses Infants Nutrient deficiency Perinatal health Pre-eclampsia Preeclampsia Pregnancy Premature birth Prenatal experience Public health Rickets Vitamin D Vitamin D requirements Vitamin D status Vitamin deficiency |
| title | Vitamin D in pregnancy: Where we are and where we should go |
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