Faustino R Pérez-López1, Vinay Pasupuleti2, Edward Mezones-Holguin3, Vicente A Benites-Zapata4, Priyaleela Thota2, Abhishek Deshpande5, Adrian V Hernandez6. 1. Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine and Lozano Blesa University Hospital, Zaragoza, Spain. Electronic address: faustino.perez@unizar.es. 2. Department of Medicine, Case Western Reserve University, Cleveland, Ohio. 3. Unit of Analysis and Generation of Evidence in Public Health (UNAGESP), Instituto Nacional de Salud, Lima, Peru; School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru. 4. Unit of Analysis and Generation of Evidence in Public Health (UNAGESP), Instituto Nacional de Salud, Lima, Peru. 5. Medicine Institute Center for Value Based Care Research, Cleveland Clinic, Cleveland, Ohio. 6. School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru; Health Outcomes and Clinical Epidemiology Section, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVE: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Not applicable. PATIENT(S): Pregnant women and neonates. INTERVENTION(S): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation ± calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. MAIN OUTCOME MEASURE(S): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). RESULT(S): Thirteen RCTs (n = 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2-66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9-155.3 g) and 0.3 cm (95% CI 0.10-0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. CONCLUSION(S): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion.
OBJECTIVE: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Not applicable. PATIENT(S): Pregnant women and neonates. INTERVENTION(S): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation ± calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. MAIN OUTCOME MEASURE(S): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). RESULT(S): Thirteen RCTs (n = 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2-66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9-155.3 g) and 0.3 cm (95% CI 0.10-0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. CONCLUSION(S): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion.
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