Am J Perinatol 2011; 28(1): 007-012
DOI: 10.1055/s-0030-1262505
© Thieme Medical Publishers

Vitamin D Deficiency and Insufficiency is Common during Pregnancy

Donna D. Johnson1 , Carol L. Wagner2 , Thomas C. Hulsey3 , Rebecca B. McNeil4 , Myla Ebeling3 , Bruce W. Hollis2
  • 1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina
  • 2Division of Pediatric Nutrition, Department of Pediatrics, Children's Research Institution, Charleston, South Carolina
  • 3Division of Pediatric Epidemiology, Department of Pediatrics, Rutledge Tower, Charleston, South Carolina
  • 4Department of Biostatistics, Mayo Clinic, Jacksonville, Florida
Further Information

Publication History

Publication Date:
16 July 2010 (online)

ABSTRACT

The objective was to determine the incidence of vitamin D deficiency, insufficiency, and sufficiency in African-American, Hispanic, and Caucasian pregnant women. Blood samples were taken from 154 African-American, 194 Hispanic, and 146 Caucasian women at <14 weeks of gestation; 25 hydroxyvitamin D levels (25(OH)D) levels were measured by radioimmunoassay. The mean 25(OH)D levels in African-American, Hispanic, and Caucasian pregnant women were 15.5 ± 7.2 (standard deviation), 24.1 ± 8.7, 29.0 ± 8.5 ng/mL, respectively. Ninety-seven percent of African-Americans, 81% of Hispanics, and 67% of Caucasians were deficient (25(OH)D levels <20 ng/mL or <50 nmol/L) or insufficient (25(OH)D levels ≥20 ng/mL or <32 ng/mL or ≥50 nmol/L or <80 nmol/L). Of these pregnant women, 82% had vitamin D levels <32 ng/mL (<80 ng/mL). In logistic regression models, race was the most important risk factor for vitamin D deficiency or insufficiency. African-American women and Hispanic women were more likely to have vitamin D insufficiency and deficiency than Caucasian women. Furthermore, primigravid women were more at risk for vitamin D insufficiency. This study demonstrates widespread vitamin D deficiency and insufficiency in pregnant females living at a southern latitude. African-Americans are at greatest risk.

REFERENCES

  • 1 Sills I N, Skuza K A, Horlick M NB, Schwartz M S, Rapaport R. Vitamin D deficiency rickets. Reports of its demise are exaggerated.  Clin Pediatr (Phila). 1994;  33 491-493
  • 2 Nesby-O'Dell S, Scanlon K S, Cogswell M E et al.. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994.  Am J Clin Nutr. 2002;  76 187-192
  • 3 Looker A C, Pfeiffer C M, Lacher D A, Schleicher R L, Picciano M F, Yetley E A. Serum 25-hydroxyvitamin D status of the US population: 1988–1994 compared with 2000–2004.  Am J Clin Nutr. 2008;  88 1519-1527
  • 4 Taha S A, Dost S M, Sedrani S H. 25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates.  Pediatr Res. 1984;  18 739-741
  • 5 Brooke O G, Brown I R, Cleeve H J, Sood A. Observations on the vitamin D state of pregnant Asian women in London.  Br J Obstet Gynaecol. 1981;  88 18-26
  • 6 Mallet E, Gügi B, Brunelle P, Hénocq A, Basuyau J P, Lemeur H. Vitamin D supplementation in pregnancy: a controlled trial of two methods.  Obstet Gynecol. 1986;  68 300-304
  • 7 Brunvand L, Haug E. Vitamin D deficiency amongst Pakistani women in Oslo.  Acta Obstet Gynecol Scand. 1993;  72 264-268
  • 8 Pehlivan I, Hatun S, Aydoğan M, Babaoğlu K, Gökalp A S. Maternal vitamin D deficiency and vitamin D supplementation in healthy infants.  Turk J Pediatr. 2003;  45 315-320
  • 9 O'Riordan M N, Kiely M, Higgins J R, Cashman K D. Prevalence of suboptimal vitamin D status during pregnancy.  Ir Med J. 2008;  101 240, 242-243
  • 10 Datta S, Alfaham M, Davies D P et al.. Vitamin D deficiency in pregnant women from a non-European ethnic minority population—an interventional study.  BJOG. 2002;  109 905-908
  • 11 Serenius F, Elidrissy A T, Dandona P. Vitamin D nutrition in pregnant women at term and in newly born babies in Saudi Arabia.  J Clin Pathol. 1984;  37 444-447
  • 12 van der Meer I M, Karamali N S, Boeke A JP et al.. High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands.  Am J Clin Nutr. 2006;  84 350-353 quiz 468-469
  • 13 Holick M F. Vitamin D deficiency.  N Engl J Med. 2007;  357 266-281
  • 14 Bodnar L M, Simhan H N, Powers R W, Frank M P, Cooperstein E, Roberts J M. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates.  J Nutr. 2007;  137 447-452
  • 15 Matsuoka L Y, Wortsman J, Haddad J G, Kolm P, Hollis B W. Racial pigmentation and the cutaneous synthesis of vitamin D.  Arch Dermatol. 1991;  127 536-538
  • 16 Hollis B W. Comparison of equilibrium and disequilibrium assay conditions for ergocalciferol, cholecalciferol and their major metabolites.  J Steroid Biochem. 1984;  21 81-86
  • 17 Hollis B W, Kamerud J Q, Selvaag S R, Lorenz J D, Napoli J L. Determination of vitamin D status by radioimmunoassay with an 125I-labeled tracer.  Clin Chem. 1993;  39 529-533
  • 18 Hollis B W. Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D.  J Nutr. 2005;  135 317-322
  • 19 Vieth R, Bischoff-Ferrari H, Boucher B J et al.. The urgent need to recommend an intake of vitamin D that is effective.  Am J Clin Nutr. 2007;  85 649-650
  • 20 Harris S S, Dawson-Hughes B. Seasonal changes in plasma 25-hydroxyvitamin D concentrations of young American black and white women.  Am J Clin Nutr. 1998;  67 1232-1236
  • 21 Levis S, Gomez A, Jimenez C et al.. Vitamin d deficiency and seasonal variation in an adult South Florida population.  J Clin Endocrinol Metab. 2005;  90 1557-1562
  • 22 Bodnar L M, Catov J M, Roberts J M, Simhan H N. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates.  J Nutr. 2007;  137 2437-2442
  • 23 Looker A C. Body fat and vitamin D status in black versus white women.  J Clin Endocrinol Metab. 2005;  90 635-640
  • 24 Wortsman J, Matsuoka L Y, Chen T C, Lu Z, Holick M F. Decreased bioavailability of vitamin D in obesity.  Am J Clin Nutr. 2000;  72 690-693
  • 25 Jacobs E T, Alberts D S, Foote J A et al.. Vitamin D insufficiency in southern Arizona.  Am J Clin Nutr. 2008;  87 608-613
  • 26 Moghraby S A, Al Shawaf T, Akiel A, Sedrani S H, el Idrissy A T, Al-Meshari A A. Parity and vitamin D metabolites.  Ann Trop Paediatr. 1987;  7 210-213
  • 27 Vieth R, Ladak Y, Walfish P G. Age-related changes in the 25-hydroxyvitamin D versus parathyroid hormone relationship suggest a different reason why older adults require more vitamin D.  J Clin Endocrinol Metab. 2003;  88 185-191
  • 28 Heaney R P, Dowell M S, Hale C A, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D.  J Am Coll Nutr. 2003;  22 142-146
  • 29 Hollis B W, Pittard III W B. Evaluation of the total fetomaternal vitamin D relationships at term: evidence for racial differences.  J Clin Endocrinol Metab. 1984;  59 652-657
  • 30 Mannion C A, Gray-Donald K, Koski K G. Association of low intake of milk and vitamin D during pregnancy with decreased birth weight.  CMAJ. 2006;  174 1273-1277
  • 31 Bodnar L M, Catov J M, Simhan H N, Holick M F, Powers R W, Roberts J M. Maternal vitamin D deficiency increases the risk of preeclampsia.  J Clin Endocrinol Metab. 2007;  92 3517-3522

Donna D JohnsonM.D. 

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of South Carolina

96 Jonathan Lucas Street, CSB 634, Charleston, SC 29425-0619

Email: johnsodo@musc.edu

    >