An observational study on the magnitude of vitamin D levels in first trimester of pregnancy and the outcomes

Yogita Mohan Naik; Sreelatha S.; Kiran Ashok; Keerti

doi:10.18203/2320-1770.ijrcog20262099

Authors

Yogita Mohan Naik Department of Obstetrics and Gynecology, ESIMC medical college and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
Sreelatha S. Department of Obstetrics and Gynecology, ESIMC medical college and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
Kiran Ashok Department of Obstetrics and Gynecology, ESIMC medical college and PGIMSR, Rajajinagar, Bangalore, Karnataka, India
Keerti Department of Obstetrics and Gynecology, ESIMC medical college and PGIMSR, Rajajinagar, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20262099

Keywords:

Pregnancy, Gestational diabetes mellitus, Low birth weight, NICU, Preeclampsia, Vitamin D deficiency

Abstract

Background: Vitamin D deficiency is a common public health concern during pregnancy and has been associated with impaired glucose metabolism, abnormal placentation, and adverse maternal and neonatal outcomes. This study assessed the magnitude of maternal vitamin D deficiency during early pregnancy and evaluate its association with maternal and neonatal outcomes.

Methods: A prospective observational study was conducted among 302 singleton pregnant women attending the department of obstetrics and gynecology, ESIMC and PGIMSR Rajajinagar, Bangalore, over 18 months. Serum 25-hydroxyvitamin D levels were measured between 12-18 weeks of gestation. Participants were followed until delivery. The maternal outcomes evaluated included gestational diabetes mellitus, hypertensive disorders during pregnancy, anaemia, hypothyroidism, mode of delivery, and preterm birth. Neonatal outcomes included birth weight, low birth weight, Apgar score, and NICU admission. Associations were analyzed using chi-square tests.

Results: Of the 302 participants, 63 (20.9%) were vitamin D deficient, 174 (57.6%) insufficient, and 65 (21.5%) sufficient, indicating that 78.5% had suboptimal vitamin D levels. GDM occurred in 63 (20.9%) women and showed a significant association with vitamin D deficiency (χ²=14.34, p<0.001). Preeclampsia (3.3%) was also significantly higher among deficient mothers (χ²=15.57, p<0.001). No significant association was observed with anaemia, hypothyroidism, low birth weight, preterm delivery, or mode of delivery. Among 286 live births, NICU admission occurred in 20.6% neonates and was markedly higher among deficient mothers.

Conclusions: Vitamin D deficiency is a public health problem. Patient awareness and pre-pregnancy counselling with adequate supplementation will improve maternal and neonatal outcomes and minimize the complications.

Metrics

Metrics Loading ...

References

Rosen CJ, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE, et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev. 2012;33(3):456-92. DOI: https://doi.org/10.1210/er.2012-1000

Bikle DD. Vitamin D regulation of immune function. Curr Osteopor Rep. 2022;20(3):186-93. DOI: https://doi.org/10.1007/s11914-022-00732-z

Gani LU, How CH. Vitamin D deficiency. Singapore Med J. 2015;56(8):433. DOI: https://doi.org/10.11622/smedj.2015119

Feldman D, Pike JW, Adams JS. Vitamin D. 3rd ed. San Diego: Elsevier Academic Press; 2011.

Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol. 2008;3(5):1535-41. DOI: https://doi.org/10.2215/CJN.01160308

Heaney RP, Dowell MS, Hale CA, Bendich A. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. Am J Clin Nutr. 2003;22(2):142-6. DOI: https://doi.org/10.1080/07315724.2003.10719287

Zehnder D, Evans KN, Kilby MD, Bulmer JN, Innes BA, Stewart PM, et al. The ontogeny of 25-hydroxyvitamin D₃ 1α-hydroxylase expression in human placenta and decidua. Am J Pathol. 2002;161(1):105-14. DOI: https://doi.org/10.1016/S0002-9440(10)64162-4

Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, et al. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after resumption of menses. Am J Clin Nutr. 1998;67(4):693-701. DOI: https://doi.org/10.1093/ajcn/67.4.693

Abrams SA. In utero physiology: role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. Am J Clin Nutr. 2007;85(2):604S-7S. DOI: https://doi.org/10.1093/ajcn/85.2.604S

Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β-cell dysfunction. Am J Clin Nutr. 2004;79(5):820-5. DOI: https://doi.org/10.1093/ajcn/79.5.820

Clifton-Bligh RJ, McElduff P, McElduff A. Maternal vitamin D deficiency, ethnicity and gestational diabetes. Diabet Med. 2008;25(6):678-84. DOI: https://doi.org/10.1111/j.1464-5491.2008.02422.x

Parlea L, Bromberg IL, Feig DS, Vieth R, Merman E, Lipscombe LL. Association between serum 25-hydroxyvitamin D in early pregnancy and risk of gestational diabetes mellitus. Diabet Med. 2012;29(7):e25-32. DOI: https://doi.org/10.1111/j.1464-5491.2011.03550.x

Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, et al. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PloS One. 2008;3(11):e3753. DOI: https://doi.org/10.1371/journal.pone.0003753

Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007;92(9):3517-22. DOI: https://doi.org/10.1210/jc.2007-0718

Baker AM, Haeri S, Camargo CA Jr, Espinola JA, Stuebe AM. A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia. J Clin Endocrinol Metab. 2010;95(11):5105-9. DOI: https://doi.org/10.1210/jc.2010-0996

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(4):366.e1-6. DOI: https://doi.org/10.1016/j.ajog.2010.06.036

Powe CE, Seely EW, Rana S, Bhan I, Ecker J, Karumanchi SA, et al. First-trimester vitamin D, vitamin D-binding protein, and subsequent preeclampsia. Hypertension. 2010;56(4):758-63. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.110.158238

Shand AW, Nassar N, Von Dadelszen P, Innis SM, Green TJ. Maternal vitamin D status in pregnancy and adverse pregnancy outcomes in a group at high risk for pre-eclampsia. BJOG. 2010;117(13):1593-8. DOI: https://doi.org/10.1111/j.1471-0528.2010.02742.x

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(7):832-9. DOI: https://doi.org/10.1111/j.1471-0528.2012.03307.x

Haugen M, Brantsæter AL, Trogstad L, Alexander J, Roth C, Magnus P, et al. Vitamin D supplementation and reduced risk of preeclampsia in nulliparous women. Epidemiology. 2009;20(5):720-6. DOI: https://doi.org/10.1097/EDE.0b013e3181a70f08

Seely EW, Wood RJ, Brown EM, Graves SW. Lower serum ionized calcium and abnormal calciotropic hormone levels in preeclampsia. J Clin Endocrinol Metab. 1992;74(6):1436-40. DOI: https://doi.org/10.1210/jcem.74.6.1592891

Viljakainen HT, Saarnio E, Hytinantti T, Miettinen M, Surcel H, Makitie O, et al. Maternal vitamin D status determines bone variables in the newborn. J Clin Endocrinol Metab. 2010;95(4):1749-57. DOI: https://doi.org/10.1210/jc.2009-1391

Weiler H, Fitzpatrick-Wong S, Veitch R, Kovacs H, Schellenberg J, McCloy U, et al. Vitamin D deficiency and whole-body and femur bone mass relative to weight in healthy newborns. CMAJ. 2005;172(6):757-61. DOI: https://doi.org/10.1503/cmaj.1040508

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(9884):2176-83. DOI: https://doi.org/10.1016/S0140-6736(12)62203-X

Lucas RM, Ponsonby AL, Pasco JA, Morley R. Future health implications of prenatal and early-life vitamin D status. Nutr Rev. 2008;66(12):710-20. DOI: https://doi.org/10.1111/j.1753-4887.2008.00126.x

Brooke OG, Brown IR, Bone CD, Carter ND, Cleeve HJ, Maxwell JD, et al. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Br Med J. 1980;280(6216):751-4. DOI: https://doi.org/10.1136/bmj.280.6216.751

Delvin EE, Salle BL, Glorieux FH, Adeleine P, David LS. Vitamin D supplementation during pregnancy: effect on neonatal calcium homeostasis. J Pediatr. 1986;109(2):328-34. DOI: https://doi.org/10.1016/S0022-3476(86)80396-1

Mallet E, Gügi B, Brunelle P, Henocq A, Basuyau JP, Lemeur H. Vitamin D supplementation in pregnancy: a controlled trial of two methods. Obstet Gynecol. 1986;68(3):300-4. DOI: https://doi.org/10.1097/00006250-198609000-00002

Marya RK, Rathee S, Lata V, Mudgil S. Effect of vitamin D supplementation during pregnancy on foetal growth. Indian J Med Res. 1988;88:488-92.

Yu CK, Ertl R, Skyfta E, Akolekar R, Nicolaides KH. Vitamin D deficiency and supplementation during pregnancy. Clin Endocrinol (Oxf). 2009;70(5):685-90. DOI: https://doi.org/10.1111/j.1365-2265.2008.03403.x

Marya RK, Rathee S, Manrow M. Effect of calcium and vitamin D supplementation on toxemia of pregnancy. Gynecol Obstet Invest. 1987;24(1):38-42. DOI: https://doi.org/10.1159/000298772

Nitish A, Anand, PK, Swarnkanta L, Dhruvendra P. Vitamin D deficiency among pregnant women in India. Bioinformation. 2024;20(12):2029-33. DOI: https://doi.org/10.6026/9732063002002029

Luo R, Wang H, Cao Y. Effects of vitamin D supplementation on glucose metabolism and pregnancy outcomes in GDM: a systematic review and meta-analysis. Front Med. 2026;13:1743776. DOI: https://doi.org/10.3389/fmed.2026.1743776

Zhang MX, Pan GT, Guo JF, Li BY, Qin LQ, Zhang ZL. Vitamin D deficiency increases the risk of gestational diabetes mellitus: a meta-analysis of observational studies. Nutrients. 2015;7(10):8366-75. DOI: https://doi.org/10.3390/nu7105398

Giourga C, Papadopoulou SK, Voulgaridou G, Karastogiannidou C, Giaginis C, Pritsa A. Vitamin D deficiency as a risk factor of preeclampsia during pregnancy. Diseases. 2023;11(4):158. DOI: https://doi.org/10.3390/diseases11040158

Zakerinasab F, Behfar Q, Daghistani H, Ansari A, Zadeh RH, Zadeh RH, et al. Vitamin D levels in early and middle pregnancy and preeclampsia: a systematic review and meta-analysis. Front Med. 2025;12:1535359. DOI: https://doi.org/10.3389/fmed.2025.1535359

Yuan Y, Cai Z, Dai Y, Hong Q, Wang X, Zhu L, et al. Association of maternal serum 25-hydroxyvitamin D concentrations with risk of gestational anemia. Cell Physiol Biochem. 2017;43(4):1526-32. DOI: https://doi.org/10.1159/000481976

Wagner CL, Greer FR. Vitamin D and haematological health in pregnancy. Nutrients. 2021;15(7):1680.

Zhao R, Zhou L, Wang S, Yin H, Yang X, Hao L. Effect of maternal vitamin D status on risk of adverse birth outcomes: a systematic review and dose-response meta-analysis of observational studies. European J Nutrit. 2022;61(6):2881-907. DOI: https://doi.org/10.1007/s00394-022-02866-3

Pilz S, Trummer C, Pandis M, Schwetz V, Lerchbaum E. Vitamin D and pregnancy outcomes: overview of systematic reviews. Nutrients. 2022;14:976.

Gernand AD, Simhan HN, Caritis S, Bodnar LM. Maternal vitamin D status and fetal growth in pregnancy. BMC Pregnancy Childbirth. 2021;21:519.

Ravinder SS. Maternal vitamin D deficiency and pregnancy outcomes in an Indian cohort. J Fam Med Prim Care. 2022

Sonowal R, Das M, Deka BP, Das P. Effects of maternal vitamin D deficiency on the newborn. Indian J Neonat Med Res. 2021;9(4):PO27-32. DOI: https://doi.org/10.7860/IJNMR/2021/47986.2318

Kumari S, Kaul KK. Study on perinatal outcome in relation to maternal vitamin D deficiency in a tertiary care hospital. Int J Acad Med Pharm. 2023;5(4):1714-8.

Dhillon G, Singh S, Dhillon HS, Sasidharan S. A study of relationship between maternal vitamin D status and mode of delivery in a tertiary care hospital. Preprint. Available at: https://www.researchsquare.com/article/rs-35417/v1. Accessed on 17 January 2026.