In the United States, significant, intractable disparities exist in rates of major pregnancy outcomes between non-Hispanic black and non-Hispanic white women. A previously unexplored candidate influence on the black-white disparity in adverse birth outcomes is maternal vitamin D status. This review summarizes the evidence relating maternal vitamin D to preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction, and addresses gaps in our understanding of the contribution of vitamin D to the intractable black-white disparity in these conditions. The literature reviewed highlights strong biologic plausibility of role for vitamin D in the pathophysiology of these poor pregnancy outcomes. Data also suggest that maternal vitamin D deficiency may increase the risk of preeclampsia and fetal growth restriction. Less research has been done in support of relations with spontaneous preterm birth and gestational diabetes, and fetal and infant survival have rarely been studied. Few trials of vitamin D supplementation have been conducted in pregnant women with adequate power to test effects on birth outcomes. Importantly, black pregnant women have rarely been studied in vitamin D—birth outcomes research. Although vitamin D is a promising candidate influence on black-white disparities in preeclampsia, spontaneous preterm birth, fetal growth restriction, and gestational diabetes, these associations require further study in large samples of black US women. Because vitamin D deficiency is widespread and black-white disparities in pregnancy outcomes and infant survival have been resistant to previous interventions, research to test vitamin D as a causal factor is of major public health significance.
Target Audience: Obstetricians & Gynecologist, Family Physicians.
Learning Objectives: After completion of this educational activity, the reader will be able to appreciate risk factors for inadequate vitamin D status. Understand the basic aspects of vitamin D metabolism. Become aware of recent literature linking inadequate vitamin D status and adverse pregnancy outcomes such as preeclampsia and preterm birth.
*Assistant Professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; *Assistant Professor and †Associate Professor and Division Chief, Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA; and *Assistant Investigator and †Associate Investigator, Magee-Womens Research Institute, Pittsburgh, PA
Chief Editor's Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2010. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.
Unless otherwise noted below, each faculty's spouse/life partner (if any) has nothing to disclose.
The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.
The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.
L.M.B. and H.N.S. conceptualized the paper, conducted the literature review, and wrote the paper. Both authors read and approved the final manuscript.
Supported by NIH grants R01 HD056999, K01 MH074092 (to L.M.B.) and NIH grants R01 HD041663, R01 HD052732 (to H.N.S.).
Reprint requests to: Lisa M. Bodnar, PhD, MPH, RD, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, A742 Crabtree Hall, 130 DeSoto St, Pittsburgh, PA 15261. E-mail: email@example.com.