Archives of Gynecology and Obstetrics

, Volume 296, Issue 1, pp 43–51 | Cite as

Higher prevalence of vitamin D deficiency in German pregnant women compared to non-pregnant women

  • Sandra Gellert
  • Alexander Ströhle
  • Norman Bitterlich
  • Andreas Hahn
Maternal-Fetal Medicine

Abstract

Purpose

Adequate vitamin D status is crucial for normal development of the fetus and for maternal health. As data on vitamin D status (25-hydroxyvitamin D, 25(OH)D) in German women of different states of pregnancy were not available, this study compared the vitamin D status of German women in all trimesters of pregnancy with that of non-pregnant women.

Methods

The study sample of 858 women (18–45 years) was recruited from April 2013 to March 2015 as a part of the cross-sectional Germany-wide VitaMinFemin study. Serum 25(OH)D levels were determined using chemiluminescence immunoassay.

Results

A total of 78.1% of the pregnant women and 53.9% of the non-pregnant women had a vitamin D status <50.0 nmol/L (p < 0.001). In pregnant women, the multivariate binary analysis showed that winter [odds ratio (OR) 13.5], longitude of residence between 6.3°E and 8.9°E (OR 2.0) or 9.0°E and 10.9°E (OR 2.3) and third trimester (OR 2.3) were associated with a higher risk of vitamin D status <25.0 nmol/L, whereas increasing age per one year (OR 0.9) with a lower risk. Compared with non-pregnant women, pregnant women were 3.7 times more likely to have a vitamin D status <25.0 nmol/L.

Conclusion

A low vitamin D status is prevalent among German pregnant women and should be improved to supply mother and fetus adequately.

Keywords

Vitamin D 25(OH)D Pregnancy Germany 

References

  1. 1.
    Norman AW, Bouillon R (2010) Vitamin D nutritional policy needs a vision for the future. Exp Biol Med (Maywood) 235(9):1034–1045. doi:10.1258/ebm.2010.010014 CrossRefGoogle Scholar
  2. 2.
    Souberbielle J-C, Body J-J, Lappe JM et al (2010) Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity and cancer: Recommendations for clinical practice. Autoimmun Rev 9(11):709–715. doi:10.1016/j.autrev.2010.06.009 CrossRefPubMedGoogle Scholar
  3. 3.
    Olmos-Ortiz A, Avila E, Durand-Carbajal M et al (2015) Regulation of calcitriol biosynthesis and activity: focus on gestational vitamin D deficiency and adverse pregnancy outcomes. Nutrients 7(1):443–480. doi:10.3390/nu7010443 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bodnar LM, Simhan HN, Catov JM et al (2014) Maternal vitamin D status and the risk of mild and severe preeclampsia. Epidemiology 25(2):207–214. doi:10.1097/EDE.0000000000000039 CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Robinson M, Whitehouse AJO, Newnham JP et al (2014) Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms. Arch Womens Ment Health 17(3):213–219. doi:10.1007/s00737-014-0422-y CrossRefPubMedGoogle Scholar
  6. 6.
    Lu M, Xu Y, Lv L et al (2016) Association between vitamin D status and the risk of gestational diabetes mellitus: a meta-analysis. Arch Gynecol Obstet 293(5):959–966. doi:10.1007/s00404-016-4010-4 CrossRefPubMedGoogle Scholar
  7. 7.
    Aghajafari F, Nagulesapillai T, Ronksley PE et al (2013) Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. BMJ 346(mar26):1169. doi:10.1136/bmj.f1169 CrossRefGoogle Scholar
  8. 8.
    Wuertz C, Gilbert P, Baier W et al (2013) Cross-sectional study of factors that influence the 25-hydroxyvitamin D status in pregnant women and in cord blood in Germany. Br J Nutr 110(10):1895–1902. doi:10.1017/S0007114513001438 CrossRefPubMedGoogle Scholar
  9. 9.
    Scholl TO, Chen X, Stein P (2012) Maternal vitamin D status and delivery by cesarean. Nutrients 4(12):319–330. doi:10.3390/nu4040319 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Lv SS, Wang JY, Wang XQ et al (2016) Serum vitamin D status and in vitro fertilization outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet 293(6):1339–1345. doi:10.1007/s00404-016-4058-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Zhu K, Whitehouse AJO, Hart PH et al (2014) Maternal vitamin D status during pregnancy and bone mass in offspring at 20 years of age: a prospective cohort study. J Bone Miner Res 29(5):1088–1095. doi:10.1002/jbmr.2138 CrossRefPubMedGoogle Scholar
  12. 12.
    Wagner CL, Baggerly C, McDonnell S et al (2016) Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009–2011 rates. J Steroid Biochem Mol Biol 155(Pt B):245–251. doi:10.1016/j.jsbmb.2015.10.022 CrossRefPubMedGoogle Scholar
  13. 13.
    Eckhardt CL, Gernand AD, Roth DE et al (2015) Maternal vitamin D status and infant anthropometry in a US multi-centre cohort study. Ann Hum Biol 42(3):215–222. doi:10.3109/03014460.2014.954616 CrossRefPubMedGoogle Scholar
  14. 14.
    Souci SW, Fachmann W, Kraut H (2015) Die Zusammensetzung der Lebensmittel, Nährwert-Tabellen [Food Composition and Nutrition Tables], 8.th. Medpharm Scientific Publishers, StuttgartGoogle Scholar
  15. 15.
    Seckmeyer G, Schrempf M, Wieczorek A et al (2013) A novel method to calculate solar UV exposure relevant to vitamin D production in humans. Photochem Photobiol 89(4):974–983. doi:10.1111/php.12074 CrossRefPubMedGoogle Scholar
  16. 16.
    Engelsen O, Brustad M, Aksnes L et al (2005) Daily duration of vitamin D synthesis in human skin with relation to latitude, total ozone, altitude, ground cover, aerosols and cloud thickness. Photochem Photobiol 81(6):1287. doi:10.1562/2004-11-19-RN-375 CrossRefPubMedGoogle Scholar
  17. 17.
    Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96(1):53–58. doi:10.1210/jc.2010-2704 CrossRefPubMedGoogle Scholar
  18. 18.
    Pludowski P, Holick MF, Pilz S et al (2013) Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev 12(10):976–989. doi:10.1016/j.autrev.2013.02.004 CrossRefPubMedGoogle Scholar
  19. 19.
    Zittermann A, Gummert JF (2010) Nonclassical vitamin D actions. Nutrients 2(4):408–425. doi:10.3390/nu2040408 PubMedGoogle Scholar
  20. 20.
    Ross CA, Taylor CL, Yaktine AL, Del Valle HB (2011) Dietary reference intakes for calcium and vitamin D. The National Academies Press (US), Washington, DCGoogle Scholar
  21. 21.
    Holick MF, Binkley NC, Bischoff-Ferrari HA et al (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930. doi:10.1210/jc.2011-0385 CrossRefPubMedGoogle Scholar
  22. 22.
    Cashman KD, Dowling KG, Skrabakova Z et al (2016) Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr 103(4):1033–1044. doi:10.3945/ajcn.115.120873 CrossRefPubMedGoogle Scholar
  23. 23.
    Rabenberg M, Scheidt-Nave C, Busch MA et al (2015) Vitamin D status among adults in Germany: results from the German health interview and examination survey for adults (DEGS1). BMC Public Health 15(1):76. doi:10.1186/s12889-015-2016-7 CrossRefGoogle Scholar
  24. 24.
    Richter K, Breitner S, Webb AR et al (2014) Influence of external, intrinsic and individual behaviour variables on serum 25(OH)D in a German survey. J Photochem Photobiol B Biol 140:120–129. doi:10.1016/j.jphotobiol.2014.07.018 CrossRefGoogle Scholar
  25. 25.
    Weisse K, Winkler S, Hirche F et al (2013) Maternal and newborn vitamin D status and its impact on food allergy development in the German LINA cohort study. Allergy 68(2):220–228. doi:10.1111/all.12081 CrossRefPubMedGoogle Scholar
  26. 26.
    Gellert S, Schuchardt JP, Hahn A (2016) Higher omega-3 index and DHA status in pregnant women compared to lactating women: results from a German nation-wide cross-sectional study. Prostaglandins Leukot Essent Fatty Acids 109:22–28. doi:10.1016/j.plefa.2016.04.002 CrossRefPubMedGoogle Scholar
  27. 27.
    Vandevijvere S, Amsalkhir S, van Oyen H et al (2012) High prevalence of vitamin D deficiency in pregnant women: a national cross-sectional survey. PLoS One 7(8):e43868. doi:10.1371/journal.pone.0043868 CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Webb AR, Engelsen O (2006) Calculated ultraviolet exposure levels for a healthy vitamin D status. Photochem Photobiol 82(6):1697–1703. doi:10.1562/2005-09-01-RA-670 CrossRefPubMedGoogle Scholar
  29. 29.
    Zhang JY, Lucey AJ, Horgan R et al (2014) Impact of pregnancy on vitamin D status: a longitudinal study. Br J Nutr 112(07):1081–1087. doi:10.1017/S0007114514001883 CrossRefPubMedGoogle Scholar
  30. 30.
    Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871CrossRefPubMedGoogle Scholar
  31. 31.
    Holmes VA, Barnes MS, Alexander HD et al (2009) Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study. Br J Nutr 102(06):876. doi:10.1017/S0007114509297236 CrossRefPubMedGoogle Scholar
  32. 32.
    Pilz S, Hahn A, Schon C et al (2017) Effect of two different multimicronutrient supplements on vitamin D status in women of childbearing age: a randomized zrial. Nutrients. doi:10.3390/nu9010030 Google Scholar
  33. 33.
    Milman N, Hvas A-M, Bergholt T (2012) Vitamin D status during normal pregnancy and postpartum. A longitudinal study in 141 Danish women. J Perinat Med 40(1):57–61. doi:10.1515/JPM.2011.120 CrossRefGoogle Scholar
  34. 34.
    Van der Meer Karamali NS, Boeke AJ et al (2006) High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands. Am J Clin Nutr 84(2):350–353 (quiz 468-9)PubMedGoogle Scholar
  35. 35.
    Cadario F, Savastio S, Magnani C et al (2015) High prevalence of vitamin D deficiency in native versus migrant mothers and newborns in the north of Italy: a call to act with a stronger prevention program. PLoS One 10(6):e0129586. doi:10.1371/journal.pone.0129586 CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    De Koning L, Al-Turkmani MR, Berg AH et al (2013) Variation in clinical vitamin D status by DiaSorin Liaison and LC-MS/MS in the presence of elevated 25-OH vitamin D2. Clin Chim Acta 415:54–58. doi:10.1016/j.cca.2012.09.002 CrossRefPubMedGoogle Scholar
  37. 37.
    Cashman KD, Dowling KG, Skrabakova Z et al (2015) Standardizing serum 25-hydroxyvitamin D data from four Nordic population samples using the Vitamin D Standardization Program protocols: shedding new light on vitamin D status in Nordic individuals. Scand J Clin Lab Invest 75(7):549–561. doi:10.3109/00365513.2015.1057898 CrossRefPubMedGoogle Scholar
  38. 38.
    Matsuoka LY, Ide L, Wortsman J et al (1987) Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab 64(6):1165–1168. doi:10.1210/jcem-64-6-1165 CrossRefPubMedGoogle Scholar
  39. 39.
    Deutsche Gesellschaft für Ernährung [German Nutrition Society] (2012) 12. Ernährungsbericht [12. Nutrition report]. DGE Medien Service, Bonn, p 66Google Scholar
  40. 40.
    Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährung [German Nutrition Society, Austrian Society for Nutrition, Swiss Society for Nutrition] (2015) Fettlösliche Vitamine: Vitamin D. In: Referenzwerte für die Nährstoffzufuhr [Fat-soluble vitamins: Vitamin D. In: Reference values for nutrient intake], 2nd edn. Neuer Umschau Buchverlag, BonnGoogle Scholar
  41. 41.
    Webb AR (2006) Who, what, where and when: influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 92(1):17–25. doi:10.1016/j.pbiomolbio.2006.02.004 CrossRefPubMedGoogle Scholar
  42. 42.
    Deutscher Wetterdienst [German Meterological Service] (2013–2015) Datenbasis 2013, 2014, 2015: berechnete Mittelwerte [Data base 2013, 2014, 2015: calculated mean values. 2013, 2014, 2015]. ftp://cdc.dwd.de/pub/CDC/. Accessed 15 Aug 2016
  43. 43.
    Karlsson T, Andersson L, Hussain A et al (2015) Lower vitamin D status in obese compared with normal-weight women despite higher vitamin D intake in early pregnancy. Clin Nutr 34(5):892–898. doi:10.1016/j.clnu.2014.09.012 CrossRefPubMedGoogle Scholar
  44. 44.
    Schneuer FJ, Roberts CL, Guilbert C et al (2014) Effects of maternal serum 25-hydroxyvitamin D concentrations in the first trimester on subsequent pregnancy outcomes in an Australian population. Am J Clin Nutr 99(2):287–295. doi:10.3945/ajcn.113.065672 CrossRefPubMedGoogle Scholar
  45. 45.
    De-Regil LM, Palacios C, Lombardo LK et al (2016) Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 1(14):CD008873. doi:10.1002/14651858.CD008873.pub3 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Institute of Food Science and Human NutritionLeibniz University HannoverHannoverGermany
  2. 2.Department of BiostatisticsMedizin and Service GmbHChemnitzGermany

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