Endocrine Abstracts (2015) 37 EP241 | DOI: 10.1530/endoabs.37.EP241

Hypovitaminosis D in pregnancy: can the Mediterranean paradox be explained? A systematic review

Spyridon Karras1, Stavroula A Paschou1, Eleni Kandaraki1, Panagiotis Anagnostis1, Cédric Annweiler2,3, Basil C Tarlatzis1, Bruce W Hollis4, William B Grant5 & Dimitrios G Goulis1


1Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece; 2Department of Geriatric Medicine, University Hospital, Angers, France; 3Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, Ontario, Canada; 4Medical University of South Carolina Children’s Hospital, Charleston, South Carolina, USA; 5Sunlight, Nutrition, and Health Research Center, San Francisco, California, USA.


Introduction: Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region, consisting a paradox. The aim of the study was to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain the paradox.

Methods: After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review, involving 2649 pregnant women and 1820 neonates. The main outcome was maternal vitamin D concentration. Possible predictors of the outcome included study, maternal and neonatal characteristics (age, BMI, race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity, season of delivery, pregnancy complications).

Results: Studies differed widely in vitamin D deficiency criteria, methods of measurement and outcomes. However, prevalence of maternal and neonatal hypovitaminosis D was up to 90%. Predictors of maternal hypovitaminosis D were dark skin phototype, race and sartorial habits. Only a few pregnant women met the recommended dietary daily intake of calcium and vitamin D. Vitamin D supplementation was not a common practice.

Conclusions: Hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive strategies seem to negate the benefits of sun exposure.