Vitamin D supplementation in pregnancy: a systematic review
Harvey NC, Holroyd C, Ntani G, Javaid K, Cooper P, Moon R, Cole Z, Tinati T, Godfrey K, Dennison E, Bishop NJ, Baird J, Cooper C
Health technology assessment (Winchester, England) · 201 citas
Cómo se estudió
- Diseño
- Revisión sistemática (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institute for Health and Care Research
- Gobierno
- Department of Health and Social Care
- Organización sin fines de lucro
- Versus Arthritis
- Gobierno
- Medical Research Council
- Gobierno
- National Institute for Health Research (NIHR)
- Subvenciones
- National Institute for Health and Care Research (10/33/04); National Institute for Health and Care Research (HTA/10/33/04); Medical Research Council (MC_UU_12011/4); National Institute for Health and Care Research (NF-SI-0508-10082); Versus Arthritis (17702); Medical Research Council (MC_UU_12011/1); National Institute for Health and Care Research (NF-SI-0513-10085)
Según 5 financiadores declarados.
Publicación
- Publicado
- 2014-07-01 · Health Technol Assess · vol. 18 · número 45 · págs. 1–190
- Editorial
- NIHR Journals Library
- Citado
- 352 citas · más que el 99% de estudios similares · 6.7× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 146 trabajos
- Acceso
- Acceso abierto (publicación gratuita) · CC-BY
- Áreas de investigación
- Vitamin D Research Studies · Vitamin K Research Studies · Nutrition and Health Studies
- Palabras clave
- vitamin D supplementation, pregnancy, 25-hydroxyvitamin D, vitamin D deficiency, maternal vitamin D status, birth weight, preterm birth, preeclampsia, gestational diabetes mellitus, neonatal outcomes, vitamin D3, vitamin D2, cost-effectiveness, rickets, bacterial vaginosis, cesarean section
- MeSH
- humans, pregnancy complications, vitamin d deficiency, birth weight, vitamins, vitamin d, pregnancy outcome, pregnancy, dietary supplements, infant, newborn, female
13 autores
- Nicholas C. Harvey🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Christopher R. Holroyd🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Georgia Ntani🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- M K Javaid🇬🇧National Institute for Health and Care Research; University of Oxford
- Philip Cooper🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Rebecca Jane Moon🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Zoe A. Cole🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Tannaze Tinati🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Keith M. Godfrey🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Elaine Margaret Dennison🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Nicholas J. Bishop🇬🇧University of Sheffield
- Janis Baird🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
- Cyrus C. Cooper🇬🇧Southampton General Hospital; MRC Lifecourse Epidemiology Unit; University of Southampton; Medical Research Council
Resumen
El texto original del estudio, en el idioma en que se publicó.
Background
It is unclear whether or not the current evidence base allows definite conclusions to be made regarding the optimal maternal circulating concentration of 25-hydroxyvitamin D [25(OH)D] during pregnancy, and how this might best be achieved.
Objectives
To answer the following questions: (1) What are the clinical criteria for vitamin D deficiency in pregnant women? (2) What adverse maternal and neonatal health outcomes are associated with low maternal circulating 25(OH)D? (3) Does maternal supplementation with vitamin D in pregnancy lead to an improvement in these outcomes (including assessment of compliance and effectiveness)? (4) What is the optimal type (D2 or D3), dose, regimen and route for vitamin D supplementation in pregnancy? (5) Is supplementation with vitamin D in pregnancy likely to be cost-effective?
Methods
We performed a systematic review and where possible combined study results using meta-analysis to estimate the combined effect size. Major electronic databases [including Database of Abstracts of Reviews of Effects (DARE), Centre for Reviews and Dissemination (CRD), Cochrane Database of Systematic Reviews (CDSR) and the Health Technology Assessment (HTA) database] were searched from inception up to June 2012 covering both published and grey literature. Bibliographies of selected papers were hand-searched for additional references. Relevant authors were contacted for any unpublished findings and additional data if necessary. Abstracts were reviewed by two reviewers.
Subjects
pregnant women or pregnant women and their offspring.
Exposure
either assessment of vitamin D status [dietary intake, sunlight exposure, circulating 25(OH)D concentration] or supplementation of participants with vitamin D or food containing vitamin D (e.g. oily fish).
Outcomes
offspring - birthweight, birth length, head circumference, bone mass, anthropometry and body composition, risk of asthma and atopy, small for gestational dates, preterm birth, type 1 diabetes mellitus, low birthweight, serum calcium concentration, blood pressure and rickets; mother - pre-eclampsia, gestational diabetes mellitus, risk of caesarean section and bacterial vaginosis.
Results
Seventy-six studies were included. There was considerable heterogeneity between the studies and for most outcomes there was conflicting evidence. The evidence base was insufficient to reliably answer question 1 in relation to biochemical or disease outcomes. For questions 2 and 3, modest positive relationships were identified between maternal 25(OH)D and (1) offspring birthweight in meta-analysis of three observational studies using log-transformed 25(OH)D concentrations after adjustment for potential confounding factors [pooled regression coefficient 5.63 g/10% change maternal 25(OH)D, 95% confidence interval (CI) 1.11 to 10.16 g], but not in those four studies using natural units, or across intervention studies; (2) offspring cord blood or postnatal calcium concentrations in a meta-analysis of six intervention studies (all found to be at high risk of bias; mean difference 0.05 mmol/l, 95% CI 0.02 to 0.05 mmol/l); and (3) offspring bone mass in observational studies judged to be of good quality, but which did not permit meta-analysis. The evidence base was insufficient to reliably answer questions 4 and 5.
Limitations
Study methodology varied widely in terms of study design, population used, vitamin D status assessment, exposure measured and outcome definition.
Conclusions
The evidence base is currently insufficient to support definite clinical recommendations regarding vitamin D supplementation in pregnancy. Although there is modest evidence to support a relationship between maternal 25(OH)D status and offspring birthweight, bone mass and serum calcium concentrations, these findings were limited by their observational nature (birthweight, bone mass) or risk of bias and low quality (calcium concentrations). High-quality randomised trials are now required.
Study registration
This study is registered as PROSPERO CRD42011001426.
Funding
The National Institute for Health Research Health Technology Assessment programme.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
Confianza de la comunidad
Cargando…
¿Cuánto confías en los hallazgos de este estudio?
Comentarios
¿Algo está mal aquí?
Señala este estudio si su información, etiquetas o financiación parecen incorrectas. Un editor revisa cada señalamiento.
Información educativa sobre investigación publicada. No es consejo médico ni una recomendación para empezar o dejar nada.