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Clinical nutrition

Vitamin D during pregnancy and its association with birth outcomes: a Brazilian cohort study



Evidence is lacking on how variation in vitamin D concentrations during gestation affects perinatal outcomes. Therefore, we evaluated the association between vitamin D serum concentrations during pregnancy and neonatal outcomes.


A prospective cohort of 180 healthy Brazilian pregnant women was followed and plasma 25-hydroxyvitamin [25(OH)D, nmol/L] was measured at 5–13 (baseline), 20–26 and 30–36 gestational weeks. Birth weight (BW), birth length (BL), BW z-scores, BL z-scores, first minute Apgar, small for gestational age (SGA), large for gestational age (LGA) and preterm birth were the outcomes. Multiple linear and Poisson regression models were estimated. Best linear unbiased prediction of random coefficients model was used to determine the association between the mean rate of change in vitamin D during pregnancy concentrations and neonatal outcomes.


Mean (SD) BW was 3300 (600) g, BW z-score 0.34 (1.11), BL 49.3 (3.3) cm, BL z-score 0.44 (1.5), and first minute Apgar score 8.2 (1.4). Prevalence of SGA, LGA and preterm birth were 6%, 18% and 13%, respectively. 25(OH)D was directly associated with the risk of preterm birth at all trimesters. Incidence-rate ratios were 1.02, 1.05 and 1.04 for the 1st, 2nd and 3rd trimester, respectively. Mean rate of change during pregnancy in 25(OH)D was directly associated with BW z-score (β: 0.36, 95% CI 0.07; 0.65), LGA risk (IRR: 1.97, 95% CI 1.07; 3.63) and preterm birth (IRR: 7.35, 95% CI 2.99; 18.07).


Mean 25(OH)D rate of change during pregnancy was directly associated with BW z-scores, and increased LGA and preterm birth risk.

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Fig. 1: Flowchart.
Fig. 2: Maternal 25(OH)D concentration comparison between birth outcomes.
Fig. 3: Relationship between mean 25(OH)D rate of change during pregnancy and birth outcomes.


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The authors are grateful to all the women who volunteered to participate in this cohort study, to the managers and professionals of the Municipal Health Centre Heitor Beltrão for providing us with the space and opportunities for the data collection and to the Quest Diagnostics Nichols Institute laboratory (San Juan Capistrano, CA, USA) for performing the vitamin D concentration analyses. Moreover, we thank the National Council for Scientific and Technological Development (CNPq in the Portuguese acronym; grant number: 471196/2010-0) and the Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ for the Portuguese acronym, grant number E-26/111.400/2010, E_14/2010) for the financial support. National Council for Scientific and Technological Development (CNPq in the Portuguese acronym; grant number: 471196/2010-0) and the Carlos Chagas Filho Foundation for Research Support of Rio de Janeiro State (FAPERJ in the Portuguese acronym, grant number E-26/111.400/2010, E_14/2010).

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CB and GK developed the research question and designed the study. CB and TRBC conducted the statistical analyses. GK, TRBC and DF provided support for the statistical analyses. TRBC assisted with the literature review and with writing the manuscript. All of the authors have made substantial contributions to the manuscript and approved this final revision.

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Correspondence to Gilberto Kac.

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The authors declare that they have no conflict of interest.

Ethical approval

The current study was performed in accordance with the guidelines of the Declaration of Helsinki. An informed consent for participation was thoroughly explained and signed by all participants. This study was approved by the Rio de Janeiro Federal University Maternity Teaching Hospital Ethics Committee (protocol number: 0023.0.361.000-08) and the Municipal Secretary of Rio de Janeiro Ethics Committee (protocol number: 0139.0.314.000-09).

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Benaim, C., Carrilho, T.R.B., Farias, D.R. et al. Vitamin D during pregnancy and its association with birth outcomes: a Brazilian cohort study. Eur J Clin Nutr (2020).

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