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Nutrition during the early life cycle

Predictors of 25-hydroxyvitamin D concentrations during pregnancy: A longitudinal analysis in the Brazilian Amazon



To determine predictors of 25-hydroxyvitamin D3 (25(OH)D3) concentrations (25th, 50th, and 75th percentiles) in the third trimester of pregnancy.


Data on sociodemographic, obstetric, lifestyle and pregnancy characteristics, including serum 25(OH)D3 and retinol, were collected among 448 pregnant women who participated in the Maternal and Child Health and Nutrition in Acre, Brazil (MINA-Brazil Study) in Cruzeiro do Sul, Brazilian Amazon (latitude 7°S). Simultaneous-quantile regression was fitted to prospectively assess predictors at the 25th, 50th and 75th percentiles of 25(OH)D3 concentrations.


In the third trimester, 25(OH)D3 <50 nmol/L was observed in 26% of pregnant women. Exposure to the Amazonian dry season during follow-up and vitamin D status ≥75 nmol/L in the second trimester of pregnancy were positively associated with 25(OH)D3 concentrations in the third trimester. Pregnant women who were the main providers of family income presented lower 25(OH)D3 concentrations (50th and 75th percentiles: −15 nmol/L, 95%CI −24; −3, p = 0.02, and −22 nmol/L, 95%CI −36; −7, p = 0.004, respectively), as well as those with sustained vitamin A insufficiency (25th and 50th percentiles: −27 nmol/L, 95%CI −40; −15, p < 0.001, and −17 nmol/L, 95%CI −33; −1, p = 0.04, respectively). Sun protection practices had a smaller negative impact on 25(OH)D3, restricted to participants whose concentrations were at the 25th percentile of the distribution.


Seasonality and vitamin A status were important predictors of 25(OH)D3 concentrations in the third trimester. Adequate exposure to sunlight and dietary sources of vitamin A within safe intake levels may help ensuring a good nutritional status of vitamin D during pregnancy.

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Fig. 1: Flowchart of the recruitment and follow-up of participants in the MINA-Brazil study.

Data availability

Additional data are available from the corresponding author on reasonable request.


  1. Mulligan ML, Felton SK, Riek AE, Bernal-Mizrachi C. Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol 2010;202:429,e1–9.

    Article  CAS  Google Scholar 

  2. Saraf R, Morton SMB, Camargo CA, Grant CC. Global summary of maternal and newborn vitamin D status – a systematic review. Matern Child Nutr 2016;12:647–68.

    Article  PubMed  Google Scholar 

  3. Aghajafari F, Nagulesapillai T, Ronksley PE, Tough SC, O’Beirne M, Rabi DM. Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: Systematic review and meta-analysis of observational studies. BMJ 2013;346:f1169.

    Article  PubMed  Google Scholar 

  4. Zhang H, Huang Z, Xiao L, Jiang X, Chen D, Wei Y. Meta-analysis of the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss. Int J Gynecol Obstet 2017;138:242–9.

    Article  CAS  Google Scholar 

  5. Tous M, Villalobos M, Iglesias L, Fernández-Barrés S, Arija V. Vitamin D status during pregnancy and offspring outcomes: a systematic review and meta-analysis of observational studies. Eur J Clin Nutr 2020;74:36–53.

    Article  CAS  PubMed  Google Scholar 

  6. Hajizadeh S, Shary JR, Reed SG, Wagner CL. The prevalence of hypovitaminosis D and its risk factors in pregnant women and their newborns in the Middle East: A systematic review. Int J Reprod BioMed 2019;17:685–708.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Al-Musharaf S, Fouda MA, Turkestani IZ, Al-Ajlan A, Sabico S, Alnaami AM, et al. Vitamin D deficiency prevalence and predictors in early pregnancy among Arab Women. Nutrients 2018;10:489.

    Article  PubMed Central  CAS  Google Scholar 

  8. Woon FC, Chin YS, Ismail IH, Batterham M, Latiff AHA, Gan WY, et al. Vitamin D deficiency during pregnancy and its associated factors among third trimester Malaysian pregnant women. PLoS One 2019;14:e0216439.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Aji AS, Erwinda E, Yusrawati Y, Malik SG, Lipoeto NI. Vitamin D deficiency status and its related risk factors during early pregnancy: a cross-sectional study of pregnant Minangkabau women, Indonesia. BMC Pregnancy Childbirth 2019;19:183.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Cabaset S, Krieger JP, Richard A, Elgizouli M, Nieters A, Rohrmann S, et al. Vitamin D status and its determinants in healthy pregnant women living in Switzerland in the first trimester of pregnancy. BMC Pregnancy Childbirth 2019;19:10.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shen Y, Pu L, Si S, Xin X, Mo M, Shao B, et al. Vitamin D nutrient status during pregnancy and its influencing factors. Clin Nutr 2020;39:1432–9.

    Article  CAS  PubMed  Google Scholar 

  12. Neves PAR, Castro MC, Oliveira CVR, Malta MB, Lourenço BH, Cardoso MA. Effect of Vitamin A status during pregnancy on maternal anemia and newborn birth weight: results from a cohort study in the Western Brazilian Amazon. Eur J Nutr 2020;59:45–56.

    Article  CAS  PubMed  Google Scholar 

  13. Lourenço BH, Silva LLS, Fawzi WW, Cardoso MA. Vitamin D sufficiency in young Brazilian children: associated factors and relationship with vitamin A corrected for inflammatory status. Public Health Nutr 2019;23:1226–35.

    Article  PubMed  Google Scholar 

  14. Momenttia AC, Estadella D, Pisani LP. Role of vitamin D in pregnancy and Toll-like receptor pathway. Steroids 2018;137:22–29.

    Article  CAS  Google Scholar 

  15. Kiely ME, Wagner CL, Roth DE. Vitamin D in pregnancy: Where we are and where we should go. J Steroid Biochem Mol Biol 2020;201:105669.

    Article  CAS  PubMed  Google Scholar 

  16. McDonnell SL, Baggerly KA, Baggerly CA, Aliano JL, French CB, Baggerly LL, et al. Maternal 25(OH)D concentrations 40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center. PLoS One 2017;12:e0180483.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Cardoso MA, Matijasevich A, Malta MB, Lourenco BH, Gimeno SGA, Ferreira MU, et al. Cohort profile: the Maternal and Child Health and Nutrition in Acre, Brazil, birth cohort study (MINA-Brazil). BMJ Open 2020;10:e034513.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Instituto Brasileiro de Geografia e Estatística. Cidades@ | Acre | Cruzeiro do Sul | Panorama. IBGE. 2019. Accessed 20 Sep 2021.

  19. Programa das Nações Unidas para o Desenvolvimento, Instituto de Pesquisa Econômica Aplicada. Fundação João Pinheiro. Índice de Desenvolvimento Humano Municipal Brasileiro. Brasília: PNUD, Ipea, FJP. 2013. Accessed 20 Sep 2021.

  20. Lourenço BH, Lima DL, Vivanco E, Fernandes RB, Duarte M, Neves PAR, et al. Agreement between antenatal gestational age by ultrasound and clinical records at birth: A prospective cohort in the Brazilian Amazon. PLoS One 2020;15:e0236055.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data - or tears: An application to educational enrollments in states of India. Demography 2001;38:115–32.

    CAS  PubMed  Google Scholar 

  22. World Health Organization. WHO Expert Committee on Physical Status. Physical status: the use of and interpretation of anthropometry, report of a WHO expert committee. WHO, Geneva. 1995. Accessed 20 Sep 2021.

  23. De Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ 2007;85:660–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Takito MY, Neri L de CL, Benício MHD. Evaluation of the reproducibility and validity of a physical activity questionnaire for pregnant women. Rev Bras Med Esport 2008;14(2):132–8.

    Article  Google Scholar 

  25. World Health Organization . Vitamin and mineral requirements in human nutrition, 2nd ed. Geneva: WHO. 2004; p. 53. Accessed 20 Sep 2021.

  26. Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther 2010;23:48–60.

    Article  PubMed  Google Scholar 

  27. Holick MF. Vitamin D: A D-Lightful health perspective. Nutr Rev 2008;66:S182–194.

    Article  PubMed  Google Scholar 

  28. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30.

    Article  CAS  PubMed  Google Scholar 

  29. World Health Organization. Global prevalence of vitamin A deficiency in population at risk 1995-2005. WHO, Geneva. 2009. Accessed 20 Sep 2021.

  30. Thurnham DI, McCabe GP, Northrop-Clewes CA, Nestel P. Effects of subclinical infection on plasma retinol concentrations and assessment of prevalence of vitamin A deficiency: meta-analysis. Lancet 2003;362:2052–8.

    Article  CAS  PubMed  Google Scholar 

  31. Victora CG, Huttly SR, Fuchs SC, Olinto MTA. The role of conceptual frameworks in epidemiological analysis: A hierarchical approach. Int J Epidemiol 1997;26:224–7.

    Article  CAS  PubMed  Google Scholar 

  32. StataCorp. Stata: Release 15. Statistical Software. College Station, TX: StataCorp LLC. 2017.

  33. Figueiredo ACC, Cocate PG, Adegboye ARA, Franco-Sena AB, Farias DR, de Castro MBT, et al. Changes in plasma concentrations of 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D during pregnancy: a Brazilian cohort. Eur J Clin Nutr 2017;57:1059–72.

    Article  CAS  Google Scholar 

  34. Vinkhuyzen AAE, Eylesa DW, Burnea TH, Blanken LME, Kruithof CJ, Verhulst F, et al. Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: The Generation R Study. J Steroid Biochem Mol Biol 2016;164:161–7.

    Article  CAS  PubMed  Google Scholar 

  35. Luxwolda MF, Kuipers RS, Kema IP, van der Veer E, Dijck-Brouwer DA, Muskiet FA. Vitamin D status indicators in indigenous populations in East Africa. Eur J Nutr 2013;52:1115–25.

    Article  CAS  PubMed  Google Scholar 

  36. United Nations Development Program. Human Development Report. UNDP. 2015. Accessed 20 Sep 2021.

  37. Dominguez-Salas P, Alarcón P, Häsler B, Dohoo IR, Colverson K, Kimani-Murage EW, et al. Nutritional characterisation of low-income households of Nairobi: socioeconomic, livestock and gender considerations and predictors of malnutrition from a cross-sectional survey. BMC Nutr 2016;2:47.

    Article  Google Scholar 

  38. Mohammadi-Nasrabadi F, Abdolahi M, Ghodsi D, Hoshiar-Rad A, Rezvani V, Ghafarpour M, et al. Do Iranian female-headed households have lower socio-economic and nutritional status compared to male-headed ones? Nutr Food Sci Res 2015;2:13–22.

    CAS  Google Scholar 

  39. Pratumvinit B, Wongkrajang P, Wataganara T, Hanyongyuth S, Nimmannit A, Chatsiricharoenkul S, et al. Maternal vitamin D status and its related factors in pregnant women in Bangkok, Thailand. PLoS One 2015;10:e0131126.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Lee CL, Ng BK, Wu LL, Cheah FC, Othman H, Ismail NAM. Vitamin D deficiency in pregnancy at term: Risk factors and pregnancy outcomes. Horm Mol Biol Clin Investig 2017;31:20170005.

    CAS  Google Scholar 

  41. Souza JRJL, Silva TSA, Figueredo ED. Hipovitaminose D na gestação: Um problema de saúde pública? Rev Bras Saúde Mater Infant 2019;19:207–15.

    Google Scholar 

  42. Linos E, Keiser E, Kanzler M, Sainani KL, Lee W, Vittinghoff E, et al. Sun protective behaviors and vitamin D levels in the US population: NHANES 2003–2006. Cancer Causes Control 2012;23:133–40.

    Article  PubMed  Google Scholar 

  43. Mehta S, Spiegelman D, Aboud S, Giovannucci EL, Msamanga GI, Hertzmark E, et al. Lipid-soluble vitamins A, D, and E in HIV-infected pregnant women in Tanzania. Eur J Clin Nutr 2010;64:808–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Shumutz EA, Zimmermann MB, Rohrmann S. The inverse association between serum 25‑hydroxyvitamin D and mortality may be modified by vitamin A status and use of vitamin A supplements. Eur J Nutr 2016;55:393–402.

    Article  CAS  Google Scholar 

  45. Sha J, Pan J, Ping P, Xuan H, Li D, Bo J, et al. Synergistic effect and mechanism of vitamin A and vitamin D on inducing apoptosis of prostate cancer cells. Mol Biol Rep. 2013;40:2763–8.

    Article  CAS  PubMed  Google Scholar 

  46. Carazo A, Macáková K, Matoušová K, Krčmová LK, Protti M, Mladěnka P. Vitamin A update: Forms, sources, kinetics, detection, function, deficiency, therapeutic use and toxicity. Nutrients 2021;13:1703.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Neves PAR, Campos CAS, Malta MB, Lourenço BH, Castro MC, Cardoso MA. Predictors of vitamin A status among pregnant women in Western Brazilian Amazon. Br J Nutr 2019;121:202–11.

    Article  CAS  PubMed  Google Scholar 

  48. Santos Q, Sichieri R, Marchioni DML, Junior EV. Brazilian pregnant and lactating women do not change their food intake to meet nutritional goals. BMC Pregnancy Childbirth 2014;14:186.

    Article  PubMed  PubMed Central  Google Scholar 

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The authors thank all the participants and health professionals involved in the study, as well as the State Health Secretariat of Acre, the Municipal Health Secretariat, the Primary Health Care Units of Cruzeiro do Sul.


This work is part of the MINA-Brazil Study, which was funded by the São Paulo Research Foundation (FAPESP grant 2016/00270-6; PI: MAC) and the Brazilian National Council for Scientific and Technological Development (CNPq grant 407255/2013-3; PI: MAC). CZR and TCC received scholarships from the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES Finance Code 001). MAC is recipient of a senior research scholarship from CNPq. Organisations involved in the financial support of this work had no role in the design, analysis, or writing of this article.

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Authors and Affiliations




CZR, TCC, and BHL conceived the analytical framework and performed the statistical analysis. PARN, MBM, MAC, and BHL participated in data collection and field overseen. MAC and BHL conceived the study design and methods. MAC was responsible for funding acquisition and project administration. CZR and TCC wrote the first draft of the paper, with critical appraisal by BHL. All authors reviewed and approved the final version of the paper.

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Correspondence to Bárbara Hatzlhoffer Lourenço.

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The authors declare no competing interests.

Ethical approval

This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving participants were approved by the Institutional Review Board of the School of Public Health of the University of São Paulo (protocol number 872.613/2014). Written informed consent was obtained from all participants. In case of teenage pregnancies, the adolescent’s legal guardian provided consent.

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Rodrigues, C.Z., Correia, T.C., Neves, P.A.R. et al. Predictors of 25-hydroxyvitamin D concentrations during pregnancy: A longitudinal analysis in the Brazilian Amazon. Eur J Clin Nutr 76, 1281–1288 (2022).

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