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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.


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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.

Corresponding author

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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