title: Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review.
abstract: Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Karras
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece.
authors.forename: S A
authors.initials: SA
authors.lastname: Paschou
authors.affiliation: Department of Endocrinology, Diabetes and Metabolism, Red Cross Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Kandaraki
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Anagnostis
authors.affiliation: Department of Geriatric Medicine, UPRES EA 4638, University Hospital, Angers, France.|Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Annweiler
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece.
authors.forename: B C
authors.initials: BC
authors.lastname: Tarlatzis
authors.affiliation: Medical University of South Carolina Children's Hospital, Charleston, SC, USA.
authors.forename: B W
authors.initials: BW
authors.lastname: Hollis
authors.affiliation: Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Grant
authors.affiliation: Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, 'Papageorgiou' General Hospital, Thessaloniki, Greece.
authors.forename: D G
authors.initials: DG
authors.lastname: Goulis
mesh_terms: D005260:Female; D006801:Humans; D019083:Mediterranean Region; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000453:epidemiology / Q000209:etiology*
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D