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Updated: Apr 18, 2026
Author Spotlight: Studying the Impact of Maternal Dietary Deficiencies on Long-Term Offspring Health Outcomes
Published on: June 28, 2024
Early-pregnancy vitamin D deficiency and risk of preterm birth subtypes
Lisa M Bodnar1, Robert W Platt, Hyagriv N Simhan
1Department of Epidemiology, Graduate School of Public Health, and the Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of Pittsburgh, and Magee-Womens Research Institute, Pittsburgh, Pennsylvania; and the Departments of Pediatrics and Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Insights
Maternal vitamin D sufficiency is linked to a reduced risk of preterm birth. Higher vitamin D levels in pregnant individuals may help prevent premature delivery, warranting further clinical trials.
Area of Science:
- Obstetrics and Gynecology
- Nutritional Science
- Perinatal Epidemiology
Background:
- Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide.
- Maternal micronutrient status, particularly vitamin D, is increasingly recognized for its role in pregnancy outcomes.
- Understanding the relationship between 25-hydroxyvitamin D (25(OH)D) and preterm birth subtypes is crucial for developing preventative strategies.
Purpose of the Study:
- To investigate the association between maternal serum 25-hydroxyvitamin D concentrations and the risk of preterm birth.
- To examine this association across different subtypes of preterm birth, including spontaneous and indicated, and at different gestational age thresholds.
Main Methods:
- A case-cohort study was conducted using data from 12,861 eligible women delivering singleton neonates.
- Serum 25(OH)D levels were measured using liquid chromatography-tandem mass spectrometry.
- Multivariable log-binomial regression models were employed to assess the association between vitamin D status and preterm birth, adjusting for potential confounders.
Main Results:
- The incidence of preterm birth (<37 weeks) was inversely associated with maternal 25(OH)D levels, with significantly lower rates observed in women with levels ≥75 nmol/L compared to those <50 nmol/L.
- Adjusted analyses revealed a significant decrease in preterm birth risk as 25(OH)D increased up to approximately 90 nmol/L, after which the risk plateaued.
- Similar protective associations were observed for spontaneous and indicated preterm births, as well as for very preterm births (<34 weeks).
Conclusions:
- Maternal vitamin D sufficiency demonstrates a protective association against preterm birth.
- These findings, combined with existing data, support the rationale for randomized clinical trials evaluating vitamin D supplementation to prevent preterm birth.
- Optimizing maternal vitamin D status may be a viable strategy to reduce the incidence of preterm birth.
Objective:
To estimate the association between maternal 25-hydroxyvitamin D concentrations and risk of preterm birth subtypes.
Methods:
We performed a case-cohort study using data and banked samples from patients at a teaching hospital in Pittsburgh, Pennsylvania. Eligible participants were women with a prenatal aneuploidy screening serum sample at or before 20 weeks of gestation who subsequently delivered a singleton, liveborn neonate. Of the 12,861 eligible women, we selected 2,327 at random as well as all remaining preterm birth cases for a total of 1,126 cases. Serum 25-hydroxyvitamin D was measured using liquid chromatography-tandem mass spectrometry. Multivariable log-binomial regression models were used to estimate associations between maternal vitamin D status and preterm birth at 37 weeks of gestation (separately by spontaneous or indicated) and preterm birth at less than 34 weeks of gestation.
Results:
The incidence of preterm birth at less than 37 weeks of gestation was 8.6% overall and 11.3%, 8.6%, and 7.3% among mothers with serum 25-hydroxyvitamin D less than 50, 50-74.9, and 75 nmol/L or greater, respectively (P<.01). After adjustment for maternal race and ethnicity, prepregnancy body mass index, season, smoking, and other confounders, the risk of preterm birth at less than 37 weeks of gestation significantly decreased as 25-hydroxyvitamin D increased to approximately 90 nmol/L and then plateaued (test of nonlinearity P<.01). Results were similar when limiting to cases that were medically indicated or occurred spontaneously and cases occurring at less than 34 weeks of gestation.
Conclusion:
Our data support a protective association maternal vitamin D sufficiency and preterm birth that combined with extant epidemiologic data may provide justification for a randomized clinical trial of maternal vitamin D replacement or supplementation to prevent preterm birth.
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