Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis

Abstract

Objective: To estimate the associations between maternal vitamin D status and adverse pregnancy outcomes.

Study design: We searched electronic databases of the human literature in PubMed, EMBASE and the Cochrane Library up to October, 2012 using the following keywords: “vitamin D” and “status” or “deficiency” or “insufficiency” and “pregnancy”. A systematic review and meta-analysis were conducted on observational studies that reported the association between maternal blood vitamin D levels and adverse pregnancy outcomes including preeclampsia, gestational diabetes mellitus (GDM), preterm birth or small-for-gestational age (SGA).

Results: Twenty-four studies met the inclusion criteria. Women with circulating 25-hydroxyvitamin D [25(OH)D] level less than 50?nmol/l in pregnancy experienced an increased risk of preeclampsia [odds ratio (OR) 2.09 (95% confidence intervals 1.50–2.90)], GDM [OR 1.38 (1.12–1.70)], preterm birth [OR 1.58 (1.08–2.31)] and SGA [OR 1.52 (1.08–2.15)].

Conclusion: Low maternal vitamin D levels in pregnancy may be associated with an increased risk of preeclampsia, GDM, preterm birth and SGA.     

Association between vitamin D status and hyperinsulinism

Abstract

Aims: Some studies have suggested that vitamin D deficiency is associated with an increased risk of first trimester miscarriages, others have suggested that it is associated with an increased risk of hyperinsulinism/insulin resistance and the development of gestational diabetes. Hyperinsulinism is also thought to increase miscarriages. We investigated the association between vitamin D levels and hyperinsulinism in a cohort of recurrent miscarriage patients.

Methods: Patients undergoing miscarriage investigations had insulin and vitamin D levels tested. Vitamin D levels were classified as: sufficient (≥75?nmol/L), insufficient (50–74.9?nmol/L) or deficient (<50?nmol/L). Hyperinsulinism was assessed via a 75?g oral glucose tolerance test (OGTT) with insulin studies.

Results: One hundred and fifty-five patients underwent the testing. Hyperinsulinism was detected in 58.3% of the vitamin D deficient group, 38.7% of the insufficient group, and 33.3% of the sufficient group (chi-square p?=?.034). There were no significant associations between BMI and vitamin D levels, or BMI and hyperinsulinism. Caucasians comprised 82% of the clinic, and 67% of these women had vitamin D insufficiency/deficiency. Noncaucasians comprised 18% of the clinic but 89% of these patients had vitamin D insufficiency/deficiency.

Discussion: We found that insufficient or deficient vitamin D levels were significantly associated with hyperinsulinism in these patients. Vitamin D deficiency is also thought to contribute to an increased risk of adverse pregnancy outcomes including preeclampsia, preterm birth, small-for-gestational-age gestational diabetes mellitus, and miscarriages. Larger level one trials are needed to establish if increasing serum vitamin D levels prior to conception or in early pregnancy improves adverse pregnancy outcomes.     

Role of vitamin D in influencing angiogenesis in preeclampsia

ABSTRACT

Objective: Vitamin D plays a key role during pregnancy and is involved in implantation and maintenance of pregnancy. Its deficiency is associated with pregnancy complications like preeclampsia, characterized by abnormal angiogenesis.Method: The current article summarises studies examining the role of vitamin D in pregnancy, with special emphasis on preeclampsia.Results and conclusion: An imbalance in pro- and anti-angiogenic factors is reported in women with preeclampsia. Cell culture studies have demonstrated that vitamin D can influence the process of angiogenesis. However, the role of maternal vitamin D in influencing placental angiogenesis in preeclampsia is unclear and needs to be explored.     

Maternal Vitamin D Status as a Critical Determinant in Gestational Diabetes

ObjectiveTo synthesize published research to determine the evidence for the association between maternal vitamin D status during pregnancy and the development of gestational diabetes mellitus (GDM).Data SourcesLiterature searches were conducted for data based articles that examined maternal vitamin D during pregnancy, GDM, glucose tolerance, and insulin resistance using the PubMed, CINAHL, and SCOPUS data bases and reference lists from reviewed papers.Study SelectionPrimary research studies published in the English language between 1999 and 2011 reporting findings regarding the association of vitamin D with glucose homeostasis during pregnancy and GDM.Data ExtractionStudy characteristics and findings related to vitamin D status determinants, gestational timing, and measures of glucose homeostasis and insulin resistance.Data SynthesisSix data based articles met the criteria for study inclusion. Study findings comprised solely Level‐2 evidence for the association of maternal vitamin D deficiency and risk of GDM. The majority of studies (66%) were conducted between 24 and 30 weeks gestation. Five (83%) studies reported an inverse relationship between circulating vitamin D levels and markers of glucose homeostasis associated with gestational diabetes or an increased risk for GDM associated with reduced maternal levels of vitamin D. In one study, researchers did not identify an association between vitamin D and GDM but did identify an association between higher vitamin D levels and lower fasting glucose and insulin levels.ConclusionMaternal vitamin D deficiency and insufficiency is prevalent among gravid women and is associated with markers of altered glucose homeostasis. These findings underscore the need for mechanistic and clinical studies to determine optimal vitamin D status in pregnancy for reduction in the risk for GDM with implications for vitamin D supplementation as a potential target for GDM prevention.     

Prevalence of vitamin D deficiency in pregnant mothers in Tehran and investigating its association with serum glucose and insulin

Purpose: (1) To determine the prevalence of vitamin D deficiency in pregnant women. (2) To identify any correlations between maternal vitamin D levels and maternal and newborns’ glucose and insulin levels.

Methods: This observational cohort study followed 149 healthy pregnant women visiting a hospital in Tehran, Iran in 2014 until the delivery of their term babies. Maternal serum vitamin D levels, and fasting blood glucose and insulin levels in both mothers and newborns were measured at delivery. Mothers’ weight before pregnancy and right before delivery and babies’ birth weight were measured.

Results: Of sample population, 27% had vitamin D deficiency, while 73% had insufficient vitamin D. No mother had sufficient vitamin D level. Maternal weight right before delivery negatively correlated with maternal serum vitamin D level (p?=?.04). Vitamin D deficiency is more prevalent in mothers who deliver a male infant (p?=?.03). Maternal serum vitamin D levels did not correlate with maternal or neonatal serum glucose or insulin levels or newborns’ birth weight. Gestational age, maternal weight right before delivery, parity and maternal serum glucose predict infant’s birth weight.

Conclusion: Vitamin D deficiency/insufficiency is prevalent among pregnant women. Factors causing this epidemic need investigation. Promoting consumption of vitamin D-fortified foods and supplements among pregnant women is suggested.     

Association between vitamin D deficiency and antepartum and postpartum depression: a systematic review and meta-analysis of longitudinal studies

Purpose

The two previous reviews performed on the association of vitamin D deficiency in pregnancy with antepartum and postpartum depression were limited in reporting forms as they were both systematic reviews and the conclusions were also deemed to be inconclusive. Considering the high prevalence of vitamin D deficiency and depression during and after pregnancy as well as their numerous hazards to pregnancy outcomes, it is of great need to synthesize existing evidence in a more accurate statistical method, so that reliable guidance related to vitamin D supplementation during pregnancy could be provided for clinical decision making.

Methods

We performed a systematic review and meta-analysis to investigate the association of vitamin D deficiency with antepartum and postpartum depression.

Results

Nine longitudinal studies with 8470 participants were included in the meta-analysis. We found serum 25(OH)D levels?<?50 nmol/l was associated with 2.67 times (OR 3.67; 95% CI 1.72–7.85) increased risk of postpartum depression than those 25(OH)D levels?≥?50 nmol/l, but we did not find a significant association between low vitamin D levels and depressive symptoms during pregnancy with a serum 25(OH)D cut-off level of 30 nmol/l (OR 1.47; 95% CI 0.92–2.36).

Conclusions

The low status of maternal vitamin D could be an adverse factor for postpartum depression, but the available evidence suggested no association between vitamin D deficiency and depressive symptoms during pregnancy. However, this result should be interpreted with caution owning to the small number of studies. Well-designed intervention studies are also needed to further evaluate the benefits of vitamin D supplementation during pregnancy.

     

Maternal Vitamin B12 Levels During Pregnancy and Their Effects on Maternal Neurocognitive Symptoms: A Systematic Review

ObjectiveVitamin B₁₂ deficiency has been linked to neurocognitive symptoms. Vitamin B₁₂ deficiency in pregnancy may be associated with antenatal or postpartum depression along with other neurocognitive symptoms including restless leg syndrome. The objective of this study was to systematically review the literature regarding vitamin B₁₂ deficiency and insufficiency in pregnancy and its effects on maternal neurocognitive symptoms.Data SourcesMEDLINE, Embase, and SCOPUS were searched from inception to October, 2020.Study SelectionObservational studies and randomized controlled trials of singleton pregnancies involving vitamin B₁₂ deficiency and reporting maternal neurocognitive outcomes were identified.Data Extraction and SynthesisData were synthesized and are presented narratively.ConclusionsThe 5 studies included in the analysis did not demonstrate a statistically significant link between vitamin B₁₂ deficiency or insufficiency and either restless leg syndrome or depression in pregnancy. To date, evidence is lacking that would support a causal link between suboptimal vitamin B₁₂ serum levels and maternal restless leg syndrome or depression.     

Vitamin D Status in Mothers and Their Newborns and Its Association with Pregnancy Outcomes: Experience from a Tertiary Care Center in Northern India

Objective

Study was planned to know vitamin D status in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcome. Study design: Two hundred consecutive pregnant women with singleton pregnancy admitted to the labor ward of a tertiary care center were recruited for the study. Maternal and cord blood samples were taken and analyzed for 25(OH) D level. Maternal and fetal outcomes were studied.

Results

High prevalence of hypovitaminosis D was found among pregnant women. Eighty-six percentage had vitamin D deficiency, 9.5% had insufficiency, and only 4.5% had sufficient vitamin D level. Women with preeclampsia had statistically significant vitamin D deficiency and insufficiency as compared to patients who had normal blood pressure levels (p = 0.04). Cesarean section rate was significantly higher in patients with vitamin D deficiency and insufficiency compared to sufficient group (p = 0.004). Cord blood 25(OH) D levels strongly correlated with maternal serum 25 (OH) D levels (p = 0.001, correlation coefficient r = 0.84).

Conclusions

This study showed a very high prevalence of hypovitaminosis D among pregnant women and excellent correlation between maternal and fetal 25(OH) D levels. Hypovitaminosis D was associated with preeclampsia, increased Cesarean rate, and low birth weight babies.

     

First trimester maternal serum vitamin D and markers of preeclampsia

Abstract

Objective: There is evidence that vitamin D deficiency is associated with preeclampsia. The aim of the study was to determine if maternal levels of vitamin D at 1st trimester were related to markers of preeclampsia.

Material: Serum levels of 25-hydroxy-vitamin D (25OHD), PAPP-A, PlGF, uterine artery pulsatility index and mean arterial pressure were measured in 280 pregnant women.

Results: Preeclampsia markers were not related to 25OHD concentration.

Conclusion: First trimester maternal serum concentration of vitamin D does not seem to be connected with markers of preeclampsia.     

Seasonal Variation of Maternal Serum Vitamin D in Newfoundland and Labrador

BackgroundResearch has suggested that vitamin D insufficiency and deficiency is common at northern latitudes, and that vitamin D insufficiency and deficiency may be common during pregnancy. We measured the serum 25-hydroxyvitamin D (25-[OH]D) status of pregnant women across the province of Newfoundland and Labrador in both summer and winter to investigate seasonal differences, age associations, and differences in geospatial distribution across the province.MethodsWe uniformly and randomly sampled blood from pregnant women in each of 79 census consolidated subdivisions across Newfoundland and Labrador from January to March 2007 and from July to September 2007.ResultsWe obtained 304 samples from the end of winter (March) and 289 samples from the end of summer (September). Mean serum 25-(OH)D concentration was 52.1 nmol/L in winter and 68.6 nmol/L in summer (P < 0.001); 89% were vitamin D insufficient in the winter and 64% in the summer (P < 0.001); 6.6% were vitamin D deficient in winter and 1.7% in summer (P = 0.003), and younger women tended to be more vitamin D insufficient in the winter than older women. The geospatial distribution of vitamin D insufficiency tends to follow a north-south distribution in the winter.ConclusionsA significant proportion of pregnant women in Newfoundland and Labrador are vitamin D insufficient. Vitamin D insufficiency may have important adverse health consequences for both the mother and the fetus. Further study is necessary to address health outcomes and effects of vitamin D supplementation and lifestyle changes in this population.     

Maternal and cord blood cyclophilin A in severe preeclampsia and normal pregnancy and its correlation with vitamin D and zinc

Objective: To investigate maternal and cord blood cyclophilin A level in severe preeclampsia compared with normal pregnancy and its correlation with vitamin D and zinc level.

Methods: We conducted a cross-sectional observational study of pregnant women who gave birth in Cipto Mangunkusumo Hospital between January and April 2014.

Results: Thirty-nine subjects were included. Subjects with severe preeclampsia have higher serum cyclophilin A levels compared with normotensive pregnancy (1299.60 vs. 1039.50; p 0.017). Maternal cyclophilin A, vitamin D, and zinc correlation were not statistically significant (p 0.189 & p 0.853).

Conclusion: Cyclophilin A levels in severe preeclampsia is higher compared to normal pregnancy. There is no correlation between cyclophilin A, zinc, and vitamin D.     

Systematic review and meta-analysis of Spanish studies regarding the association between maternal 25-hydroxyvitamin D levels and perinatal outcomes

Abstract

Objective: This systematic review and meta-analysis of Spanish studies assessed the association of maternal 25-hydroxyvitamin D [25(OH)D] levels on perinatal outcomes.

Methods: PubMed, Cochrane Library, Embase, Scielo, Scopus, and Web of Science research databases were searched from inception through December 30 2017 using the terms ‘vitamin D’, ‘pregnancy’, and ‘Spain’. Studies that compared first or second half of pregnancy normal 25(OH)D (≥30.0?ng/mL) versus insufficient (20.0–29.9?ng/mL) or deficient (<20.0?ng/mL) circulating levels and perinatal outcomes were systematically extracted. Data are presented as pooled odds ratios and their 95% confidence intervals (CIs) for categorical variables or mean differences and CIs for continuous variables. Risk of bias was evaluated with the Newcastle–Ottawa Scale.

Results: Five cohort studies met inclusion criteria. The risk of gestational diabetes mellitus, preeclampsia, preterm birth, and small-for-gestational-age infants, and birthweight was not influenced by first half of pregnancy maternal 25(OH)D levels. In addition, second half of pregnancy 25(OH) levels did not affect birthweight.

Conclusion: Maternal 25(OH)D levels during pregnancy did not affect studied perinatal outcomes and birthweight.     

Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy

Background: Vitamin D may influence pregnancy and infant outcomes, especially infant respiratory health. This study aimed to examine vitamin D status in pregnant women with asthma, and whether higher vitamin D levels are associated with fewer adverse respiratory outcomes in their infants.

Methods: Pregnant women with asthma, recruited from John Hunter Hospital Newcastle Australia (latitude 33°S), had serum total 25-hydroxyvitamin-D (25(OH)D) measured at 16 and 35 weeks gestation. Infant respiratory outcomes were collected at 12 months by parent-report questionnaire. Mother–infant dyads were grouped by serum 25(OH)D during pregnancy: 25(OH)D?Results: In 52 pregnant women with asthma, mean serum 25(OH)D levels were 61 (range 26–110) nmol/L at 16 weeks, and 65 (range 32–116) nmol/L at 35 weeks, gestation. Thirty-one (60%) women had 25(OH)D?p?=?.04). Infant acute-care presentations (45 versus 13%, p?=?.02) and oral corticosteroid use (26 versus 4%, p?=?.03) due to “asthma/wheezing” were higher in the maternal group with 25(OH)D?Conclusions: Most pregnant women with asthma had low vitamin D status, which persisted across gestation. Low maternal vitamin D status was associated with greater risk of adverse respiratory outcomes in their infants, a group at high risk of developing childhood asthma.     

Evidence of an Association Between Vitamin D Deficiency and Preterm Birth and Preeclampsia: A Critical Review

Vitamin D deficiency has been associated with adverse pregnancy and birth outcomes such as increased risk for preterm birth and preeclampsia. This state of the science review analyzed recently published meta‐analyses and relevant studies that have evaluated the association between vitamin D deficiency and preeclampsia or preterm birth. The results suggest that a positive association between vitamin D deficiency and preterm birth exists. However, the findings of the relationship between vitamin D deficiency and preeclampsia were inconclusive, possibly because of the need for supplementation to occur prior to placentation. This may be because of a lack of studies with ethnic minority populations, who are more likely to experience vitamin D deficiency, and inadequate supplementation doses used for treatment of vitamin D deficiency. Health care providers should screen pregnant women at risk for vitamin D deficiency and supplement women accordingly based on their vitamin D status. Lastly, well‐designed and standardized clinical trials need to include large cohorts of minority pregnant women to establish the impact of vitamin D supplementation on improving preterm birth and preeclampsia risk in pregnancy.     

Association of vitamin D level and vitamin D deficiency with risk of preeclampsia: A systematic review and updated meta-analysis

Objectives

Because of the immune modulatory effects of vitamin D3 in preeclampsia, we intend to have a systematic review and meta-analysis on association of both 25-hydroxy vitamin D (25-OHD) level (parametric approach) and 25-OHD deficiency (non-parametric approach) with preeclampsia. As well, for the parametric part, we used receiver operating characteristic (ROC) curve model.

Is first trimester vitamin D status in nulliparous women associated with pregnancy related hypertensive disorders?

Objectivesthis study aimed to explore if maternal vitamin D status in early pregnancy was associated with pre-eclampsia and pregnancy-induced hypertension. Relationships between vitamin D status and blood pressure at the start of pregnancy as well as the occurrence of a mid-pregnancy drop in blood pressure were also explored. This secondary analysis was completed to investigate a possible mechanism for the association between vitamin D status and pregnancy related hypertensive disorders.Design and settingdata were obtained from the Amsterdam Born Children and their Development study, a prospective community-based cohort study based in Amsterdam, The Netherlands.Participantsa total of 2074 nulliparous women without pre-existing hypertension and with a known vitamin D status before 17 weeks gestation were included in the study. Vitamin D status was categorized into four groups: “normal” (≥50 nmol/L), “insufficient” (30–49.9 nmol/L) “deficient” (20–29.9 nmol/L) or “severely deficient” (<20 nmol/L).Measurementslogistic regression analysis was used to investigate if vitamin D status was related to the odds of experiencing pre-eclampsia or pregnancy-induced hypertension. Models were corrected for maternal age, ethnicity, pre-pregnancy BMI, smoking and socioeconomic status. χ² and ANOVA tests were used to investigate relationships between vitamin D status and the blood pressure parameters.Findingswhen compared to women with a normal vitamin D status, women who were severely deficient had an increased risk for pre-eclampsia (OR 2.08; 95% CI, 1.05–4.13), but the association was rendered non-significant after correction (OR 1.88; 95% CI 0.79–4.48). There were no associations between vitamin D status and pregnancy-induced hypertension, starting blood pressure or the occurrence of a mid-pregnancy drop in blood pressure.Key conclusionsno strong evidence was found for an association between first trimester vitamin D status and pregnancy related hypertensive disorders in nulliparous women.Implications for practiceat this time, vitamin D supplementation is not warranted for the specific purpose of preventing pregnancy related hypertensive disorders.     

Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

Background

Adequate vitamin D concentrations during pregnancy are necessary to neonatal calcium homeostasis, bone maturation and mineralization. The aim of study is to evaluate serum vitamin D concentrations in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcomes.

Methods

552 pregnant women were recruited from Tehran University educating hospitals in the winter of 2002. Maternal and cord blood samples were taken at delivery. The serum was assayed for 25-hydroxyvitamin D3, calcium, phosphorus and parathyroid hormone.

Results

The prevalence of vitamin D deficiency in maternal and cord blood samples were 66.8% and 93.3%, respectively (<35 nmol/l). There was significant correlation between maternal and cord blood serum concentrations of vitamin D. In mothers with vitamin D deficiency, cord blood vitamin D concentrations was lower than those from normal mothers (P = .001). Also, a significant direct correlation was seen between maternal vitamin D intake and weight gain during pregnancy.

Conclusion

Consideration to adequate calcium and vitamin D intake during pregnancy is essential. Furthermore, we think it is necessary to reconsider the recommendation for vitamin D supplementation for women during pregnancy.     

The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity

Background: The Mediterranean diet (MD) is associated with decreased risk of metabolic syndrome and gestational diabetes due to the anti-inflammatory and antioxidative properties of its components. The aim was to investigate the potential association of MD adherence (MDA) during pregnancy by mothers delivering prematurely, with intrauterine growth as expressed by neonates’ anthropometry at birth and complications of prematurity.

Participants and methods: This is a single-center, prospective, observational cohort study of 82 women who delivered preterm singletons at post conceptional age (PCA)?≤?34 weeks and their live-born neonates. Maternal and neonatal demographic and clinical data were recorded. All mothers filled in a food frequency questionnaire, and the MDA score was calculated. Based on 50th centile of MD score, participants were classified into high-MDA and low-MDA groups.

Results: The low-MDA mothers had significantly higher pregestational BMI and rates of overweight/obesity (odd ratios (OR) 3.5) and gestational hypertension/preeclampsia (OR 3.8). Neonates in the low-MDA group had significantly higher incidence of intrauterine growth restriction (IUGR) (OR 3.3) and lower z-scores of birth weight and BMI. Regarding prematurity-related complications, the low MDA-group was more likely to develop necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity (OR 3.2, 1.3, and 1.6, respectively), while they were less likely to develop respiratory distress syndrome (OR 0.49), although the differences were not statistically significant. However, adjustment for confounders revealed MDA as a significant independent predictor of hypertension/preeclampsia, IUGR, birth weight z-score, necrotizing enterocolitis, and bronchopulmonary dysplasia.

Conclusions: High MDA during pregnancy may favorably affect intrauterine growth and certain acute and chronic complications of prematurity as well as maternal hypertension/preeclampsia.     

Maternal Vitamin D Levels During Pregnancy and Their Effects on Maternal–Fetal Outcomes: A Systematic Review

To synthesize and critically review the current evidence available on maternal vitamin D deficiency and its effects on maternal–fetal outcomes, this study reviewed the maternal–fetal outcomes, including prolonged labour or cesarean delivery, preeclampsia, gestational diabetes, low birth weight and small for gestational age, and preterm birth. An extensive systematic searched was performed in Medline and EMBASE, where a medical subject heading (MeSH) was used with terms “Vitamin D/25(OH)D” and “pregnancy/fetal outcomes”; these terms were combined with “and.” In Web of Science and Google Scholar, a key word search was used. Nineteen articles were included for full review. This review found that the current state of the evidence is equivocal for maternal–fetal outcomes such as the risk of prolonged labour and cesarean delivery, gestational diabetes, low birth weight and small for gestational age, and preterm birth. Although some previous studies have found improvement in pregnancy outcomes with sufficient vitamin D levels, others have not shown any association with the aforementioned outcomes. This systematic review also highlights an association between the risk of preeclampsia and maternal vitamin D levels that is found to be consistent among studies.     

Association between maternal circulating 25 hydroxyvitamin D concentration and placental volume in the first trimester

Objectives: We aimed to assess placental volume and placental mean gray value in vitamin D deficiency and healthy placentas in the first trimester of pregnancy using three-dimensional (3D) ultrasonography (USG) and Virtual Organ Computer-aided Analysis (VOCAL).

Methods: This prospective cross sectional study comprised 274 patients, divided into two groups according to the presence or absence of vitamin D deficiency (<20?ng/ml deficient, n?=?153, >20?ng/ml not deficient, n=?121) in the first trimester of pregnancy. Placental volume and placental volumetric mean gray values were evaluated. Placental volume (cm³) was analyzed using the VOCAL imaging program and a 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Placental volume was significantly less in the vitamin D deficiency group (p?=?0.017) Volumetric mean gray value of the placenta was significantly higher in the vitamin D deficiency group (p=?0.003). Maternal serum PAPP-A (MoM) and f-β Hcg (MoM) were significantly lower in the vitamin D deficiency group (p=?0.008, p?=?0.003, respectively). In linear regression analyses, serum vitamin D concentration was significantly associated with the plasental volume (β?=?0.16; p?=?0.01).

Conclusion: Placental configuration and development were associated with vitamin D even in the first trimester of pregnancy. To ensure healthy pregnancy outcomes, vitamin D screening applied in the early stages of pregnancy or even before pregnancy.