Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

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Abstract

Background

Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis.

Methods

Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women.

Results

The random effects combined estimate was 32.35% (95% CI, (12.58–117.48). High heterogeneity (tau ² = 0.39, I ² = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54( P = 0.01).

Conclusion

Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

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Most cited references 57

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Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

Michael F Holick, Neil C Binkley, Heike A Bischoff-Ferrari … (2011)

The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.

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Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement.

Damian Hoy, Peter Brooks, Anthony Woolf … (2012)

In the course of performing systematic reviews on the prevalence of low back and neck pain, we required a tool to assess the risk of study bias. Our objectives were to (1) modify an existing checklist and (2) test the final tool for interrater agreement. The final tool consists of 10 items addressing four domains of bias plus a summary risk of bias assessment. Two researchers tested the interrater agreement of the tool by independently assessing 54 randomly selected studies. Interrater agreement overall and for each individual item was assessed using the proportion of agreement and Kappa statistic. Raters found the tool easy to use, and there was high interrater agreement: overall agreement was 91% and the Kappa statistic was 0.82 (95% confidence interval: 0.76, 0.86). Agreement was almost perfect for the individual items on the tool and moderate for the summary assessment. We have addressed a research gap by modifying and testing a tool to assess risk of study bias. Further research may be useful for assessing the applicability of the tool across different conditions. Copyright © 2012 Elsevier Inc. All rights reserved.

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Global vitamin D status and determinants of hypovitaminosis D.

A Mithal, D Wahl, J-P Bonjour … (2009)

This review describes the vitamin D status in different regions of the world with the objective of understanding the scope of hypovitaminosis D and the factors related to its prevalence that may contribute to the pathogenesis of osteoporosis and fragility fractures. Vitamin D status has been linked to the pathogenesis of hip fractures as well as other skeletal and non-skeletal disorders. The purpose of this review is to provide a global perspective of vitamin D status across different regions of the world and to identify the common and significant determinants of hypovitaminosis D. Six regions of the world were reviewed-Asia, Europe, Middle East and Africa, Latin America, North America, and Oceania-through a survey of published literature. The definition of vitamin D insufficiency and deficiency, as well as assay methodology for 25-hydroxyvitamin D or 25(OH)D, vary between studies. However, serum 25(OH)D levels below 75 nmol/L are prevalent in every region studied whilst levels below 25 nmol/L are most common in regions such as South Asia and the Middle East. Older age, female sex, higher latitude, winter season, darker skin pigmentation, less sunlight exposure, dietary habits, and absence of vitamin D fortification are the main factors that are significantly associated with lower 25(OH)D levels. Reports from across the world indicate that hypovitaminosis D is widespread and is re-emerging as a major health problem globally.

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Author and article information

Contributors

Angeline Jeyakumar: angelinejaykumar@gmail.com , angejp@unipune.ac.in

Vidhya Shinde: vidya.shinde722@gmail.com

Reshma Ravindran: ravi.rechu@gmail.com

Journal

Journal ID (nlm-ta): J Health Popul Nutr

Journal ID (iso-abbrev): J Health Popul Nutr

Title: Journal of Health, Population, and Nutrition

Publisher: BioMed Central (London )

ISSN (Print): 1606-0997

ISSN (Electronic): 2072-1315

Publication date (Electronic): 29 June 2021

Publication date PMC-release: 29 June 2021

Publication date Collection: 2021

Volume: 40

Electronic Location Identifier: 28

Affiliations

[1 ]GRID grid.32056.32, ISNI 0000 0001 2190 9326, Interdisciplinary School of Health Sciences, , Savitribai Phule Pune University, ; Maharashtra, India

[2 ]GRID grid.412988.e, ISNI 0000 0001 0109 131X, School of Hospitality Management, , University of Johannesburg, ; Johannesburg, South Africa

Article

Publisher ID: 253

DOI: 10.1186/s41043-021-00253-y

PMC ID: 8243731

PubMed ID: 34187594

SO-VID: fc579c52-9952-4a9c-89d1-a6ffe0e519fe

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 September 2019

Date accepted : 2 June 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100001501, University Grants Commission;

Award ID: UGC-UPE2016-18

Award Recipient : Angeline Jeyakumar

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: vitamin d deficiency,pregnant women,systematic review,meta-analysis

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: vitamin d deficiency, pregnant women, systematic review, meta-analysis

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Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

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Abstract

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Conclusion

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Karger: Nutrition and Dietetics

Most cited references 57

Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement.

Global vitamin D status and determinants of hypovitaminosis D.

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