Vitamin D supplementation and incident preeclampsia:: A systematic review and meta-analysis of randomized clinical trials

the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group; Adrian Vladimir Hernández Diaz; Silvia Fogacci; Federica Fogacci; Maciej Banach; Erin D. Michos; Gregory Y.H. Lip; Michael J. Blaha; Peter P. Toth; Claudio Borghi; Arrigo F.G. Cicero

doi:10.1016/j.clnu.2019.08.015

Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials

the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, Adrian Vladimir Hernández Diaz, Silvia Fogacci, Federica Fogacci, Maciej Banach, Erin D. Michos, Gregory Y.H. Lip, Michael J. Blaha, Peter P. Toth, Claudio Borghi, Arrigo F.G. Cicero

Research output: Contribution to journal › Article › peer-review

56 Scopus citations

Abstract

BACKGROUND: Maternal vitamin D deficiency has been associated with an increased risk for preeclampsia. Despite this, the current evidence regarding the efficacy of vitamin D supplementation in preventing preeclampsia is controversial. To assess the impact of vitamin D supplementation on the risk of preeclampsia, we performed a systematic review of the literature and a meta-analysis of the available randomized clinical trials (RCTs).

METHODS: The primary outcome was preeclampsia. Subgroup analyses were carried out considering the timing of the supplementation, type of intervention and the study design. Meta-regression analysis, including the amount of vitamin D and maternal age, were planned to explore heterogeneity (PROSPERO database registration number: CRD42019119207).

RESULTS: Data were pooled from 27 RCTs comprising 59 arms, which included overall 4777 participants, of whom 2487 were in the vitamin D-treated arm and 2290 in the control arm. Vitamin D administration in pregnancy was associated with a reduced risk of preeclampsia (odd ratio [OR] 0.37, 95% confidence interval [CI]: 0.26, 0.52; I2 = 0%). If the vitamin D supplementation was started up to 20 weeks' gestation, the odds was a little lower (OR 0.35, 95% CI: 0.24, 0.50, p < 0.001). The effect was largely independent of the supplementation cessation (until delivery or not), type of intervention (vitamin D alone or in association with calcium), and study design. Increasing dose of vitamin D was associated with reduced incidence of preeclampsia (slope of log OR: -1.1, 95% CI: -1.73, -0.46; p < 0.001).

CONCLUSIONS: Results suggest that vitamin D supplementation may be useful in preventing preeclampsia. These data are especially useful for health-care providers who engage in the management of pregnant women at risk for preeclampsia. Our findings are a call for action to definitively address vitamin D supplementation as a possible intervention strategy in preventing preeclampsia in pregnancy.

Original language	American English
Pages (from-to)	1742-1752
Number of pages	11
Journal	Clinical Nutrition
Volume	39
Issue number	6
DOIs	https://doi.org/10.1016/j.clnu.2019.08.015 https://doi.org/10.1016/j.clnu.2019.08.015 https://doi.org/10.1016/j.clnu.2019.08.015
State	Published - 1 Jan 2019

Keywords

Adolescent
Adult
Avitaminosis/blood
Dietary Supplements/adverse effects
Female
Humans
Incidence
Middle Aged
Pre-Eclampsia/diagnosis
Pregnancy
Protective Factors
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Treatment Outcome
Vitamin D/adverse effects
Young Adult

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the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, Hernández Diaz, A. V., Fogacci, S., Fogacci, F., Banach, M., Michos, E. D., Lip, G. Y. H., Blaha, M. J., Toth, P. P., Borghi, C., & Cicero, A. F. G. (2019). Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clinical Nutrition, 39(6), 1742-1752. https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015

the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group ; Hernández Diaz, Adrian Vladimir ; Fogacci, Silvia ; Fogacci, Federica ; Banach, Maciej ; Michos, Erin D. ; Lip, Gregory Y.H. ; Blaha, Michael J. ; Toth, Peter P. ; Borghi, Claudio ; Cicero, Arrigo F.G. / Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. In: Clinical Nutrition. 2019 ; Vol. 39, No. 6. pp. 1742-1752.

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title = "Vitamin D supplementation and incident preeclampsia:: A systematic review and meta-analysis of randomized clinical trials",

abstract = "BACKGROUND: Maternal vitamin D deficiency has been associated with an increased risk for preeclampsia. Despite this, the current evidence regarding the efficacy of vitamin D supplementation in preventing preeclampsia is controversial. To assess the impact of vitamin D supplementation on the risk of preeclampsia, we performed a systematic review of the literature and a meta-analysis of the available randomized clinical trials (RCTs).METHODS: The primary outcome was preeclampsia. Subgroup analyses were carried out considering the timing of the supplementation, type of intervention and the study design. Meta-regression analysis, including the amount of vitamin D and maternal age, were planned to explore heterogeneity (PROSPERO database registration number: CRD42019119207).RESULTS: Data were pooled from 27 RCTs comprising 59 arms, which included overall 4777 participants, of whom 2487 were in the vitamin D-treated arm and 2290 in the control arm. Vitamin D administration in pregnancy was associated with a reduced risk of preeclampsia (odd ratio [OR] 0.37, 95% confidence interval [CI]: 0.26, 0.52; I2 = 0%). If the vitamin D supplementation was started up to 20 weeks' gestation, the odds was a little lower (OR 0.35, 95% CI: 0.24, 0.50, p < 0.001). The effect was largely independent of the supplementation cessation (until delivery or not), type of intervention (vitamin D alone or in association with calcium), and study design. Increasing dose of vitamin D was associated with reduced incidence of preeclampsia (slope of log OR: -1.1, 95% CI: -1.73, -0.46; p < 0.001).CONCLUSIONS: Results suggest that vitamin D supplementation may be useful in preventing preeclampsia. These data are especially useful for health-care providers who engage in the management of pregnant women at risk for preeclampsia. Our findings are a call for action to definitively address vitamin D supplementation as a possible intervention strategy in preventing preeclampsia in pregnancy.",

keywords = "Adolescent, Adult, Avitaminosis/blood, Dietary Supplements/adverse effects, Female, Humans, Incidence, Middle Aged, Pre-Eclampsia/diagnosis, Pregnancy, Protective Factors, Randomized Controlled Trials as Topic, Risk Assessment, Risk Factors, Treatment Outcome, Vitamin D/adverse effects, Young Adult",

author = "{the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group} and {Hern{\'a}ndez Diaz}, {Adrian Vladimir} and Silvia Fogacci and Federica Fogacci and Maciej Banach and Michos, {Erin D.} and Lip, {Gregory Y.H.} and Blaha, {Michael J.} and Toth, {Peter P.} and Claudio Borghi and Cicero, {Arrigo F.G.}",

year = "2019",

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doi = "10.1016/j.clnu.2019.08.015",

language = "American English",

volume = "39",

pages = "1742--1752",

journal = "Clinical Nutrition",

issn = "0261-5614",

publisher = "Elsevier BV",

number = "6",

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the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, Hernández Diaz, AV, Fogacci, S, Fogacci, F, Banach, M, Michos, ED, Lip, GYH, Blaha, MJ, Toth, PP, Borghi, C & Cicero, AFG 2019, 'Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials', Clinical Nutrition, vol. 39, no. 6, pp. 1742-1752. https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015

Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. / the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group ; Hernández Diaz, Adrian Vladimir; Fogacci, Silvia; Fogacci, Federica; Banach, Maciej; Michos, Erin D.; Lip, Gregory Y.H.; Blaha, Michael J.; Toth, Peter P.; Borghi, Claudio; Cicero, Arrigo F.G.

In: Clinical Nutrition, Vol. 39, No. 6, 01.01.2019, p. 1742-1752.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Vitamin D supplementation and incident preeclampsia:

T2 - A systematic review and meta-analysis of randomized clinical trials

AU - the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group

AU - Hernández Diaz, Adrian Vladimir

AU - Fogacci, Silvia

AU - Fogacci, Federica

AU - Banach, Maciej

AU - Michos, Erin D.

AU - Lip, Gregory Y.H.

AU - Blaha, Michael J.

AU - Toth, Peter P.

AU - Borghi, Claudio

AU - Cicero, Arrigo F.G.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - BACKGROUND: Maternal vitamin D deficiency has been associated with an increased risk for preeclampsia. Despite this, the current evidence regarding the efficacy of vitamin D supplementation in preventing preeclampsia is controversial. To assess the impact of vitamin D supplementation on the risk of preeclampsia, we performed a systematic review of the literature and a meta-analysis of the available randomized clinical trials (RCTs).METHODS: The primary outcome was preeclampsia. Subgroup analyses were carried out considering the timing of the supplementation, type of intervention and the study design. Meta-regression analysis, including the amount of vitamin D and maternal age, were planned to explore heterogeneity (PROSPERO database registration number: CRD42019119207).RESULTS: Data were pooled from 27 RCTs comprising 59 arms, which included overall 4777 participants, of whom 2487 were in the vitamin D-treated arm and 2290 in the control arm. Vitamin D administration in pregnancy was associated with a reduced risk of preeclampsia (odd ratio [OR] 0.37, 95% confidence interval [CI]: 0.26, 0.52; I2 = 0%). If the vitamin D supplementation was started up to 20 weeks' gestation, the odds was a little lower (OR 0.35, 95% CI: 0.24, 0.50, p < 0.001). The effect was largely independent of the supplementation cessation (until delivery or not), type of intervention (vitamin D alone or in association with calcium), and study design. Increasing dose of vitamin D was associated with reduced incidence of preeclampsia (slope of log OR: -1.1, 95% CI: -1.73, -0.46; p < 0.001).CONCLUSIONS: Results suggest that vitamin D supplementation may be useful in preventing preeclampsia. These data are especially useful for health-care providers who engage in the management of pregnant women at risk for preeclampsia. Our findings are a call for action to definitively address vitamin D supplementation as a possible intervention strategy in preventing preeclampsia in pregnancy.

AB - BACKGROUND: Maternal vitamin D deficiency has been associated with an increased risk for preeclampsia. Despite this, the current evidence regarding the efficacy of vitamin D supplementation in preventing preeclampsia is controversial. To assess the impact of vitamin D supplementation on the risk of preeclampsia, we performed a systematic review of the literature and a meta-analysis of the available randomized clinical trials (RCTs).METHODS: The primary outcome was preeclampsia. Subgroup analyses were carried out considering the timing of the supplementation, type of intervention and the study design. Meta-regression analysis, including the amount of vitamin D and maternal age, were planned to explore heterogeneity (PROSPERO database registration number: CRD42019119207).RESULTS: Data were pooled from 27 RCTs comprising 59 arms, which included overall 4777 participants, of whom 2487 were in the vitamin D-treated arm and 2290 in the control arm. Vitamin D administration in pregnancy was associated with a reduced risk of preeclampsia (odd ratio [OR] 0.37, 95% confidence interval [CI]: 0.26, 0.52; I2 = 0%). If the vitamin D supplementation was started up to 20 weeks' gestation, the odds was a little lower (OR 0.35, 95% CI: 0.24, 0.50, p < 0.001). The effect was largely independent of the supplementation cessation (until delivery or not), type of intervention (vitamin D alone or in association with calcium), and study design. Increasing dose of vitamin D was associated with reduced incidence of preeclampsia (slope of log OR: -1.1, 95% CI: -1.73, -0.46; p < 0.001).CONCLUSIONS: Results suggest that vitamin D supplementation may be useful in preventing preeclampsia. These data are especially useful for health-care providers who engage in the management of pregnant women at risk for preeclampsia. Our findings are a call for action to definitively address vitamin D supplementation as a possible intervention strategy in preventing preeclampsia in pregnancy.

KW - Adolescent

KW - Adult

KW - Avitaminosis/blood

KW - Dietary Supplements/adverse effects

KW - Female

KW - Humans

KW - Incidence

KW - Middle Aged

KW - Pre-Eclampsia/diagnosis

KW - Pregnancy

KW - Protective Factors

KW - Randomized Controlled Trials as Topic

KW - Risk Assessment

KW - Risk Factors

KW - Treatment Outcome

KW - Vitamin D/adverse effects

KW - Young Adult

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UR - http://www.mendeley.com/research/vitamin-d-supplementation-incident-preeclampsia-systematic-review-metaanalysis-randomized-clinical-t

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DO - 10.1016/j.clnu.2019.08.015

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JO - Clinical Nutrition

JF - Clinical Nutrition

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the Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group, Hernández Diaz AV, Fogacci S, Fogacci F, Banach M, Michos ED et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clinical Nutrition. 2019 Jan 1;39(6):1742-1752. https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015, https://doi.org/10.1016/j.clnu.2019.08.015

Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials

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