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

Silvia Fogacci, Federica Fogacci, Maciej Banach, Erin D. Michos, Adrian V. Hernandez, Gregory Y.H. Lip, Michael J. Blaha, Peter P. Toth, Claudio Borghi, Arrigo F.G. Cicero

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Resumen

© 2019 The Author(s) 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.
Idioma originalInglés estadounidense
PublicaciónClinical Nutrition
DOI
EstadoPublicada - 1 ene 2019

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    Fogacci, S., Fogacci, F., Banach, M., Michos, E. D., Hernandez, A. V., 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. https://doi.org/10.1016/j.clnu.2019.08.015