MLS Health and Nutrition Research
Vol. 2 Núm. 2 (2023)
ISSN: 2952-2471
Implicación de la vitamina D sérica durante el embarazo, en los resultados obstétricos y perinatales
Publicado Oct 9, 2023
Resumen
La nutrición materna es un factor determinante en el correcto desarrollo del embarazo. Uno de los micronutrientes que cobran especial importancia en esta etapa es la vitamina D. El papel principal de la Vitamina D es la regulación del homeostasis del calcio, aunque, también ejerce un papel importante en el desarrollo del embarazo. Se ha descrito que la deficiencia de Vitamina D durante esta etapa está asociada con resultados adversos como parto prematuro, problemas en el feto o preeclampsia. El objetivo de esta revisión bibliográfica es analizar la implicación de la vitamina D en el correcto desarrollo del embarazo. Se seleccionaron artículos pertenecientes a revistas científicas, indexadas y con un factor de impacto ≥1,5, en inglés o en español y publicados en los últimos 5 años. Se consultó en Pubmed, Sciencedirect y Cochrane. Se asociaron las bajas concentraciones de vitamina D sérica con resultados adversos como diabetes gestacional o preeclampsia. Niveles adecuados mostraron efectos beneficiosos en el desarrollo de la descendencia, mejorando el sistema inmune o previniendo fracturas óseas, sin embargo, no han mostrado beneficios en el crecimiento del neonato. Dosis altas de suplementación con esta vitamina mostraron ser seguras. También se concluyó que la suplementación con vitamina D con dosis de hasta 4000 UI/día resultaría seguro tanto para la madre como para el feto.
Palabras clave:
Vitamina D, embarazo, preeclampsia, suplementación
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Cómo citar
De Santiago Arozamena, A. (2023). Implicación de la vitamina D sérica durante el embarazo, en los resultados obstétricos y perinatales. MLS Health and Nutrition Research, 2(2). https://doi.org/10.60134/mlshnr.v2i2.2261
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(1). Lindsay KL, Buss C, Wadhwa PD, Entringer S. The interplay between nutrition and stress in pregnancy: Implications for fetal programming of brain development. Biol Psychiatry 2019, 85(2):135–49. https://pubmed.ncbi.nlm.nih.gov/30057177/
(2). Mate A. Lifestyle, maternal nutrition and healthy pregnancy. Curr Vasc Pharmacol. 2021,19(2):132–40. https://www.eurekaselect.com/article/105580
(3). Cortés-Albornoz MC, García-Guáqueta DP, Velez-van-Meerbeke A, Talero-Gutiérrez C. Maternal nutrition and neurodevelopment: A scoping review. Nutrients. 2021 13(10):3530. http://dx.doi.org/10.3390/nu13103530
(4). Mousa A, Naqash A, Lim S. Macronutrient and micronutrient intake during pregnancy: An overview of recent evidence. Nutrients. 2019; 11(2):443. http://dx.doi.org/10.3390/nu11020443
(5). Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Crit Rev Food Sci Nutr. 2018;58(5):755–69. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27558700/
(6). Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull. 2018; 126 (1):57–77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003599/
(7). Fogacci S, Fogacci F, Banach M, Michos ED, Hernandez AV, Lip GYH, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr. 2020. 39(6):1742–52. https://www.clinicalnutritionjournal.com/article/S0261-5614(19)33027-4/fulltext
(8). Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients. 2022;14(9):1900. https://pubmed.ncbi.nlm.nih.gov/35565867/ Pilz S, Zittermann A, Obeid R, Hahn A, Pludowski P, Trummer C, et al. The role of vitamin D in fertility and during pregnancy and lactation: A review of clinical data. Int J Environ Res Public Health.15(10):2241. https://pubmed.ncbi.nlm.nih.gov/30322097/
(9). Chang S-W, Lee H-C. Vitamin D and health - The missing vitamin in humans. Pediatr Neonatol. 2019;60(3):237–44. https://pubmed.ncbi.nlm.nih.gov/31101452/
(10). Jeon S-M, Shin E-A. Exploring vitamin D metabolism and function in cancer. Exp Mol Med [Internet]. 2018. 50(4):1–14. http://dx.doi.org/10.1038/s12276-018-0038-9
(11). Cyprian F, Lefkou E, Varoudi K, Girardi G. Immunomodulatory effects of vitamin D in pregnancy and beyond. Front Immunol. 2019;10:2739. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31824513/
(12). Hasan HA, Barber TM, Cheaib S, Coussa A. Preconception vitamin D level and in vitro fertilization: Pregnancy outcome. Endocr Pract. 2023;29(4):235–9. https://www.sciencedirect.com/science/article/pii/S1530891X23000162
(13). Vieyra-Garcia PA, Wolf P. From early immunomodulatory triggers to immunosuppressive outcome: Therapeutic implications of the complex interplay between the wavebands of sunlight and the skin. Front Med (Lausanne). 2018; 5:232. https://pubmed.ncbi.nlm.nih.gov/30250844/
(14). Liang S, Cai J, Li Y, Yang R. 1,25-Dihydroxy-Vitamin D3 induces macrophage polarization to M2 by upregulating T-cell Ig-mucin-3 expression. Mol Med Rep. 2019 19(5): 3707–13. https://pubmed.ncbi.nlm.nih.gov/30896850/
(15). Baldini D, Malvasi A, Kosmas I, Baldini GM, Silvestris E. Increased bioavailability of Vitamin D improved pregnancy outcomes in in vitro fertilization cycles, only in patients over 36 years: a cross-sectional study. Eur Rev Med Pharmacol Sci. 2021;25(15):4964–72. http://dx.doi.org/10.26355/eurrev_202108_26453
(16). Mailhot G, White JH. Vitamin D and immunity in infants and children. Nutrients [Internet]. 2020;12(5):1233. http://dx.doi.org/10.3390/nu12051233
(17). Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol;119(4):825–39. https://pubmed.ncbi.nlm.nih.gov/30830277/
(18). Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. Mechanisms involved in the relationship between vitamin D and insulin resistance: Impact on clinical practice. Nutrients. 13(10):3491.
(19). Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull 2018. 126(1):57–77. https://pubmed.ncbi.nlm.nih.gov/29684104/
(20). Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients;14(9):1900. https://pubmed.ncbi.nlm.nih.gov/35565867/
(21). Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is supplementation with micronutrients still necessary during pregnancy? A review. Nutrients 13(9):3134. http://dx.doi.org/10.3390/nu13093134
(22). Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab. 2018 31(3):247–60. https://pubmed.ncbi.nlm.nih.gov/29397388/
(23). Akbari S, Khodadadi B, Ahmadi SAY, Abbaszadeh S, Shahsavar F. Association of vitamin D level and vitamin D deficiency with risk of preeclampsia: A systematic review and updated meta-analysis. Taiwan J Obstet Gynecol. ;57(2):241–7. https://pubmed.ncbi.nlm.nih.gov/29673668/
(24). Xiaomang J, Yanling W. Effect of vitamin D3 supplementation during pregnancy on high risk factors - a randomized controlled trial. J Perinat Med. 2021 49(4):480–4. https://pubmed.ncbi.nlm.nih.gov/33554587/
(25). Raia-Barjat T, Sarkis C, Rancon F, Thibaudin L, Gris J-C, Alfaidy N, et al. Vitamin D deficiency during late pregnancy mediates placenta-associated complications. Sci Rep. 11(1):20708 http://dx.doi.org/10.1038/s41598-021-00250-5
(26). Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin 2020. 74(11):1498–513. https://pubmed.ncbi.nlm.nih.gov/31959942/
(27). Wagner CL, Hollis BW. The implications of vitamin D status during pregnancy on mother and her developing child. Front Endocrinol (Lausanne); 9:500. https://pubmed.ncbi.nlm.nih.gov/30233496/
(28). Hollis BW. Vitamin D status during pregnancy: The importance of getting it right. EBioMedicine. 2019; 39:23–4. http://dx.doi.org/10.1016/j.ebiom.2018.12.021
(29). Enkhmaa D, Tanz L, Ganmaa D, Enkhtur S, Oyun-Erdene B, Stuart J, et al. Randomized trial of three doses of vitamin D to reduce deficiency in pregnant Mongolian women. EBioMedicine. 2019; 39:510–9. http://dx.doi.org/10.1016/j.ebiom.2018.11.060
(30). Rostami M, Tehrani FR, Simbar M, Bidhendi Yarandi R, Minooee S, Hollis BW, et al. Effectiveness of prenatal vitamin D deficiency screening and treatment program: A stratified randomized field trial. J Clin Endocrinol Metab. 2018;103(8):2936–48. http://dx.doi.org/10.1210/jc.2018-00109
(31). Palacios C, Trak-Fellermeier MA, Martinez RX, Lopez-Perez L, Lips P, Salisi JA, et al. Regimens of vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;10(10):CD013446. http://dx.doi.org/10.1002/14651858.CD013446
(32). Díaz-López A, Jardí C, Villalobos M, Serrat N, Basora J, Arija V. Prevalence and risk factors of hypovitaminosis D in pregnant Spanish women. Sci Rep. 2020;10(1):15757. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02192698/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(33). Vestergaard AL, Justesen S, Volqvartz T, Aagaard SK, Andreasen MF, Lesnikova I, et al. Vitamin D insufficiency among Danish pregnant women-Prevalence and association with adverse obstetric outcomes and placental vitamin D metabolism. Acta Obstet Gynecol Scand. 2021;100(3):480–8. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02191613/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(34). Hornsby E, Pfeffer PE, Laranjo N, Cruikshank W, Tuzova M, Litonjua AA, et al. Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial. J Allergy Clin Immunol. 2018;141(1):269-278.e1. https://pubmed.ncbi.nlm.nih.gov/28552588/
(35). Roth DE, Morris SK, Zlotkin S, Gernand AD, Ahmed T, Shanta SS, et al. Vitamin D supplementation in pregnancy and lactation to promote infant growth. N Engl J Med. 2018, 379(6):535–46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004541/
(36). Brustad N, Chawes BL, Thorsen J, Krakauer M, Lasky-Su J, Weiss ST, et al. High-dose vitamin D supplementation in pregnancy and 25(OH)D sufficiency in childhood reduce the risk of fractures and improve bone mineralization in childhood: Follow-up of a randomized clinical trial. EClinicalMedicine. 2022; 43(101254):101254. https://www.sciencedirect.com/science/article/pii/S2589537021005356
(37). Yin W-J, Tao R-X, Hu H-L, Zhang Y, Jiang X-M, Zhang M-X, et al. The association of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus: a Chinese prospective birth cohort study. Am J Clin Nutr. 2020; 111(1):122–30. https://www.sciencedirect.com/science/article/pii/S0002916522009790
(38). Bakleicheva M, Bespalova O, Kovaleva I. Features of the 1st trimester of pregnancy course with severe deficiency of 25(OH)D. Gynecol Endocrinol. 2021;37(sup1):49–53. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02380505/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(39). Liu C-C, Huang J-P. Potential benefits of vitamin D supplementation on pregnancy. J Formos Med Assoc [Internet]. 2023; https://www.sciencedirect.com/science/article/pii/S092966462300058X
(40). Ogiji J, Rich W. An exploratory study of vitamin D levels during pregnancy and its association with postpartum depression. Psychiatry Res Commun. 2022;2(1):100021. https://www.sciencedirect.com/science/article/pii/S2772598722000022
(2). Mate A. Lifestyle, maternal nutrition and healthy pregnancy. Curr Vasc Pharmacol. 2021,19(2):132–40. https://www.eurekaselect.com/article/105580
(3). Cortés-Albornoz MC, García-Guáqueta DP, Velez-van-Meerbeke A, Talero-Gutiérrez C. Maternal nutrition and neurodevelopment: A scoping review. Nutrients. 2021 13(10):3530. http://dx.doi.org/10.3390/nu13103530
(4). Mousa A, Naqash A, Lim S. Macronutrient and micronutrient intake during pregnancy: An overview of recent evidence. Nutrients. 2019; 11(2):443. http://dx.doi.org/10.3390/nu11020443
(5). Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Crit Rev Food Sci Nutr. 2018;58(5):755–69. Disponible en: https://pubmed.ncbi.nlm.nih.gov/27558700/
(6). Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull. 2018; 126 (1):57–77. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003599/
(7). Fogacci S, Fogacci F, Banach M, Michos ED, Hernandez AV, Lip GYH, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr. 2020. 39(6):1742–52. https://www.clinicalnutritionjournal.com/article/S0261-5614(19)33027-4/fulltext
(8). Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients. 2022;14(9):1900. https://pubmed.ncbi.nlm.nih.gov/35565867/ Pilz S, Zittermann A, Obeid R, Hahn A, Pludowski P, Trummer C, et al. The role of vitamin D in fertility and during pregnancy and lactation: A review of clinical data. Int J Environ Res Public Health.15(10):2241. https://pubmed.ncbi.nlm.nih.gov/30322097/
(9). Chang S-W, Lee H-C. Vitamin D and health - The missing vitamin in humans. Pediatr Neonatol. 2019;60(3):237–44. https://pubmed.ncbi.nlm.nih.gov/31101452/
(10). Jeon S-M, Shin E-A. Exploring vitamin D metabolism and function in cancer. Exp Mol Med [Internet]. 2018. 50(4):1–14. http://dx.doi.org/10.1038/s12276-018-0038-9
(11). Cyprian F, Lefkou E, Varoudi K, Girardi G. Immunomodulatory effects of vitamin D in pregnancy and beyond. Front Immunol. 2019;10:2739. Disponible en: https://pubmed.ncbi.nlm.nih.gov/31824513/
(12). Hasan HA, Barber TM, Cheaib S, Coussa A. Preconception vitamin D level and in vitro fertilization: Pregnancy outcome. Endocr Pract. 2023;29(4):235–9. https://www.sciencedirect.com/science/article/pii/S1530891X23000162
(13). Vieyra-Garcia PA, Wolf P. From early immunomodulatory triggers to immunosuppressive outcome: Therapeutic implications of the complex interplay between the wavebands of sunlight and the skin. Front Med (Lausanne). 2018; 5:232. https://pubmed.ncbi.nlm.nih.gov/30250844/
(14). Liang S, Cai J, Li Y, Yang R. 1,25-Dihydroxy-Vitamin D3 induces macrophage polarization to M2 by upregulating T-cell Ig-mucin-3 expression. Mol Med Rep. 2019 19(5): 3707–13. https://pubmed.ncbi.nlm.nih.gov/30896850/
(15). Baldini D, Malvasi A, Kosmas I, Baldini GM, Silvestris E. Increased bioavailability of Vitamin D improved pregnancy outcomes in in vitro fertilization cycles, only in patients over 36 years: a cross-sectional study. Eur Rev Med Pharmacol Sci. 2021;25(15):4964–72. http://dx.doi.org/10.26355/eurrev_202108_26453
(16). Mailhot G, White JH. Vitamin D and immunity in infants and children. Nutrients [Internet]. 2020;12(5):1233. http://dx.doi.org/10.3390/nu12051233
(17). Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol;119(4):825–39. https://pubmed.ncbi.nlm.nih.gov/30830277/
(18). Contreras-Bolívar V, García-Fontana B, García-Fontana C, Muñoz-Torres M. Mechanisms involved in the relationship between vitamin D and insulin resistance: Impact on clinical practice. Nutrients. 13(10):3491.
(19). Curtis EM, Moon RJ, Harvey NC, Cooper C. Maternal vitamin D supplementation during pregnancy. Br Med Bull 2018. 126(1):57–77. https://pubmed.ncbi.nlm.nih.gov/29684104/
(20). Mansur JL, Oliveri B, Giacoia E, Fusaro D, Costanzo PR. Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children. Nutrients;14(9):1900. https://pubmed.ncbi.nlm.nih.gov/35565867/
(21). Santander Ballestín S, Giménez Campos MI, Ballestín Ballestín J, Luesma Bartolomé MJ. Is supplementation with micronutrients still necessary during pregnancy? A review. Nutrients 13(9):3134. http://dx.doi.org/10.3390/nu13093134
(22). Antonucci R, Locci C, Clemente MG, Chicconi E, Antonucci L. Vitamin D deficiency in childhood: old lessons and current challenges. J Pediatr Endocrinol Metab. 2018 31(3):247–60. https://pubmed.ncbi.nlm.nih.gov/29397388/
(23). Akbari S, Khodadadi B, Ahmadi SAY, Abbaszadeh S, Shahsavar F. Association of vitamin D level and vitamin D deficiency with risk of preeclampsia: A systematic review and updated meta-analysis. Taiwan J Obstet Gynecol. ;57(2):241–7. https://pubmed.ncbi.nlm.nih.gov/29673668/
(24). Xiaomang J, Yanling W. Effect of vitamin D3 supplementation during pregnancy on high risk factors - a randomized controlled trial. J Perinat Med. 2021 49(4):480–4. https://pubmed.ncbi.nlm.nih.gov/33554587/
(25). Raia-Barjat T, Sarkis C, Rancon F, Thibaudin L, Gris J-C, Alfaidy N, et al. Vitamin D deficiency during late pregnancy mediates placenta-associated complications. Sci Rep. 11(1):20708 http://dx.doi.org/10.1038/s41598-021-00250-5
(26). Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Köstenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin 2020. 74(11):1498–513. https://pubmed.ncbi.nlm.nih.gov/31959942/
(27). Wagner CL, Hollis BW. The implications of vitamin D status during pregnancy on mother and her developing child. Front Endocrinol (Lausanne); 9:500. https://pubmed.ncbi.nlm.nih.gov/30233496/
(28). Hollis BW. Vitamin D status during pregnancy: The importance of getting it right. EBioMedicine. 2019; 39:23–4. http://dx.doi.org/10.1016/j.ebiom.2018.12.021
(29). Enkhmaa D, Tanz L, Ganmaa D, Enkhtur S, Oyun-Erdene B, Stuart J, et al. Randomized trial of three doses of vitamin D to reduce deficiency in pregnant Mongolian women. EBioMedicine. 2019; 39:510–9. http://dx.doi.org/10.1016/j.ebiom.2018.11.060
(30). Rostami M, Tehrani FR, Simbar M, Bidhendi Yarandi R, Minooee S, Hollis BW, et al. Effectiveness of prenatal vitamin D deficiency screening and treatment program: A stratified randomized field trial. J Clin Endocrinol Metab. 2018;103(8):2936–48. http://dx.doi.org/10.1210/jc.2018-00109
(31). Palacios C, Trak-Fellermeier MA, Martinez RX, Lopez-Perez L, Lips P, Salisi JA, et al. Regimens of vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2019;10(10):CD013446. http://dx.doi.org/10.1002/14651858.CD013446
(32). Díaz-López A, Jardí C, Villalobos M, Serrat N, Basora J, Arija V. Prevalence and risk factors of hypovitaminosis D in pregnant Spanish women. Sci Rep. 2020;10(1):15757. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02192698/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(33). Vestergaard AL, Justesen S, Volqvartz T, Aagaard SK, Andreasen MF, Lesnikova I, et al. Vitamin D insufficiency among Danish pregnant women-Prevalence and association with adverse obstetric outcomes and placental vitamin D metabolism. Acta Obstet Gynecol Scand. 2021;100(3):480–8. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02191613/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(34). Hornsby E, Pfeffer PE, Laranjo N, Cruikshank W, Tuzova M, Litonjua AA, et al. Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial. J Allergy Clin Immunol. 2018;141(1):269-278.e1. https://pubmed.ncbi.nlm.nih.gov/28552588/
(35). Roth DE, Morris SK, Zlotkin S, Gernand AD, Ahmed T, Shanta SS, et al. Vitamin D supplementation in pregnancy and lactation to promote infant growth. N Engl J Med. 2018, 379(6):535–46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004541/
(36). Brustad N, Chawes BL, Thorsen J, Krakauer M, Lasky-Su J, Weiss ST, et al. High-dose vitamin D supplementation in pregnancy and 25(OH)D sufficiency in childhood reduce the risk of fractures and improve bone mineralization in childhood: Follow-up of a randomized clinical trial. EClinicalMedicine. 2022; 43(101254):101254. https://www.sciencedirect.com/science/article/pii/S2589537021005356
(37). Yin W-J, Tao R-X, Hu H-L, Zhang Y, Jiang X-M, Zhang M-X, et al. The association of vitamin D status and supplementation during pregnancy with gestational diabetes mellitus: a Chinese prospective birth cohort study. Am J Clin Nutr. 2020; 111(1):122–30. https://www.sciencedirect.com/science/article/pii/S0002916522009790
(38). Bakleicheva M, Bespalova O, Kovaleva I. Features of the 1st trimester of pregnancy course with severe deficiency of 25(OH)D. Gynecol Endocrinol. 2021;37(sup1):49–53. https://www.cochranelibrary.com/es/central/doi/10.1002/central/CN-02380505/full?highlightAbstract=d%7Cvitamin%7Cpregnanc%7Cpregnancy
(39). Liu C-C, Huang J-P. Potential benefits of vitamin D supplementation on pregnancy. J Formos Med Assoc [Internet]. 2023; https://www.sciencedirect.com/science/article/pii/S092966462300058X
(40). Ogiji J, Rich W. An exploratory study of vitamin D levels during pregnancy and its association with postpartum depression. Psychiatry Res Commun. 2022;2(1):100021. https://www.sciencedirect.com/science/article/pii/S2772598722000022
