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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (1): 16-20    DOI: 10.31083/j.ceog.2020.01.4930
Original Research Previous articles | Next articles
Maternal serum vitamin D and spontaneous preterm birth
A. Kalok1, N.H.A. Aziz1, D.A. Malik1, S.A. Shah3, D.N. Nasuruddin2, M.H. Omar1, N.A.M. Ismail1, M.N. Shafiee1, *()
1Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
2Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
3UKM Medical Molecular Biology Institute (UMBI), Kuala Lumpur, Malaysia
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Poor maternal vitamin D status is associated with adverse pregnancy outcomes such as preeclampsia, gestational diabetes. And increased risk of caesarean delivery. The authors conducted a prospective observational study to determine the association between maternal serum vitamin D levels and spontaneous preterm delivery. Pregnant women between 26 and 34 weeks of gestation, with symptoms of preterm labour were recruited. The control group consisted of healthy pregnant women of similar gestation age. The maternal serum vitamin D and calcium levels were measured and all women were followed up until delivery. The patients’ demographics data and their respective perinatal outcomes were collected and analysed. A total of 161 women were recruited for the study. The prevalence of vitamin D deficiency, insufficiency, and sufficiency were 41.3%, 50.9%, and 6.8% respectively (p < 0.001). The mean maternal serum vitamin D for control, threatened preterm labour, and preterm birth group were 26.5 ± 3.8 ng/mL, 17.9 ± 8.0 ng/mL, and 13.5 ± 6.98 ng/mL respectively (p < 0.001). There were no significant differences in the means of serum vitamin D among women with or without antenatal complications, such as gestational diabetes, gestational hypertension or preeclampsia. Vitamin D level was positively correlated with gestational age at delivery (p < 0.001) and newborn weight (p < 0.001). Vitamin D deficiency is associated with increased risk of spontaneous preterm labour, although there is no strong evidence of correlation with other antenatal complications. In view of high prevalence of vitamin D deficiency and insufficiency in this population, routine supplement of vitamin D maybe beneficial in reduction of premature births.

Key words:  Vitamin D      Prematurity      Preterm birth     
Published:  15 February 2020     
*Corresponding Author(s):  M.N. Shafiee     E-mail:

Cite this article: 

A. Kalok, N.H.A. Aziz, D.A. Malik, S.A. Shah, D.N. Nasuruddin, M.H. Omar, N.A.M. Ismail, M.N. Shafiee. Maternal serum vitamin D and spontaneous preterm birth. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(1): 16-20.

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Table 1  — Demographics and clinical data of studied group vs. controls.
Demographics Controls (n=75) Women with symptoms of preterm labour
after 37 weeks (n= 36)
preterm before 37 weeks (n=50)
Age, years; mean (SD) 29.59 (4.94) 30.33 (4.62) 30.18 (4.60) 0.09
Parity, n (%)
Nulliparous 28 (37.3) 15 (41.7) 18 (36) 0.57
Multiparous 47 (62.7) 21 (58.3) 32 (64)
BMI, kg/m2; mean (SD) 25.73 (4.32) 27.22 (4.57) 24.51 (4.35) 0.10
Figure 1.  — Patients’ recruitment.

Figure 2.  — Scatterplot of serum Vitamin D level and gestational age at delivery.

Figure 3.  — Scatteplot of vitamin D against birthweight.

Table 2  — Clinical data and vitamin D levels for study group vs controls.
Clinical outcomes Controls (n=75) Women with symptoms of preterm labour p-value
Delivered after 37 weeks (n= 36) Delivered preterm (< 37 weeks) (n=50)
Vitamin D ng/mL, mean (SD) 26.5 (3.8) 17.9 (8.0) 13.5 (6.9) < 0.001
Corrected Calcium level, mean (SD) 2.24 (0.2) 2.25 (1.1). 2.20 (0.2) 0.17
Vitamin D levels, n (%)
Adequate 9 (12.0) 2 (5.6) 0 (0) p < 0.001
Insufficient 62 (82.7) 7 (19.4) 13 (26.0)
Deficient 4 (5.3) 27 (75.0) 37 (74.0)
Antenatal complications n (%)
GDM 29 (39) 22 (61) 25 (50) 0.08
Gestational HTN 31 (41) 18 (50) 8 (16)
Pre-eclampsia 13 (17) 6 (17) 7 (14)
Gestational age at delivery, weeks; median (SD) 38 (1.46) 37 (1.46) 32 (1.22) 0.003
Mode of delivery, n (%)
Vaginal delivery 58 (77) 26 (72) 39 (100) 0.04
LSCS 17 (23) 10 (28) 0(0)
Newborn weight, kg; mean (SD) 3.03 (0.44) 2.69 (0.47) 1.78 (0.36) < 0.001
Cord pH; mean (SD) 7.29 (0.10) 7.28 (0.10) 7.30 (0.10) 0.98
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