An estimate of the economic burden of vitamin D deficiency in pregnant women in the United Kingdom

Abstract

Pregnancy is associated with an increased risk of vitamin D deficiency beyond that of the general population. The aim of the current analysis was to synthesize the current evidence on the dose–outcome relationship of vitamin D/serum 25 hydroxyvitamin D (25-OHD) and complications during pregnancy. An additional aim was to estimate the economic burden attributable to inadequate levels of serum 25-OHD. Published literature on the effects of vitamin D supplementation/serum 25-OHD on pregnancy complications, including randomized control trials and non-interventional studies, was searched in bibliographic databases including Pubmed, Google Scholar, Scopus and EMBASE. A positive and significant treatment effect was obtained for pre-eclampsia (OR = 0.75 95% CI 0.662–0.843), but not for preterm birth (OR = 0.783, 95% CI 0.49–1.251) or small for gestational age (OR = 0.76 95% CI 0.38–1.28). Inadequate vitamin D accounted for 14.04% of risk for pre-eclampsia. It is estimated that addressing vitamin D inadequacy in pregnant women in England and Wales would reduce the number of cases of pre-eclampsia by 4126; and would result in a net saving of £18.6 million for the NHS in England and Wales. The current results suggest that based on current evidence a public health policy preventing vitamin D inadequacy in pregnant women is likely to have a positive impact on the NHS budget in England and Wales. This is contingent upon further evidence regarding the vitamin D dose-pregnancy outcome relationship becoming available.

Chinese abstract

妊娠与维生素D缺乏风险升高有关, 该风险超过了普通人群。此次分析的目标是综述妊娠期维生素D/血清中25-羟基维生素D（25-OHD）的剂量与妊娠期并发症之间的剂量-效应关系的现有研究。另一个目标是分析血清中25-OHD水平偏低带来的经济负担。在包括Pubmed, Google Scholar, Scopus 和EMBASE的文献数据库中进行对关于维生素D补充/血清25-OHD在妊娠并发症的效果的已出版的论著的搜索, 包括随机对照研究和无干涉研究。在先兆子痫上获得了有效和显著的效果(OR =0.75 95% CI 0.662–0.843), 但在早产(OR =0.75 95% CI 0.662–0.843)和小于胎龄儿上并没有此疗效(OR =0.76 95% CI 0.38–1.28)。维生素D缺乏使先兆子痫发生风险升高14.04%。在英格兰和威尔士处理维生素D缺乏问题预计将会减少4126例先兆子痫； 并将会给英格兰和威尔士的国家医疗体系（NHS）净节约18.6百万英镑。目前结果表明, 基于现有证据, 一个预防妊娠女性维生素D缺乏的公共健康政策可能会在英格兰和威尔士的NHS预算上产生正向影响。这取决于关于维生素D剂量和妊娠结局联系的更多可用证据。

• 25-hydroxyvitamin D
• gestational diabetes mellitus
• preeclampsia
• pregnancy outcomes
• preterm birth
• small for gestational age
• vitamin D deficiency
• vitamin D supplementation

Acknowledgements

We are grateful to Mr. Paul Tredwell for assisting with sourcing cost information.

Declaration of interest

Dr J.S. Davies is a medical advisor to Internis Pharmaceutical Ltd. Dr C. Poole has provided consulting services to Internis Pharmaceutical Ltd. Dr P. Kamudoni has no conflict of interest to declare.

Supplementary material available online Tables S1–S5