Skip to main content Accessibility help
Hostname: page-component-59b7f5684b-j5sqr Total loading time: 0.412 Render date: 2022-10-01T09:16:22.378Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue true

Maternal vitamin D deficiency and GDM risk: evidence for the case of investing more attention in antenatal clinics

Published online by Cambridge University Press:  20 December 2021

Anvesha Mahendra*
MRC Lifecourse Epidemiology Centre, University of Southampton SO16 6YD, Southampton, UK Epidemiology Research Unit, CSI Holdsworth Memorial Hospital, Mysore570001, India
Caroline H. D. Fall
MRC Lifecourse Epidemiology Centre, University of Southampton SO16 6YD, Southampton, UK
*Corresponding author: Anvesha Mahendra, email


Gestational diabetes mellitus (GDM) is a global public health problem, and in India, it affects about 20% of pregnancies. India, despite being a tropical country with abundant sunshine has a high prevalence (80%) of vitamin D deficiency (VDD) among reproductive-aged women. Global and Indian evidence links VDD with a higher risk of hyperglycaemia in pregnancy and GDM. VDD has also been implicated in gestational hypertension, preterm birth and poorer offspring health. Global scientific consensus acknowledges the need for maternal vitamin D screening and supplementation, but knowledge gaps exist about optimal blood levels (50–100 nmol/l), and the required vitamin D dosage (400–4000 IU). Diet can provide <10% of the vitamin D requirements, food fortification can deliver limited amounts, and hence optimal antenatal supplementation is key. Prenatal calcium supplements containing 400 IU of vitamin D may be sufficient for calcium absorption and bone health, but may not provide immunomodulatory benefits, including GDM prevention. Increasing evidence calls for higher maternal vitamin D requirements (2000–4000 IU) for skeletal, metabolic and immune health benefits. Current screening and supplementation for maternal VDD in India is low. We need to invest in future studies to determine optimal maternal vitamin D requirements and formulate policies for vitamin D supplementation to prevent GDM. Improving the maternal vitamin D status is an important nutritional priority for policymakers to reduce the large economic burden of non-communicable diseases (10% of India's gross domestic product), and eventually achieve the 2030 UN sustainable development goals.

Conference on Nutrition in a changing world
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of The Nutrition Society

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Metzger, BE, Gabbe, SG, Persson, B et al. (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycaemia in pregnancy. Diabetes Care 33, 676682.CrossRefGoogle Scholar
Kim, C, Newton, KM & Knopp, RH (2002) Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25, 18621868.CrossRefGoogle ScholarPubMed
Huang, Y, Hu, Y, Ma, Y et al. (2015) Glycated albumin is an optimal biomarker for gestational diabetes mellitus. Exp Ther Med 10, 21452149.CrossRefGoogle ScholarPubMed
Billionnet, C, Mitanchez, D, Weill, A et al. (2017) Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 60, 636644.CrossRefGoogle ScholarPubMed
Reitter, A, Hajduk, B, Geka, F et al. (2011) Doppler studies of gestational diabetes in the third trimester. Ultraschall Med 32, E162E168.CrossRefGoogle ScholarPubMed
Deierlein, AL, Siega-riz, AM, Adair, LS et al. (2011) Effects of pre-pregnancy body mass index and gestational weight gain on infant anthropometric outcomes. J Pediatr 158, 221226.CrossRefGoogle ScholarPubMed
Li, KT, Naik, S, Alexander, M et al. (2018) Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 55, 613625.CrossRefGoogle ScholarPubMed
International Diabetes Federation (2019) The IDF approach for care and management of gestational diabetes mellitus, WINGS Project Summary Report. (accessed Nov 2019).Google Scholar
Holick, MF (2009) Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol 19, 7378.CrossRefGoogle ScholarPubMed
Hollis, B & Wagner, C (2017) New insights into the vitamin D requirements during pregnancy. J Bone Miner Res 5, 17030.Google ScholarPubMed
Mithal, A & Kalra, S (2014) Vitamin D supplementation in pregnancy. Indian J Endocrinol Metab 18, 593596.Google ScholarPubMed
Zhang, Y, Gong, Y, Xue, H et al. (2018) Vitamin D and gestational diabetes mellitus: a systematic review based on data free of Hawthorne effect. BJOG 125, 784793.CrossRefGoogle ScholarPubMed
Aparna, P, Muthathal, S, Nongkynrih, B et al. (2018) Vitamin D deficiency in India. J Family Med Prim Care 7, 324330.Google ScholarPubMed
Sahu, M, Bhatia, V, Aggarwal, A et al. (2009) Vitamin D deficiency in rural girls and pregnant women despite abundant sunshine in northern India. Clin Endocrinol 70, 680684.CrossRefGoogle ScholarPubMed
Ritu, G & Gupta, A (2014) Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients 6, 729775.Google Scholar
Dasgupta, A, Saikia, U & Sarma, D (2012) Status of 25(OH)D levels in pregnancy: a study from the North Eastern part of India. Indian J Endocrinol Metab 16, S405S407.Google ScholarPubMed
Specker, BL (2012) Does vitamin D during pregnancy impact offspring growth and bone? Proc Nutr Soc 71, 3845.CrossRefGoogle ScholarPubMed
Hyppönen, E, Cavadino, A, Williams, D et al. (2013) Vitamin D and pre-eclampsia: original data, systematic review and meta-analysis. Ann Nutr Metab 63, 331340.CrossRefGoogle Scholar
Bikle, DD, Gee, E, Halloran, B et al. (1984) Free 1,25-dihydroxyvitamin D levels in serum from normal subjects, pregnant subjects, and subjects with liver disease. J Clin Invest 74, 19661971.CrossRefGoogle ScholarPubMed
Hollis, BW, Johnson, D, Hulsey, TC et al. (2011) Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 26, 23412357.CrossRefGoogle ScholarPubMed
Hewison, M (2010) Vitamin D and the immune system: new perspectives on an old theme. Endocrinol Metab Clin North Am 39, 365379.CrossRefGoogle Scholar
Hollis, BW & Wagner, CL (2013) Vitamin D and pregnancy: skeletal effects, nonskeletal effects, and birth outcomes. Calcif Tissue Int 92, 128139.CrossRefGoogle ScholarPubMed
Aghajafari, F, Nagulesapillai, T, Ronksley, PE et al. (2013) Association between maternal serum 25-hydroxyvitamin D level and pregnancy and neonatal outcomes: systematic review and meta-analysis of observational studies. Br Med J 346, f1169.CrossRefGoogle ScholarPubMed
Wei, SQ, Qi, HP, Luo, ZC et al. (2013) Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 26, 889899.CrossRefGoogle ScholarPubMed
Dwarkanath, P, Vinotha, P, Thomas, T et al. (2019) Relationship of early vitamin D concentrations and gestational diabetes mellitus in Indian pregnant women. Front Nutr 6, 116.CrossRefGoogle ScholarPubMed
Farrant, HJ, Krishnaveni, GV, Hill, JC et al. (2009) Vitamin D insufficiency is common in Indian mothers but is not associated with gestational diabetes or variation in newborn size. Eur J Clin Nutr 63, 646652.CrossRefGoogle ScholarPubMed
Keller, A, Varela, VC, Dangol, R et al. (2020) The role of vitamin D in the development of diabetes post gestational diabetes mellitus: a systematic literature review. Nutrients 12, 1733.CrossRefGoogle ScholarPubMed
De-Regil, LM, Palacios, C, Lombardo, LK et al. (2016) Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 14, CD008873. doi: 10.1002/14651858.Google Scholar
Roth, DE, Leung, M, Mesfin, E et al. (2017) Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials. Br Med J 359, j5237.CrossRefGoogle ScholarPubMed
Heaney, RP, Davies, KM, Chen, TC et al. (2003) Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 77, 204210.CrossRefGoogle ScholarPubMed
Grant, CC, Stewart, AW, Scragg, R et al. (2014) Vitamin D during pregnancy and infancy and infant serum 25-hydroxyvitamin D concentration. Pediatrics 133, e143e153.CrossRefGoogle ScholarPubMed
Dawodu, A, Saadi, HF, Bekdache, G et al. (2013) Randomized controlled trial (RCT) of vitamin D supplementation in pregnancy in a population with endemic vitamin D deficiency. J Clin Endocrinol Metab 98, 23372346.CrossRefGoogle Scholar
Enkhmaa, D, Tanz, L, Ganma, D et al. (2019) Randomized trial of three doses of vitamin D to reduce deficiency in pregnant Mongolian women. EBioMedicine 39, 510519.CrossRefGoogle ScholarPubMed
Rostami, M, Tehrani, FR, Simbar, M et al. (2018) Effectiveness of prenatal vitamin D deficiency screening and treatment program: a stratified randomized field trial. J Clin Endocrinol Metab 103, 29362948.CrossRefGoogle ScholarPubMed
Wolsk, AM, Harshfield, BJ, Laranjo, N et al. (2017) Vitamin D supplementation in pregnancy, prenatal 25 (OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: secondary analysis from the vitamin D antenatal asthma reduction trial. J Allergy Clin Immunol 140, 14231429.CrossRefGoogle ScholarPubMed
McDonnel, SL, Baggerly, KA, Baggerly, CA et al. (2017) Maternal 25(OH)D concentrations ≥40 ng/ml associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center. PLoS ONE 12, e0180483. doi: 10.1371/journal.pone.0180483.CrossRefGoogle Scholar
Mirzakhani, H, Litonjua, AA, McElrath, TF et al. (2016) Early pregnancy vitamin D status and risk of preeclampsia. J Clin Invest 126, 47024715.CrossRefGoogle ScholarPubMed
Mumford, SI, Garbose, RA, Kim, K et al. (2018) Association of preconception serum 25(OH)D concentrations with live birth and pregnancy loss: a prospective cohort study. Lancet Diabetes Endocrinol 6, 725732.CrossRefGoogle Scholar
Sablok, A, Batra, A, Thariani, K et al. (2015) Supplementation of vitamin D in pregnancy and its correlation with feto-maternal outcome. Clin Endocrinol 83, 536541.CrossRefGoogle ScholarPubMed
Soheilykhah, S, Mojibian, M, Rashidi, M et al. (2010) Maternal vitamin D status in gestational diabetes mellitus. Nutr Clin Pract 25, 524527.CrossRefGoogle ScholarPubMed
Poel, YH, Hummel, P, Lips, P et al. (2012) Vitamin D and gestational diabetes: a systematic review and meta-analysis. Eur J Clin Nutr 23, 465469.Google ScholarPubMed
A Report of the Expert Group of the Indian Council of Medical Research (2010) Jamai-Osmania PO, Hyderabad: National Institute of Nutrition, Indian Council of Medical Research, Nutrient Requirements and Recommended Dietary Allowances for Indians. 2009. (accessed September 2021).Google Scholar
National Institute of Clinical Excellence (2017) Vitamin D: supplement use in specific population groups. (accessed October 2021).Google Scholar
Food and Nutrition Board (2010) Dietary Reference Intakes for Vitamin D and Calcium. National Academy Press; Washington, DC, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes.Google Scholar
European Food Safety Authority (2016) Scientific opinion on dietary reference values for vitamin D. EFSA J 14, 4547.Google Scholar
International Osteoporosis Foundation (2021) Vitamin D. (accessed October 2021).Google Scholar
Holick, MF, Binkley, NC, Bischoff-Ferrari, HA et al. (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96, 19111930.CrossRefGoogle ScholarPubMed
Marwaha, RK, Mithal, A, Bhari, N et al. (2018) Supplementation with three different daily doses of vitamin D3 in healthy pre-pubertal school girls: a cluster randomized trial. Indian Pediatr 55, 951956.CrossRefGoogle ScholarPubMed
Marya, RK, Rathee, S, Lata, V et al. (1981) Effects of vitamin D supplementation in pregnancy. Gynecol Obstet Invest 12, 155161.CrossRefGoogle ScholarPubMed
Baidya, A, Chowdhury, S, Mukhopadhyay, S et al. (2012) Profile of vitamin D in a cohort of physicians and diabetologists in Kolkata. Indian J Endocrinol Metab 16, S416S417.Google Scholar
Marwaha, RK, Puri, S, Tandon, N et al. (2011) Effects of sports training & nutrition on bone mineral density in young Indian healthy females. Indian J Med Res 134, 307313.Google Scholar
Balk, EM, Adam, GP, Langberg, VN et al. (2017) International osteoporosis foundation calcium steering committee. Global dietary calcium intake among adults: a systematic review. Osteoporos Int 28, 33153324.CrossRefGoogle Scholar
Wahl, DA, Cooper, C, Ebeling, PR et al. (2012) A global representation of vitamin D status in healthy populations. Arch Osteoporos 7, 155172.CrossRefGoogle ScholarPubMed
Harinarayan, CV, Ramalakshmi, T, Prasad, UV et al. (2007) High prevalence of low dietary calcium, high phytate consumption, and vitamin D deficiency in healthy south Indians. Am J Clin Nutr 85, 10621067.CrossRefGoogle ScholarPubMed
Johnson, C, Devarsetty, P, Pope, A et al. (2017) Mean population salt consumption in India. J Hypertension 35, 39.CrossRefGoogle ScholarPubMed
World Health Organisation (2020) Salt reduction. (accessed October 2021).Google Scholar
International Lifesciences Institute India Monograph. Fortification of milk with vitamin D: strategy to eliminate vitamin D deficiency in India. (accessed October 2021).Google Scholar
Ekbote, VH, Khadilkar, AV, Chiplonkar, SA et al. (2011) A pilot randomized controlled trial of oral calcium and vitamin D supplementation using fortified laddoos in underprivileged Indian toddlers. Eur J Clin Nutr 65, 440446.CrossRefGoogle ScholarPubMed
Khadgawat, R, Marwaha, RK, Garg, MK et al. (2013) Impact of vitamin D fortified milk supplementation on vitamin D status of healthy school children aged 10–14 years. Osteoporos Int 24, 23352343.CrossRefGoogle ScholarPubMed
Dawson-Hughes, B, Heaney, RP, Holick, MF et al. (2005) Estimates of optimal vitamin D status. Osteoporos Int 16, 713716.CrossRefGoogle ScholarPubMed
Giustina, A, Bouillon, R, Binkley, N et al. (2020) Controversies in vitamin D: a statement from the third international conference. JBMR Plus 4, e10417.CrossRefGoogle ScholarPubMed
Salle, BL, Delvin, EE, Lapillonne, A et al. (2000) Perinatal metabolism of vitamin D. Am J Clin Nutr 71, 1317S1324S.CrossRefGoogle ScholarPubMed
Lhamo, Y, Chugh, PK & Tripathi, CD (2016) Vitamin D supplements in the Indian market. Indian J Pharm Sci 78, 4147.Google ScholarPubMed
Binns, C, Lee, MK, Low, WY et al. (2017) Nutrition in achieving the sustainable development goals in the Asia Pacific region. Asia Pac J Public Health 29, 617624.CrossRefGoogle ScholarPubMed
United Nations System Standing Committee on Nutrition (2017) A spotlight on the nutrition decade. Available from Scholar
Arokiasamy, P (2018) India's escalating burden of non-communicable diseases. Lancet Glob Health 6, e1262e1263.CrossRefGoogle ScholarPubMed

Save article to Kindle

To save this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Maternal vitamin D deficiency and GDM risk: evidence for the case of investing more attention in antenatal clinics
Available formats

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Maternal vitamin D deficiency and GDM risk: evidence for the case of investing more attention in antenatal clinics
Available formats

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Maternal vitamin D deficiency and GDM risk: evidence for the case of investing more attention in antenatal clinics
Available formats

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *