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      Pooled estimate of vitamin D deficiency among pregnant women in India: a systematic review and meta-analysis

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          Abstract

          Background

          Vitamin D deficiency among pregnant women is a public health concern globally. In India, individual studies report high prevalence. However, lack of national data masks the true burden. This work determined the pooled prevalence of vitamin D deficiency among pregnant women in India through a systematic review of literature and meta-analysis.

          Methods

          Three different search engines yielded 15 eligible articles. Study quality was assessed by 10 different criteria and summary of study quality was categorized as per Cochrane standards. Meta-analysis was performed to estimate pooled prevalence of vitamin D deficiency among healthy pregnant women and heterogeneity among selected studies. A sample of n = 4088 was used to study the pooled prevalence among pregnant women.

          Results

          The random effects combined estimate was 32.35% (95% CI, (12.58–117.48). High heterogeneity (tau 2 = 0.39, I 2 = 100%) and high risk of bias was observed among the selected studies. The test for overall effect was observed to be z = 2.54( P = 0.01).

          Conclusion

          Pooled estimate > 30% emphasizes the need for screening through antenatal care services and initiate preventive measures to address the deficiency.

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          Most cited references57

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          Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

          The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
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            Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement.

            In the course of performing systematic reviews on the prevalence of low back and neck pain, we required a tool to assess the risk of study bias. Our objectives were to (1) modify an existing checklist and (2) test the final tool for interrater agreement. The final tool consists of 10 items addressing four domains of bias plus a summary risk of bias assessment. Two researchers tested the interrater agreement of the tool by independently assessing 54 randomly selected studies. Interrater agreement overall and for each individual item was assessed using the proportion of agreement and Kappa statistic. Raters found the tool easy to use, and there was high interrater agreement: overall agreement was 91% and the Kappa statistic was 0.82 (95% confidence interval: 0.76, 0.86). Agreement was almost perfect for the individual items on the tool and moderate for the summary assessment. We have addressed a research gap by modifying and testing a tool to assess risk of study bias. Further research may be useful for assessing the applicability of the tool across different conditions. Copyright © 2012 Elsevier Inc. All rights reserved.
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              Maternal vitamin D status and adverse pregnancy outcomes: a systematic review and meta-analysis.

              To estimate the associations between maternal vitamin D status and adverse pregnancy outcomes. We searched electronic databases of the human literature in PubMed, EMBASE and the Cochrane Library up to October, 2012 using the following keywords: "vitamin D" and "status" or "deficiency" or "insufficiency" and "pregnancy". A systematic review and meta-analysis were conducted on observational studies that reported the association between maternal blood vitamin D levels and adverse pregnancy outcomes including preeclampsia, gestational diabetes mellitus (GDM), preterm birth or small-for-gestational age (SGA). Twenty-four studies met the inclusion criteria. Women with circulating 25-hydroxyvitamin D [25(OH)D] level less than 50 nmol/l in pregnancy experienced an increased risk of preeclampsia [odds ratio (OR) 2.09 (95% confidence intervals 1.50-2.90)], GDM [OR 1.38 (1.12-1.70)], preterm birth [OR 1.58 (1.08-2.31)] and SGA [OR 1.52 (1.08-2.15)]. Low maternal vitamin D levels in pregnancy may be associated with an increased risk of preeclampsia, GDM, preterm birth and SGA.
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                Author and article information

                Contributors
                angelinejaykumar@gmail.com , angejp@unipune.ac.in
                vidya.shinde722@gmail.com
                ravi.rechu@gmail.com
                Journal
                J Health Popul Nutr
                J Health Popul Nutr
                Journal of Health, Population, and Nutrition
                BioMed Central (London )
                1606-0997
                2072-1315
                29 June 2021
                29 June 2021
                2021
                : 40
                : 28
                Affiliations
                [1 ]GRID grid.32056.32, ISNI 0000 0001 2190 9326, Interdisciplinary School of Health Sciences, , Savitribai Phule Pune University, ; Maharashtra, India
                [2 ]GRID grid.412988.e, ISNI 0000 0001 0109 131X, School of Hospitality Management, , University of Johannesburg, ; Johannesburg, South Africa
                Article
                253
                10.1186/s41043-021-00253-y
                8243731
                34187594
                fc579c52-9952-4a9c-89d1-a6ffe0e519fe
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 15 September 2019
                : 2 June 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001501, University Grants Commission;
                Award ID: UGC-UPE2016-18
                Award Recipient :
                Categories
                Review Article
                Custom metadata
                © The Author(s) 2021

                Nutrition & Dietetics
                vitamin d deficiency,pregnant women,systematic review,meta-analysis
                Nutrition & Dietetics
                vitamin d deficiency, pregnant women, systematic review, meta-analysis

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