Vitamin D deficiency at the time of delivery – Prevalence and risk of postpartum infections

Autoři: Daniel Axelsson aff001;  Jan Brynhildsen aff002;  Marie Blomberg aff002
Působiště autorů: Department of Obstetrics and Gynecology, Ryhov County Hospital, Jönköping, Sweden and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden aff001;  Department of Obstetrics and Gynecology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article



Postpartum infections are a common cause of morbidity after childbirth. Vitamin D deficiency has been shown to increase the risk for several infections in a non-pregnant population. Vitamin D deficiency has been described as common in pregnant women.


To investigate whether vitamin D deficiency in pregnant women in labor was associated with an increased risk of overall postpartum infectious morbidity within eight weeks of delivery. A secondary aim was to estimate the prevalence of vitamin D deficiency among pregnant women in Linköping, Sweden at the time of delivery.

Material and methods

Serum vitamin D levels in labor were analyzed for 1397 women. Vitamin D deficiency was defined as serum levels <50 nmol/L. All ICD-10 codes given to the women eight weeks postpartum were reviewed and postpartum infections were defined as the presence of an ICD-10 code suggestive of infection. The prevalence of postpartum infections among women with sufficient vitamin D levels was compared with women with vitamin D deficiency. Adjusted Odds Ratios and 95% confidence intervals for postpartum infections were calculated using multivariate logistic regression analysis.


Fifty eight per cent of the women had serum vitamin D levels <50 nmol/L. The proportion of women with vitamin D deficiency varied, as expected, with season. No association between vitamin D deficiency and postpartum infections was found. For vitamin D 25–50 nmol/L the adjusted Odds Ratio was 0.85 (95% confidence interval 0.56–1.29) and for vitamin D <25 nmol/L the adjusted Odds Ratio was 1.15 (95% confidence interval 0.66–2.03). Women who smoked or who had a cesarean section had an increased risk of postpartum infections.


Vitamin D deficiency was more common than previously reported in Swedish pregnant women. No association between vitamin D deficiency and postpartum infections was found. Other well-known risk factors for postpartum infection were identified.

Klíčová slova:

Labor and delivery – Medical risk factors – Obstetrics and gynecology – Pregnancy – Staphylococcal infection – Sweden


1. Ahnfeldt-Mollerup P, Petersen LK, Kragstrup J, Christensen RD, Sorensen B. Postpartum infections: occurrence, healthcare contacts and association with breastfeeding. Acta obstetricia et gynecologica Scandinavica. 2012;91(12):1440–4. Epub 2012/11/06. doi: 10.1111/aogs.12008 23121089.

2. Axelsson D, Blomberg M. Prevalence of postpartum infections: a population-based observational study. Acta obstetricia et gynecologica Scandinavica. 2014;93(10):1065–8. Epub 2014/08/19. doi: 10.1111/aogs.12455 25132521.

3. Maharaj D. Puerperal pyrexia: a review. Part I. Obstetrical & gynecological survey. 2007;62(6):393–9. Epub 2007/05/22. doi: 10.1097/01.ogx.0000265998.40912.5e 17511893.

4. Burrows LJ, Meyn LA, Weber AM. Maternal morbidity associated with vaginal versus cesarean delivery. Obstetrics and gynecology. 2004;103(5 Pt 1):907–12. Epub 2004/05/04. doi: 10.1097/01.AOG.0000124568.71597.ce 15121564

5. Leth RA, Moller JK, Thomsen RW, Uldbjerg N, Norgaard M. Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women. Acta obstetricia et gynecologica Scandinavica. 2009;88(9):976–83. Epub 2009/07/31. doi: 10.1080/00016340903147405 19642043.

6. Karsnitz DB. Puerperal infections of the genital tract: a clinical review. Journal of midwifery & women's health. 2013;58(6):632–42. Epub 2014/01/11. doi: 10.1111/jmwh.12119 24406036

7. Jacobsson B, Pernevi P, Chidekel L, Jorgen Platz-Christensen J. Bacterial vaginosis in early pregnancy may predispose for preterm birth and postpartum endometritis. Acta obstetricia et gynecologica Scandinavica. 2002;81(11):1006–10. Epub 2002/11/08. doi: 10.1034/j.1600-0412.2002.811103.x 12421167.

8. Axelsson D, Brynhildsen J, Blomberg M. Postpartum infection in relation to maternal characteristics, obstetric interventions and complications. Journal of perinatal medicine. 2018;46(3):271–8. Epub 2017/07/05. doi: 10.1515/jpm-2016-0389 28672754.

9. Lang PO, Samaras N, Samaras D, Aspinall R. How important is vitamin D in preventing infections? Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2013;24(5):1537–53. Epub 2012/11/20. doi: 10.1007/s00198-012-2204-6 23160915.

10. Thomason J, Rentsch C, Stenehjem EA, Hidron AI, Rimland D. Association between vitamin D deficiency and methicillin-resistant Staphylococcus aureus infection. Infection. 2015;43(6):715–22. Epub 2015/07/05. doi: 10.1007/s15010-015-0815-5 26141819.

11. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ (Clinical research ed). 2017;356:i6583. Epub 2017/02/17. doi: 10.1136/bmj.i6583 28202713; PubMed Central PMCID: PMC5310969.

12. Holick MF. Vitamin D deficiency. The New England journal of medicine. 2007;357(3):266–81. Epub 2007/07/20. doi: 10.1056/NEJMra070553 17634462.

13. Lundqvist A, Sandstrom H, Stenlund H, Johansson I, Hultdin J. Vitamin D Status during Pregnancy: A Longitudinal Study in Swedish Women from Early Pregnancy to Seven Months Postpartum. PloS one. 2016;11(3):e0150385. Epub 2016/03/05. doi: 10.1371/journal.pone.0150385 26938997; PubMed Central PMCID: PMC4777524.

14. Barebring L, Schoenmakers I, Glantz A, Hulthen L, Jagner A, Ellis J, et al. Vitamin D Status during Pregnancy in a Multi-Ethnic Population-Representative Swedish Cohort. Nutrients. 2016;8(10). Epub 2016/10/27. doi: 10.3390/nu8100655 27782070; PubMed Central PMCID: PMC5084041.

15. Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Critical reviews in food science and nutrition. 2018;58(5):755–69. Epub 2016/08/26. doi: 10.1080/10408398.2016.1220915 27558700; PubMed Central PMCID: PMC6056893.

16. Alshahrani F, Aljohani N. Vitamin D: deficiency, sufficiency and toxicity. Nutrients. 2013;5(9):3605–16. Epub 2013/09/27. doi: 10.3390/nu5093605 PubMed Central PMCID: PMC3798924. 24067388

17. Socialstyrelsen. Socialstyrelsens statistikdatabas 2019 [cited 2019 october 7]. Available from:

18. Andersen LB, Abrahamsen B, Dalgard C, Kyhl HB, Beck-Nielsen SS, Frost-Nielsen M, et al. Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population-based cohort study. Clinical endocrinology. 2013;79(3):333–41. Epub 2013/01/12. doi: 10.1111/cen.12147 23305099.

19. Bjorn Jensen C, Thorne-Lyman AL, Vadgard Hansen L, Strom M, Odgaard Nielsen N, Cohen A, et al. Development and validation of a vitamin D status prediction model in Danish pregnant women: a study of the Danish National Birth Cohort. PloS one. 2013;8(1):e53059. Epub 2013/01/18. doi: 10.1371/journal.pone.0053059 23326380; PubMed Central PMCID: PMC3541280.

20. Petersen SB, Olsen SF, Molgaard C, Granstrom C, Cohen A, Vestergaard P, et al. Maternal vitamin D status and offspring bone fractures: prospective study over two decades in Aarhus City, Denmark. PloS one. 2014;9(12):e114334. Epub 2014/12/05. doi: 10.1371/journal.pone.0114334 PubMed Central PMCID: PMC4256222. 25474409

21. Ross AC. The 2011 report on dietary reference intakes for calcium and vitamin D. Public health nutrition. 2011;14(5):938–9. Epub 2011/04/16. doi: 10.1017/S1368980011000565 21492489.

22. Dawson-Hughes B, Mithal A, Bonjour JP, Boonen S, Burckhardt P, Fuleihan GE, et al. IOF position statement: vitamin D recommendations for older adults. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2010;21(7):1151–4. Epub 2010/04/28. doi: 10.1007/s00198-010-1285-3 20422154

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2019 Číslo 12
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