Tidwell, Diane K.

Committee Member

Oliver, Brittney D.

Committee Member

Briley, Chiquita A.

Committee Member

Allsopp, Marie

Committee Member

Williams, Ron D.

Date of Degree


Document Type

Dissertation - Open Access



Degree Name

Doctor of Philosophy


College of Agriculture and Life Sciences


Department of Food Science, Nutrition and Health Promotion


Vitamin D inadequacy is highly prevalent among pregnant women worldwide. Inadequacy or deficiency of vitamin D can lead to adverse outcomes during pregnancy such as pre-eclampsia, gestational diabetes, and caesarian section. A systematic review and meta-analysis were conducted to examine the effectiveness of vitamin D supplementation on serum vitamin D status during pregnancy in randomized controlled trials (RCTs). A search was conducted in PubMed, Scopus, ProQuest, EBSCO, Cochrane CENTRAL Database of Controlled Clinical Trials, PsycINFO, CINAHL, and Google Scholar, in addition to searching reference lists in published reviews. A comprehensive list of RCTs of vitamin D status and supplemental use in pregnancy was compiled. The random effects model was used to determine a summary effect size using pre/post means and standard deviations of serum vitamin D levels from intervention and control groups. Sixteen RCTs indicated a large effect size (d = .849, 95% CI .607 – 1.001, p < .001). Serum vitamin D concentration at delivery was higher with vitamin D supplementation, and thereby the metabolic outlook was favorable for the mother and newborn. Heterogeneity of the meta-analysis was significant (Q = 344.418, p < .001); the I-squared statistic showed moderate heterogeneity (61.89%), which warranted subgroup analysis to identify possible sources of variation among the studies. Moderators for subgroup analysis included vitamin D dosages, use of a placebo, use of multivitamins in addition to vitamin D, duration of interventions, age, low or adequate baseline vitamin D status, trimester when supplementation was started, country where the RCT was conducted (USA/UK/AUS versus other countries), and blinded versus non-blinded RCTs. Subgroup analysis only demonstrated a significant impact on heterogeneity from the trimester moderator (p < .001). Women who began vitamin D supplementation during the first trimester had a higher effect size and improved vitamin D status compared to those who began supplementation in the second or third trimester. Since pregnant women with vitamin D inadequacy or deficiency are more susceptible to complications, routine examination of vitamin D status should be conducted in pregnant women.