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Study flow diagram for this update
Figuras y tablas -
Figure 1

Study flow diagram for this update

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Funnel plot of comparison: 1 Vitamin D alone versus no treatment/placebo (no vitamins or minerals), outcome: 1.15 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Vitamin D alone versus no treatment/placebo (no vitamins or minerals), outcome: 1.15 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 1 Pre‐eclampsia (ALL).
Figuras y tablas -
Analysis 1.1

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 1 Pre‐eclampsia (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 2 Gestational diabetes (ALL).
Figuras y tablas -
Analysis 1.2

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 2 Gestational diabetes (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 3 Maternal adverse events.
Figuras y tablas -
Analysis 1.3

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 3 Maternal adverse events.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 4 Preterm birth (less than 37 weeks' gestation) (ALL).
Figuras y tablas -
Analysis 1.4

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 4 Preterm birth (less than 37 weeks' gestation) (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 5 Low birthweight (less than 2500 g) (ALL).
Figuras y tablas -
Analysis 1.5

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 5 Low birthweight (less than 2500 g) (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 6 Pre‐eclampsia (by start of supplementation).
Figuras y tablas -
Analysis 1.6

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 6 Pre‐eclampsia (by start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 7 Pre‐eclampsia (by pre‐gestational BMI).
Figuras y tablas -
Analysis 1.7

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 7 Pre‐eclampsia (by pre‐gestational BMI).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 8 Pre‐eclampsia (by supplementation scheme/regimen).
Figuras y tablas -
Analysis 1.8

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 8 Pre‐eclampsia (by supplementation scheme/regimen).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 9 Pre‐eclampsia (by skin pigmentation based on Fitzpatrick skin tone chart).
Figuras y tablas -
Analysis 1.9

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 9 Pre‐eclampsia (by skin pigmentation based on Fitzpatrick skin tone chart).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 10 Pre‐eclampsia (by latitude).
Figuras y tablas -
Analysis 1.10

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 10 Pre‐eclampsia (by latitude).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 11 Pre‐eclampsia (by season at the start of pregnancy).
Figuras y tablas -
Analysis 1.11

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 11 Pre‐eclampsia (by season at the start of pregnancy).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 12 Gestational diabetes (by start of supplementation).
Figuras y tablas -
Analysis 1.12

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 12 Gestational diabetes (by start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 13 Gestational diabetes (by pre‐gestational BMI).
Figuras y tablas -
Analysis 1.13

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 13 Gestational diabetes (by pre‐gestational BMI).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 14 Gestational diabetes (by supplementation scheme/regimen).
Figuras y tablas -
Analysis 1.14

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 14 Gestational diabetes (by supplementation scheme/regimen).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 15 Gestational diabetes (by skin pigmentation based on Fitzpatrick skin tone chart).
Figuras y tablas -
Analysis 1.15

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 15 Gestational diabetes (by skin pigmentation based on Fitzpatrick skin tone chart).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 16 Gestational diabetes (by latitude).
Figuras y tablas -
Analysis 1.16

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 16 Gestational diabetes (by latitude).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 17 Gestational diabetes (by season at the start of supplementation).
Figuras y tablas -
Analysis 1.17

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 17 Gestational diabetes (by season at the start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 18 Preterm birth (less than 37 weeks' gestation) (by start of supplementation).
Figuras y tablas -
Analysis 1.18

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 18 Preterm birth (less than 37 weeks' gestation) (by start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 19 Preterm birth (less than 37 weeks' gestation) (by pre‐gestational BMI).
Figuras y tablas -
Analysis 1.19

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 19 Preterm birth (less than 37 weeks' gestation) (by pre‐gestational BMI).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 20 Preterm birth (less than 37 weeks' gestation) (by supplementation scheme/regimen).
Figuras y tablas -
Analysis 1.20

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 20 Preterm birth (less than 37 weeks' gestation) (by supplementation scheme/regimen).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 21 Preterm birth (less than 37 weeks' gestation) (by skin pigmentation based on Fitzpatrick skin tone chart).
Figuras y tablas -
Analysis 1.21

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 21 Preterm birth (less than 37 weeks' gestation) (by skin pigmentation based on Fitzpatrick skin tone chart).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 22 Preterm birth (less than 37 weeks' gestation) (by latitude).
Figuras y tablas -
Analysis 1.22

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 22 Preterm birth (less than 37 weeks' gestation) (by latitude).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 23 Preterm birth (less than 37 weeks' gestation) (by season at the start of supplementation).
Figuras y tablas -
Analysis 1.23

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 23 Preterm birth (less than 37 weeks' gestation) (by season at the start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 24 Low birthweight (less than 2500 g) (by start of supplementation).
Figuras y tablas -
Analysis 1.24

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 24 Low birthweight (less than 2500 g) (by start of supplementation).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 25 Low birthweight (less than 2500 g) (by pre‐gestational BMI).
Figuras y tablas -
Analysis 1.25

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 25 Low birthweight (less than 2500 g) (by pre‐gestational BMI).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 26 Low birthweight (less than 2500 g) (by supplementation scheme/regimen).
Figuras y tablas -
Analysis 1.26

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 26 Low birthweight (less than 2500 g) (by supplementation scheme/regimen).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 27 Low birthweight (less than 2500 g) (by skin pigmentation based on Fitzpatrick skin to.
Figuras y tablas -
Analysis 1.27

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 27 Low birthweight (less than 2500 g) (by skin pigmentation based on Fitzpatrick skin to.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 28 Low birthweight (less than 2500 g) (by latitude).
Figuras y tablas -
Analysis 1.28

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 28 Low birthweight (less than 2500 g) (by latitude).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 29 Low birthweight (less than 2500 g) (by season at the start of pregnancy).
Figuras y tablas -
Analysis 1.29

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 29 Low birthweight (less than 2500 g) (by season at the start of pregnancy).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 30 Caesarean section.
Figuras y tablas -
Analysis 1.30

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 30 Caesarean section.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 31 Gestational hypertension.
Figuras y tablas -
Analysis 1.31

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 31 Gestational hypertension.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 32 Maternal death (death while pregnant or within 42 days of termination of pregnancy) (ALL).
Figuras y tablas -
Analysis 1.32

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 32 Maternal death (death while pregnant or within 42 days of termination of pregnancy) (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 33 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).
Figuras y tablas -
Analysis 1.33

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 33 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 34 Birth length (cm).
Figuras y tablas -
Analysis 1.34

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 34 Birth length (cm).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 35 Head circumference at birth (cm).
Figuras y tablas -
Analysis 1.35

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 35 Head circumference at birth (cm).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 36 Birthweight (g).
Figuras y tablas -
Analysis 1.36

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 36 Birthweight (g).

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 37 Stillbirth.
Figuras y tablas -
Analysis 1.37

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 37 Stillbirth.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 38 Neonatal death.
Figuras y tablas -
Analysis 1.38

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 38 Neonatal death.

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Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 39 Apgar score less than seven at five minutes.
Figuras y tablas -
Analysis 1.39

Comparison 1 Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals), Outcome 39 Apgar score less than seven at five minutes.

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 1 Pre‐eclampsia (ALL).
Figuras y tablas -
Analysis 2.1

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 1 Pre‐eclampsia (ALL).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 2 Gestational diabetes (ALL).
Figuras y tablas -
Analysis 2.2

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 2 Gestational diabetes (ALL).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 3 Preterm birth (less than 37 weeks' gestation) (ALL).
Figuras y tablas -
Analysis 2.3

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 3 Preterm birth (less than 37 weeks' gestation) (ALL).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 4 Low birthweight (less than 2500 g) (ALL).
Figuras y tablas -
Analysis 2.4

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 4 Low birthweight (less than 2500 g) (ALL).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 5 Caesarean section.
Figuras y tablas -
Analysis 2.5

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 5 Caesarean section.

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 6 Gestational hypertension.
Figuras y tablas -
Analysis 2.6

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 6 Gestational hypertension.

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 7 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).
Figuras y tablas -
Analysis 2.7

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 7 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 8 Birth length (cm).
Figuras y tablas -
Analysis 2.8

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 8 Birth length (cm).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 9 Head circumference at birth (cm).
Figuras y tablas -
Analysis 2.9

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 9 Head circumference at birth (cm).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 10 Birthweight (g).
Figuras y tablas -
Analysis 2.10

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 10 Birthweight (g).

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Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 11 Neonatal death.
Figuras y tablas -
Analysis 2.11

Comparison 2 Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals), Outcome 11 Neonatal death.

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 1 Gestational diabetes (ALL).
Figuras y tablas -
Analysis 3.1

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 1 Gestational diabetes (ALL).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 2 Maternal adverse events.
Figuras y tablas -
Analysis 3.2

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 2 Maternal adverse events.

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 3 Preterm birth (less than 37 weeks' gestation) (ALL).
Figuras y tablas -
Analysis 3.3

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 3 Preterm birth (less than 37 weeks' gestation) (ALL).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 4 Low birthweight (less than 2500 g) (ALL).
Figuras y tablas -
Analysis 3.4

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 4 Low birthweight (less than 2500 g) (ALL).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 5 Caesarean section.
Figuras y tablas -
Analysis 3.5

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 5 Caesarean section.

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 6 Gestational hypertension.
Figuras y tablas -
Analysis 3.6

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 6 Gestational hypertension.

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 7 Maternal death (death while pregnant or within 42 days of termination of pregnancy).
Figuras y tablas -
Analysis 3.7

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 7 Maternal death (death while pregnant or within 42 days of termination of pregnancy).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 8 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).
Figuras y tablas -
Analysis 3.8

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 8 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 9 Birth length (cm).
Figuras y tablas -
Analysis 3.9

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 9 Birth length (cm).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 10 Head circumference at birth (cm).
Figuras y tablas -
Analysis 3.10

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 10 Head circumference at birth (cm).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 11 Birthweight (g).
Figuras y tablas -
Analysis 3.11

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 11 Birthweight (g).

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 12 Stillbirth.
Figuras y tablas -
Analysis 3.12

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 12 Stillbirth.

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Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 13 Neonatal death.
Figuras y tablas -
Analysis 3.13

Comparison 3 Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D), Outcome 13 Neonatal death.

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Summary of findings for the main comparison. Vitamin D supplementation compared to placebo or no intervention for pregnancy and neonatal health outcomes

Vitamin D supplementation compared to placebo/control for pregnancy and neonatal health outcomes

Patient or population: pregnant women and their infants.
Setting: trials were carried from 1980s to 2015 in countries from Bangladesh, India, Iran, New Zealand and UK. Most trials were conducted outside the tropics and in different seasons.
Intervention: vitamin D supplementation.
Comparison: placebo or no intervention.

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo/control

Risk with vitamin D supplementation

Pre‐eclampsia

Study population

RR 0.48 (0.30, 0.79)

499
(4 RCTs)

⊕⊕⊕⊝
MODERATE1

Included trials: Asemi 2013a; Naghshineh 2016; Sablok 2015; Sasan 2017

168 per 1000

79 per 1000
(49 to 131)

Gestational diabetes

Study population

RR 0.51
(0.27 to 0.97)

446
(4 RCTs)

⊕⊕⊕⊝
MODERATE 2

Included trials: Asemi 2013a; Sablok 2015; Shahgheibi 2016; Tehrani 2014

127 per 1000

65 per 1000
(34 to 123)

Maternal adverse events: severe postpartum haemorrhage

Study population

RR 0.68
(0.51 to 0.91)

1134
(1 RCT)

⊕⊕⊝⊝
LOW 3

Included trial: Harvey 2012

158 per 1000

106 per 1000
(79 to 142)

Maternal adverse event: nephritic syndrome

Study population

RR 0.17 (0.01 to 4.06)

135

(1 RCT)

⊕⊝⊝⊝
VERY LOW 4,5

Included trial: Yu 2008

22 per 1000

4 per 1000 (0 to 90)

Maternal adverse event: hypercalcaemia

Study population

Not estimable

1134
(1 RCT)

⊕⊕⊝⊝
LOW 3,6

Included trial: Harvey 2012

0 per 1000

0 per 1000

Preterm birth (less than 37 weeks' gestation)

Study population

RR 0.66 (0.34 to 1.30)

1640
(7 RCTs)

⊕⊕⊝⊝
LOW 7,8

Included trials: Asemi 2013a; Delvin 1986; Grant 2013; Harvey 2012; Mirghafourvand 2013; Roth 2010; Singh 2015

87 per 1000

57 per 1000
(29 to 113)

Low birthweight (less than 2500 g)

Study population

RR 0.55
(0.35 to 0.87)

697
(5 RCTs)

⊕⊕⊕⊝
MODERATE 9

Included trials: Brooke 1980; Bhutta 2011; Marya 1988; Roth 2010; Sablok 2015

136 per 1000

75 per 1000
(48 to 118)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RCT: randomised controlled trial; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded (1) level for serious limitations in study design due to one trial being assessed as high risk of bias for several domains and two trials having unclear allocation concealment.

2 We downgraded (1) level for serious limitations in study design due to one trial being assessed as high risk of bias for several domains.

3 We downgraded (2) levels for very serious limitations in study design due to one study being assessed as high risk of other bias because we do not know the impact of the participants who were allowed to continue taking their own multivitamin with 400 IU/d of vitamin D as this was not recorded.

4 We downgraded (1) level for serious limitations in study design due to one study being assessed as high risk of bias for performance and detection bias.

5 We downgraded (2) levels for very serious limitations in imprecision as only one small study, with a small number of events and wide 95% confidence intervals (CI) contributed data.

6 We downgraded (1) level for serious limitations in imprecision due to a single study with zero events contributing data.

7 We downgraded (1) level for serious limitations in study design due to two studies being at unclear risk of selection bias and one study being at high risk of other bias.

8 We downgraded (1) level for serious limitations in imprecision as the 95% confidence interval (CI) was wide and crossed the line of no effect.

9 We downgraded (1) level for serious limitations in study design due to two studies being at unclear risk of selection bias, one study being at high risk of bias for allocation concealment, and three studies being at high risk of attrition bias.

Figuras y tablas -
Summary of findings for the main comparison. Vitamin D supplementation compared to placebo or no intervention for pregnancy and neonatal health outcomes
Ir a la tabla de la revisión
Summary of findings 2. Vitamin D + calcium supplementation compared to placebo or no intervention for pregnancy and neonatal health outcomes

Vitamin D + calcium supplementation compared to placebo/control for pregnancy and neonatal health outcomes

Patient or population: pregnant women and their infants..
Setting: trials were carried from 1980s to 2015 in countries from Iran, India, and Brazil. Only the study in Brazil was within the tropics. Most did not report the season in which it was carried out or it was mixed.
Intervention: vitamin D + calcium supplementation.
Comparison: placebo/control.

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo/control

Risk with vitamin D + calcium supplementation

Pre‐eclampsia

Study population

RR 0.50
(0.32 to 0.78)

1174
(4 RCTs)

⊕⊕⊕⊝
MODERATE1

Included trials: Asemi 2012; Marya 1987; Samimi 2016; Taherian 2002

94 per 1000

47 per 1000
(30 to 73)

Gestational diabetes

Study population

RR 0.33
(0.01 to 7.84)

54
(1 RCT)

⊕⊝⊝⊝
VERY LOW2,3

Included trial: Asemi 2012

37 per 1000

12 per 1000
(0 to 290)

Maternal adverse events

‐

‐

‐

‐

‐

No trials reported on this outcome

Preterm birth (less than 37 weeks' gestation)

Study population

RR 1.52
(1.01 to 2.28)

942
(5 RCTs)

⊕⊕⊝⊝
LOW4,5

Included trials: Asemi 2012; Diogenes 2013, Mirghafourvand 2013, Samimi 2016; Taherian 2002;

72 per 1000

110 per 1000
(73 to 165)

Low birthweight (less than 2500 g)

Study population

RR 0.68
(0.10 to 4.55)

110
(2 RCTs)

⊕⊝⊝⊝
VERY LOW6,7

Included trials: Diogenes 2013; Samimi 2016

59 per 1000

40 per 1000
(6 to 268)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RCT: randomised controlled trial; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded (1) level for serious limitations in study design due to one study being at high risk of attrition and selection bias and three studies being at high risk of performance and detection bias.

2 We downgraded (1) level for serious limitations in study design due to one study being at high risk of performance and detection bias.

3 We downgraded (2) levels for very serious limitations in imprecision due to one small study, with a single event and wide 95% confidence intervals (CI) crossing the line of no effect contributing data.

4 We downgraded (1) level for serious limitations in study design due to three studies being at unclear risk of allocation concealment and three studies being at high risk of performance and detection bias.

5 We downgraded (1) level for serious limitations in imprecision due to wide 95% confidence intervals (CI).

6 We downgraded (1) level for serious limitations in study design due to one study being at unclear risk of allocation concealment and one study being at high risk of attrition bias.

7 We downgraded (2) levels for very serious limitations in imprecision due two small studies, with very few events and wide 95% confidence intervals (CI) crossing the line of no effect contributing data.

Figuras y tablas -
Summary of findings 2. Vitamin D + calcium supplementation compared to placebo or no intervention for pregnancy and neonatal health outcomes
Ir a la tabla de la revisión
Summary of findings 3. Vitamin D + calcium + other vitamins and minerals compared to calcium + other vitamins and minerals (but no vitamin D) for pregnancy and neonatal health outcomes

Vitamin D + calcium + other vitamins and minerals compared to calcium + other vitamins and minerals (but no vitamin D) for pregnancy and neonatal health outcomes

Patient or population: pregnant women and their infants..
Setting: the only study included in this comparison was conducted in Bangladesh, which is located outside the tropics and it was conducted in different seasons of the year.
Intervention: vitamin D + calcium + other vitamins and minerals.
Comparison: calcium + other vitamins and minerals (but no vitamin D).

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with calcium + other vitamins and minerals (but no vitamin D)

Risk with vitamin D + calcium + other vitamins and minerals

Pre‐eclampsia

Study population

‐

(0 trials)

‐

No trials reported on this outcome

see comment

see comment

Gestational diabetes

Study population

RR 0.42
(0.10 to 1.73)

1298
(1 RCT)

⊕⊝⊝⊝
VERY LOW 1,2

Included trial: Roth 2013

12 per 1000

5 per 1000
(1 to 20)

Maternal adverse event: hypercalcaemia

Study population

‐

1298
(1 RCT)

⊕⊝⊝⊝
VERY LOW 2,3

Included trial: Roth 2013

23 per 1000

64 per 1000
(28 to 147)

Maternal adverse event: hypercalciuria

Study population

0.25 (0.02 to 3.97)

1298
(1 RCT)

⊕⊝⊝⊝
VERY LOW1,2

Included trial: Roth 2013

4 per 1000

1 per 1000 (0 to 15)

Preterm birth (less than 37 weeks' gestation)

Study population

RR 1.04
(0.68 to 1.59)

1298
(1 RCT)

⊕⊕⊝⊝
LOW 2,3

Included trial: Roth 2013

93 per 1000

96 per 1000
(63 to 147)

Low birthweight (less than 2500 g)

Study population

RR 1.12
(0.82 to 1.51)

1298
(1 RCT)

⊕⊕⊝⊝
LOW 2,3

Included trial: Roth 2013

162 per 1000

182 per 1000
(133 to 245)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RCT: randomised controlled trial; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 We downgraded (2) levels for very serious limitations in imprecision with only one trial, with few events, and wide 95% confidence intervals (CI) crossing the line of no effect contributing data.

2 We downgraded (1) level for serious indirectness as there were multiple nutrient interventions in addition to vitamin D.

2 We downgraded (2) levels for very serious limitations in imprecision with only one trial, with zero events, and wide 95% confidence intervals (CI) crossing the line of no effect contributing data.

3 We downgraded (1) level for serious limitations in imprecision due to only one trial with wide 95% confidence intervals (CI) crossing the line of no effect contributing data.

Figuras y tablas -
Summary of findings 3. Vitamin D + calcium + other vitamins and minerals compared to calcium + other vitamins and minerals (but no vitamin D) for pregnancy and neonatal health outcomes
Ir a la tabla de la revisión
Comparison 1. Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pre‐eclampsia (ALL) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

2 Gestational diabetes (ALL) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

3 Maternal adverse events Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Severe postpartum haemorrhage

1

1134

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.51, 0.91]

3.2 Nephritic syndrome

1

135

Risk Ratio (M‐H, Random, 95% CI)

0.17 [0.01, 4.06]

3.3 Hypercalcaemia

1

1134

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Preterm birth (less than 37 weeks' gestation) (ALL) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

5 Low birthweight (less than 2500 g) (ALL) Show forest plot

5

697

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.35, 0.87]

6 Pre‐eclampsia (by start of supplementation) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

6.1 Less than 20 weeks of pregnancy

1

138

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.06, 1.37]

6.2 20 weeks of pregnancy or more

2

219

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.21, 1.24]

6.3 Unknown/unreported/mixed

1

142

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.98]

7 Pre‐eclampsia (by pre‐gestational BMI) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

7.1 Underweight (lower than 18.5)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7.2 Normal weight (18.5 to 24.9)

1

165

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.21, 1.33]

7.3 Overweight (25 or higher)

1

54

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.84]

7.4 Unknown/unreported/mixed

2

280

Risk Ratio (M‐H, Random, 95% CI)

0.47 [0.26, 0.86]

8 Pre‐eclampsia (by supplementation scheme/regimen) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

8.1 Single dose

1

165

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.21, 1.33]

8.2 Daily

2

192

Risk Ratio (M‐H, Random, 95% CI)

0.30 [0.08, 1.20]

8.3 Weekly/monthly

1

142

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.98]

9 Pre‐eclampsia (by skin pigmentation based on Fitzpatrick skin tone chart) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

9.1 Three or less

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.2 Four or more

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9.3 Unknown/unreported/mixed

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

10 Pre‐eclampsia (by latitude) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

10.1 Between Tropics of Cancer and Capricorn

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

10.2 North of the Tropic of Cancer or South of the Tropic of Capricorn

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

10.3 Unknown/unreported

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11 Pre‐eclampsia (by season at the start of pregnancy) Show forest plot

4

499

Risk Ratio (M‐H, Random, 95% CI)

0.48 [0.30, 0.79]

11.1 Summer

1

54

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.84]

11.2 Fall

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

11.3 Winter

1

138

Risk Ratio (M‐H, Random, 95% CI)

0.29 [0.06, 1.37]

11.4 Mixed/unknown

2

307

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.31, 0.88]

12 Gestational diabetes (by start of supplementation) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

12.1 Less than 20 weeks of pregnancy

1

140

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.34, 2.28]

12.2 20 weeks of pregnancy or more

2

219

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.05, 3.45]

12.3 Unknown/unreported/mixed

1

87

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.13, 0.82]

13 Gestational diabetes (by pre‐gestational BMI) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

13.1 Underweight (lower than 18.5)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

13.2 Normal weight (18.5 to 24.9)

2

305

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.33, 2.05]

13.3 Overweight (25 or higher)

2

141

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.13, 0.79]

13.4 Unknown/unreported/mixed

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

14 Gestational diabetes (by supplementation scheme/regimen) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

14.1 Single dose

1

165

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.03, 8.28]

14.2 Daily

2

141

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.13, 0.79]

14.3 Weekly/monthly

1

140

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.34, 2.28]

15 Gestational diabetes (by skin pigmentation based on Fitzpatrick skin tone chart) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

15.1 Three or less

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Four or more

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

15.3 Unknown/unreported/mixed

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

16 Gestational diabetes (by latitude) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

16.1 Between Tropics of Cancer and Capricorn

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

16.2 North of the Tropic of Cancer or South of the Tropic of Capricorn

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

16.3 Unknown/unreported

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17 Gestational diabetes (by season at the start of supplementation) Show forest plot

4

446

Risk Ratio (M‐H, Random, 95% CI)

0.51 [0.27, 0.97]

17.1 Summer

1

54

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.84]

17.2 Fall

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

17.3 Winter

1

140

Risk Ratio (M‐H, Random, 95% CI)

0.88 [0.34, 2.28]

17.4 Mixed/unknown

2

252

Risk Ratio (M‐H, Random, 95% CI)

0.34 [0.14, 0.82]

18 Preterm birth (less than 37 weeks' gestation) (by start of supplementation) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

18.1 Less than 20 weeks of pregnancy

3

1149

Risk Ratio (M‐H, Random, 95% CI)

0.73 [0.26, 2.04]

18.2 20 weeks of pregnancy or more

4

491

Risk Ratio (M‐H, Random, 95% CI)

0.49 [0.13, 1.87]

18.3 Unknown/unreported/mixed

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19 Preterm birth (less than 37 weeks' gestation) (by pre‐gestational BMI) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

19.1 Underweight (lower than 18.5)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19.2 Normal weight (18.5 to 24.9)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

19.3 Overweight (25 or higher)

2

138

Risk Ratio (M‐H, Random, 95% CI)

0.60 [0.15, 2.46]

19.4 Unknown/unreported/mixed

5

1502

Risk Ratio (M‐H, Random, 95% CI)

0.64 [0.27, 1.54]

20 Preterm birth (less than 37 weeks' gestation) (by supplementation scheme/regimen) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

20.1 Single dose

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

20.2 Daily

6

1495

Risk Ratio (M‐H, Random, 95% CI)

0.61 [0.23, 1.58]

20.3 Weekly/monthly

1

145

Risk Ratio (M‐H, Random, 95% CI)

0.70 [0.32, 1.54]

21 Preterm birth (less than 37 weeks' gestation) (by skin pigmentation based on Fitzpatrick skin tone chart) Show forest plot

9

1943

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.30, 0.91]

21.1 Three or less

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.2 Four or more

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

21.3 Unknown/unreported/mixed

9

1943

Risk Ratio (M‐H, Random, 95% CI)

0.52 [0.30, 0.91]

22 Preterm birth (less than 37 weeks' gestation) (by latitude) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

22.1 Between Tropics of Cancer and Capricorn

2

358

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.05, 1.34]

22.2 North of the Tropic of Cancer or South of the Tropic of Capricorn

5

1282

Risk Ratio (M‐H, Random, 95% CI)

0.99 [0.59, 1.66]

22.3 Unknown/unreported

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23 Preterm birth (less than 37 weeks' gestation) (by season at the start of supplementation) Show forest plot

7

1640

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.34, 1.30]

23.1 Summer

2

199

Risk Ratio (M‐H, Random, 95% CI)

0.72 [0.34, 1.53]

23.2 Winter

1

34

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

23.3 Mixed/unknown

4

1407

Risk Ratio (M‐H, Random, 95% CI)

0.55 [0.19, 1.66]

24 Low birthweight (less than 2500 g) (by start of supplementation) Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

24.1 Less than 20 weeks of pregnancy

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

24.2 20 weeks of pregnancy or more

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

24.3 Unknown/unreported/mixed

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25 Low birthweight (less than 2500 g) (by pre‐gestational BMI) Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

25.1 Underweight (lower than 18.5)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.2 Normal weight (18.5 to 24.9)

1

165

Risk Ratio (M‐H, Random, 95% CI)

0.43 [0.19, 0.98]

25.3 Overweight (25 or higher)

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

25.4 Unknown/unreported/mixed

2

326

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.14, 0.88]

26 Low birthweight (less than 2500 g) (by supplementation scheme/regimen) Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

26.1 Single dose

2

365

Risk Ratio (M‐H, Random, 95% CI)

0.32 [0.16, 0.65]

26.2 Daily

1

126

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.23, 1.21]

26.3 Weekly/monthly

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27 Low birthweight (less than 2500 g) (by skin pigmentation based on Fitzpatrick skin to Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

27.1 Three or less

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.2 Four or more

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

27.3 Unknown/unreported/mixed

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

28 Low birthweight (less than 2500 g) (by latitude) Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

28.1 Between Tropics of Cancer and Capricorn

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

28.2 North of the Tropic of Cancer or South of the Tropic of Capricorn

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

28.3 Unknown/unreported

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29 Low birthweight (less than 2500 g) (by season at the start of pregnancy) Show forest plot

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

29.1 Summer

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.2 Fall

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.3 Winter

0

0

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

29.4 Mixed/unknown

3

491

Risk Ratio (M‐H, Random, 95% CI)

0.39 [0.24, 0.65]

30 Caesarean section Show forest plot

10

1104

Risk Ratio (M‐H, Random, 95% CI)

0.98 [0.80, 1.21]

31 Gestational hypertension Show forest plot

2

1130

Risk Ratio (M‐H, Random, 95% CI)

0.78 [0.41, 1.49]

32 Maternal death (death while pregnant or within 42 days of termination of pregnancy) (ALL) Show forest plot

1

180

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

33 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL) Show forest plot

14

2470

Mean Difference (IV, Random, 95% CI)

35.66 [24.19, 47.13]

34 Birth length (cm) Show forest plot

8

931

Mean Difference (IV, Random, 95% CI)

0.57 [0.19, 0.95]

35 Head circumference at birth (cm) Show forest plot

8

1841

Mean Difference (IV, Random, 95% CI)

0.11 [‐0.21, 0.44]

36 Birthweight (g) Show forest plot

17

2828

Mean Difference (IV, Random, 95% CI)

80.30 [‐14.40, 175.00]

37 Stillbirth Show forest plot

3

584

Risk Ratio (M‐H, Random, 95% CI)

0.35 [0.06, 1.98]

38 Neonatal death Show forest plot

2

326

Risk Ratio (M‐H, Random, 95% CI)

0.27 [0.04, 1.67]

39 Apgar score less than seven at five minutes Show forest plot

1

165

Risk Ratio (M‐H, Random, 95% CI)

0.53 [0.11, 2.53]
Figuras y tablas -
Comparison 1. Supplementation with vitamin D alone versus placebo or no intervention (no vitamins or minerals)
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Comparison 2. Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pre‐eclampsia (ALL) Show forest plot

4

1174

Risk Ratio (M‐H, Random, 95% CI)

0.50 [0.32, 0.78]

2 Gestational diabetes (ALL) Show forest plot

1

54

Risk Ratio (M‐H, Random, 95% CI)

0.33 [0.01, 7.84]

3 Preterm birth (less than 37 weeks' gestation) (ALL) Show forest plot

5

942

Risk Ratio (M‐H, Random, 95% CI)

1.52 [1.01, 2.28]

4 Low birthweight (less than 2500 g) (ALL) Show forest plot

2

110

Risk Ratio (M‐H, Random, 95% CI)

0.68 [0.10, 4.55]

5 Caesarean section Show forest plot

2

146

Risk Ratio (M‐H, Random, 95% CI)

1.16 [0.87, 1.54]

6 Gestational hypertension Show forest plot

1

59

Risk Ratio (M‐H, Random, 95% CI)

0.26 [0.06, 1.12]

7 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL) Show forest plot

1

60

Mean Difference (IV, Random, 95% CI)

12.5 [3.80, 21.20]

8 Birth length (cm) Show forest plot

3

194

Mean Difference (IV, Random, 95% CI)

‐0.07 [‐0.67, 0.52]

9 Head circumference at birth (cm) Show forest plot

3

198

Mean Difference (IV, Random, 95% CI)

‐0.03 [‐0.39, 0.33]

10 Birthweight (g) Show forest plot

3

194

Mean Difference (IV, Random, 95% CI)

42.39 [‐86.96, 171.74]

11 Neonatal death Show forest plot

1

660

Risk Ratio (M‐H, Random, 95% CI)

0.2 [0.01, 4.15]
Figuras y tablas -
Comparison 2. Supplementation with vitamin D + calcium versus placebo or no intervention (no vitamin or minerals)
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Comparison 3. Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Gestational diabetes (ALL) Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

0.42 [0.10, 1.73]

2 Maternal adverse events Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Hypercalcaemia

1

1298

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Hypercalciuria

1

1298

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.02, 3.97]

3 Preterm birth (less than 37 weeks' gestation) (ALL) Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

1.04 [0.68, 1.59]

4 Low birthweight (less than 2500 g) (ALL) Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.82, 1.51]

5 Caesarean section Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

1.10 [0.95, 1.27]

6 Gestational hypertension Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.31, 2.79]

7 Maternal death (death while pregnant or within 42 days of termination of pregnancy) Show forest plot

1

1300

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.02, 3.98]

8 Maternal vitamin D concentration at term (25‐hydroxyvitamin D) (nmol/L) (ALL) Show forest plot

1

635

Mean Difference (IV, Random, 95% CI)

75.17 [71.97, 78.37]

9 Birth length (cm) Show forest plot

1

1297

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.28, 0.28]

10 Head circumference at birth (cm) Show forest plot

1

1297

Mean Difference (IV, Random, 95% CI)

0.0 [‐0.17, 0.17]

11 Birthweight (g) Show forest plot

1

1297

Mean Difference (IV, Random, 95% CI)

‐7.0 [‐55.95, 41.95]

12 Stillbirth Show forest plot

1

1300

Risk Ratio (M‐H, Random, 95% CI)

0.66 [0.29, 1.46]

13 Neonatal death Show forest plot

1

1298

Risk Ratio (M‐H, Random, 95% CI)

0.69 [0.22, 2.14]
Figuras y tablas -
Comparison 3. Supplementation with vitamin D + calcium + other vitamins and minerals versus calcium + other vitamins and minerals (but no vitamin D)
Ir a la tabla de la revisión