Vitamin D Deficiency Linked to Bacterial Vaginosis in Pregnant Women

Laurie Barclay, MD

October 06, 2010

October 6, 2010 — Vitamin D deficiency (VDD) has been linked to bacterial vaginosis (BV) among pregnant women, according to the results of a study reported online October 4 in the American Journal of Obstetrics & Gynecology.

"Recent data suggest ...VDD is associated with ...BV during pregnancy," write Katherine J. Hensel, MPH, from the College of Physicians and Surgeons at Columbia University in New York, NY, and colleagues. "We hypothesized that VDD is a risk factor for BV in nonpregnant women."

The investigators conducted multivariable logistic regression analyses stratified by pregnancy, using data from the National Health and Nutrition Examination Survey.

In pregnant women, but not in nonpregnant women, VDD was associated with an increased risk for BV (adjusted odds ratio [AOR], 2.87; 95% confidence interval [CI], 1.13 - 7.28).

Factors associated with BV in nonpregnant women were douching (AOR, 1.72; 95% CI, 1.25 - 2.37), smoking (AOR, 1.66; 95% CI, 1.23 - 2.24), and black race (AOR, 2.41; 95% CI, 1.67 - 3.47). Use of oral contraceptives was inversely associated with BV (AOR, 0.60; 95% CI, 0.40 - 0.90). In nonpregnant women, VDD modulated the association between smoking and BV.

"Risk factors for BV differ by pregnancy status," the study authors write. "VDD was a modifiable risk factor for BV among pregnant women; evaluation of vitamin D supplementation for prevention or adjunct therapy of BV in pregnancy is warranted."

Limitations of this study include cross-sectional design, sexual behavior data limited to women 20 years or older, and information on unprotected sex asked only of women reporting multiple sexual partners in 1 year. In addition, changes in laboratory methods with time may result in variability in the vitamin D assay, and this analysis did not examine the association between VDD and BV by trimester of pregnancy.

"Because antimicrobial treatment for BV has failed to reduce some adverse sequelae of this disease in pregnancy, BV prevention is paramount," the study authors conclude. "[I]dentification of VDD as a modifiable risk factor for BV among pregnant women may be important in improving health outcomes among this population....In addition, optimization of strategies for the use of prenatal vitamins, including preconceptual use, may aid in the prevention of BV during pregnancy."

Senior author Adam J. Ratner, MD, MPH, is supported by the Doris Duke Charitable Foundation, Flight Attendant Medical Research Institute, John M. Driscoll Children's Fund Scholar Award (Columbia University), Louis V. Gerstner Jr Scholar Award (Columbia University), and Irving Scholars Award (Columbia University).

Am J Obstet Gynecol. Published online October 4, 2010.

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