The Relationship between Vitamin D Levels and Bacterial Vaginosis in Pregnant Women: A Systematic Review and Meta-Analysis

Document Type : Review Article

Authors

1 PhD Student of Reproductive Health, Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 PhD of Reproductive Health, Clinical Research Development Center, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran.

3 PhD of Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 M.Sc. of Midwifery, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

5 M.Sc. student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

6 Assistant professor, Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

7 Professor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Bacterial vaginosis (BV) during pregnancy is associated with adverse outcomes. Some studies have suggested that vitamin D deficiency may contribute to the development of BV, while others have found no association. This systematic review was conducted with aim to determine the relationship between serum vitamin D levels and bacterial vaginosis in pregnant women.
Methods: Electronic databases including PubMed, Web of Science, Scopus, and Embase were searched using the keywords of pregnancy, vitamin ", and bacterial vaginosis without time restrictions up to March 12, 2025. Google search engine was also reviewed. The quality of the included studies was assessed using the modified Newcastle–Ottawa Scale. Meta-analysis was performed using Stata software. Study heterogeneity was assessed using the I² index and Cochran’s Q test, and publication bias was evaluated using funnel plots and Egger’s and Begg’s tests.
Results: Of the initial 224 studies, 15 studies with 4963 participants were included in the review. The association between vitamin D levels and bacterial vaginosis, based on the adjusted odds ratio (AOR=0.98) (95% CI: 0.91–1.05), indicated that due to no statistically significant relationship, vitamin D deficiency was not associated with increased or decreased risk of BV.
Conclusion: Serum vitamin D levels showed no statistically significant association with bacterial vaginosis during pregnancy. It seems that this relationship is influenced by multiple intervening factors, and vitamin D alone cannot be considered an independent risk factor.

Keywords

Main Subjects

References

  1. Coudray MS, Madhivanan P. Bacterial vaginosis—A brief synopsis of the literature. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 245:143-8.
  2. Abbe C, Mitchell CM. Bacterial vaginosis: a review of approaches to treatment and prevention. Frontiers in reproductive health 2023; 5:1100029.
  3. Khedkar R, Pajai S. Bacterial vaginosis: a comprehensive narrative on the etiology, clinical features, and management approach. Cureus 2022; 14(11):e31314.
  4. Sabour S, Arzanlou M, Vaez H, Rahimi G, Sahebkar A, Khademi F. Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: a systematic review and meta-analysis. Archives of gynecology and obstetrics 2018; 297(5):1101-13.
  5. Livani S, Nosrat SB, Alhosseini MN, Sheykholeslami AS, Vakili MA, Ghaemi EA. The role of Gardnerella vaginalis, Autopobium vaginae and Mobiloncus spp in preterm delivery: a case-control study. Iranian Journal of Obstetrics, Gynecology and Infertility 2023; 26(6):50-59.
  6. Bhakta V, Aslam S, Aljaghwani A. Bacterial vaginosis in pregnancy: prevalence and outcomes in a tertiary care hospital. African journal of reproductive health 2021; 25(1):49-55.
  7. Ng BK, Chuah JN, Cheah FC, Mohamed Ismail NA, Tan GC, Wong KK, et al. Maternal and fetal outcomes of pregnant women with bacterial vaginosis. Frontiers in surgery 2023; 10:1084867.
  8. Jayaram PM, Mohan MK, Konje J. Bacterial vaginosis in pregnancy–a storm in the cup of tea. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 253:220-4.
  9. Fan Y, Gu Y, Xian Y, Li Q, He Y, Chen K, et al. Efficacy and safety of different drugs for the treatment of bacterial vaginosis: a systematic review and network meta-analysis. Frontiers in Cellular and Infection Microbiology 2024; 14:1402346.
  10. Abdel Rahman H, Mamdouh SM, Mourad MH, Shokhba NS. Effect of Progressive Muscle Relaxation technique on postpartum afterpains intensity among multiparous women. Alexandria Scientific Nursing Journal 2022; 24(4):48-63.
  11. Mojtahedi SF, Mohammadzadeh A, Mohammadzadeh F, Jalili Shahri J, Bahri N. Association between bacterial vaginosis and 25-Hydroxy vitamin D: a case-control study. BMC Infectious Diseases 2023; 23(1):208.
  12. Nikvarz N, Ghasemnejad Berenji M, Mousavy S, Vazifekhah N. Study of the Effect of High Dose Vitamin D on the Improvement of Bacterial Vaginosis in Vitamin D Deficient Women. J Iran Med Counc 2023; 6(2):272-282.
  13. Guan J, Dong Y, Zhang W, Gui Q, Luo D, Wen H, et al. Effect of vitamin D level on female vaginitis in Xi’an, China. International Journal of Women's Health 2024:2103-12.
  14. Turner AN, Reese PC, Chen PL, Kwok C, Jackson RD, Klebanoff MA, et al. Serum vitamin D status and bacterial vaginosis prevalence and incidence in Zimbabwean women. American journal of obstetrics and gynecology 2016; 215(3):332-e1.
  15. Baloach S, Arshad M, Parveen T, Seher A, Sohail F, Malhan A, et al. Frequency of Vitamin D Deficiency in Patients with Bacterial Vaginosis during First Trimester of Pregnancy: Vitamin D Deficiency in Patients with Bacterial Vaginosis. Pakistan Journal of Health Sciences 2023: 64-7.
  16. Lee CL, Ng BK, Wu LL, Cheah FC, Othman H, Ismail NA. Vitamin D deficiency in pregnancy at term: risk factors and pregnancy outcomes. Hormone molecular biology and clinical investigation 2017; 31(3):20170005.
  17. Palpitany SA, Alchawshili KH, Hassan AZ, Al-Banna DA. Association between Vitamin D Deficiency and Bacterial Vaginosis among First Trimester Pregnant Women in Erbil Maternity Hospital. Diyala Journal of Medicine 2019; 17(1):51-9.
  18. Ma L, Zhang Z, Li L, Zhang L, Lin Z, Qin H. Vitamin D deficiency increases the risk of bacterial vaginosis during pregnancy: Evidence from a meta-analysis based on observational studies. Frontiers in Nutrition 2022; 9:1016592.
  19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. bmj 2021; 372.
  20. Peterson J, Welch V, Losos M, Tugwell PJ. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute 2011; 2(1):1-12.
  21. Osmani V. Methods S1. Modified Newcastle-Ottawa Scale (NOS) Scale. BMJ Glob Health 2025; 10:e017309.
  22. Ana PH, Patrícia AD, Carolina CM. Quality assessment criteria used for cross-sectional studies through a modified version of Newcastle-Ottawa Scale for observational studies. PLoS ONE Dataset; 2014.
  23. Olivier J, May WL, Bell ML. Relative effect sizes for measures of risk. Communications in statistics-theory and methods 2017; 46(14):6774-81.
  24. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane database of systematic reviews 2019; 2019(10):ED000142.
  25. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. bmj 1997; 315(7109):629-34.
  26. NA P. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol 2008; 37:1148-57.
  27. Mahesh N, Navikala K, Seshadri JG. Comparison of Serum Vitamin D Levels with and without Bacterial Vaginosis among Women in First Trimester of Pregnancy in a Tertiary Care Hospital. Journal of South Asian Federation of Obstetrics and Gynaecology 2023; 15(3):287-91.
  28. Christoph P, Challande P, Raio L, Surbek D. High prevalence of severe vitamin D deficiency during the first trimester in pregnant women in Switzerland and its potential contributions to adverse outcomes in the pregnancy. Swiss medical weekly 2020; 150(2122):w20238.
  29. Akoh CC, Pressman EK, Cooper E, Queenan RA, Pillittere J, O’Brien KO. Low vitamin D is associated with infections and proinflammatory cytokines during pregnancy. Reproductive Sciences 2018; 25(3):414-23.
  30. Rosen EM, Martin CL, Siega‐Riz AM, Dole N, Basta PV, Serrano M, et al. Is prenatal diet associated with the composition of the vaginal microbiome?. Paediatric and perinatal epidemiology 2022; 36(2):243-53.
  31. Hensel KJ, Randis TM, Gelber SE, Ratner AJ. Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis. American journal of obstetrics and gynecology 2011; 204(1):41-e1.
  32. Dunlop AL, Taylor RN, Tangpricha V, Fortunato S, Menon R. Maternal vitamin D, folate, and polyunsaturated fatty acid status and bacterial vaginosis during pregnancy. Infectious diseases in obstetrics and gynecology 2011; 2011(1):216217.
  33. Dunlop AL, Jordan SL, Ferranti EP, Hill CC, Patel S, Hao L, et al. Total and Free 25‐Hydroxy‐Vitamin D and Bacterial Vaginosis in Pregnant African American Women. Infectious Diseases in Obstetrics and Gynecology 2019; 2019(1):9426795.
  34. Bodnar LM, Krohn MA, Simhan HN. Maternal vitamin D deficiency is associated with bacterial vaginosis in the first trimester of pregnancy. The Journal of nutrition 2009; 139(6):1157-61.
  35. Aied Nehi Z, Ghani Omran D, HMhdei K, Abdulazeem L. Effects of parathyroid hormone and Vitamin –D level on incidence of bacterial vaginosis during first trimester of pregnancy. NeuroQuantology 2022; 20(8):7583-90.
  36. Riahinejad S, Ghasemi-Tehrani H, Alipour-Hafshejani E, Ghasemi M, Nourizadeh-Dehkordi F. Valuation of vitamin d level at the end of first trimester and its relation with anemia, bacterial vaginosis, and toothache in pregnant mothers. Journal of Isfahan Medical School 2014; 32(311):2015-24.
  37. Maliar VV. Perinatal aspects of pregnancy and childbirth on the background of vitamin D lack in pregnant women. ALUNA Publishing House; 2021.
  38. Artusa P, White JH. Vitamin D and its analogs in immune system regulation. Pharmacological Reviews 2025; 77(2):100032.
  39. Liu N, Kaplan AT, Low J, Nguyen L, Liu GY, Equils O, et al. Vitamin D induces innate antibacterial responses in human trophoblasts via an intracrine pathway. Biology of reproduction 2009; 80(3):398-406.
  40. Davis LM, Chang SC, Mancini J, Nathanson MS, Witter FR, O'Brien KO. Vitamin D insufficiency is prevalent among pregnant African American adolescents. Journal of pediatric and adolescent gynecology 2010; 23(1):45-52.
  41. Balu RB, Savitz DA, Ananth CV, Hartmann KE, Miller WC, Thorp JM, et al. Bacterial vaginosis, vaginal fluid neutrophil defensins, and preterm birth. Obstetrics & Gynecology 2003; 101(5):862-8.
  42. Simhan HN, Caritis SN, Krohn MA, Hillier SL. The vaginal inflammatory milieu and the risk of early premature preterm rupture of membranes. American journal of obstetrics and gynecology 2005; 192(1):213-8.
  43. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: Double‐blind, randomized clinical trial of safety and effectiveness. Journal of bone and mineral research 2011; 26(10):2341-57.
  44. Scholl TO CX, Stein TP. Vitamin D supplementation during pregnancy: an overview of maternal characteristics and birth outcomes. Am J Obstet Gynecol 2014; 211(3):e1-8.
  45. Skowrońska-Jóźwiak E, Lebiedzińska K, Smyczyńska J, Lewandowski KC, Głowacka E, Lewiński A. Effects of maternal vitamin D status on pregnancy outcomes, health of pregnant women and their offspring. Neuro Endocrinol Lett 2014; 35(5):367-72.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 28, Issue 11
January 2026
Pages 80-99

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