BackgroundVitamin D concentrations during pregnancy are measured to diagnose states of insufficiency or deficiency. The aim of this study is to apply accurate assays of vitamin D forms [single- hydroxylated [25(OH)D2, 25(OH)D3], double-hydroxylated [1α,25(OH)2D2, 1α,25(OH)2D3], epimers [3-epi-25(OH)D2, 3-epi-25(OH)D3] in mothers (serum) and neonates (umbilical cord) to i) explore maternal and neonatal vitamin D biodynamics and ii) to identify maternal predictors of neonatal vitamin D concentrations.MethodsAll vitamin D forms were quantified in 60 mother- neonate paired samples by a novel liquid chromatography -mass spectrometry (LC-MS/MS) assay. Maternal characteristics [age, ultraviolet B exposure, dietary vitamin D intake, calcium, phosphorus and parathyroid hormone] were recorded. Hierarchical linear regression was used to predict neonatal 25(OH)D concentrations.ResultsMothers had similar concentrations of 25(OH)D2 and 25(OH)D3 forms compared to neonates (17.9 ± 13.2 vs. 15.9 ± 13.6 ng/mL, p = 0.289) with a ratio of 1:3. The epimer concentrations, which contribute approximately 25% to the total vitamin D levels, were similar in mothers and neonates (4.8 ± 7.8 vs. 4.5 ± 4.7 ng/mL, p = 0.556). No correlation was observed in mothers between the levels of the circulating form (25OHD3) and its active form. Neonatal 25(OH)D2 was best predicted by maternal characteristics, whereas 25(OH)D3 was strongly associated to maternal vitamin D forms (R2 = 0.253 vs. 0.076 and R2 = 0.109 vs. 0.478, respectively). Maternal characteristics explained 12.2% of the neonatal 25(OH)D, maternal 25(OH)D concentrations explained 32.1%, while epimers contributed an additional 11.9%.ConclusionsBy applying a novel highly specific vitamin D assay, the present study is the first to quantify 3-epi-25(OH)D concentrations in mother - newborn pairs. This accurate assay highlights a considerable proportion of vitamin D exists as epimers and a lack of correlation between the circulating and active forms. These results highlight the need for accurate measurements to appraise vitamin D status. Maternal characteristics and circulating forms of vitamin D, along with their epimers explain 56% of neonate vitamin D concentrations. The roles of active and epimer forms in the maternal - neonatal vitamin D relationship warrant further investigation.

Vitamin D status during pregnancy is linked to bone mineralization of developing fetus, which justifies targeting sufficient levels of vitamin D in pregnant women. Despite high level of sunshine in the Mediterranean regions, maternal hypovitaminosis D remain common in these countries. The aim of this narrative review was to provide potential explanations for this phenomenon in an effort to guide future public health policies and vitamin D intakes during pregnancy. We searched Medline for publications regarding hypovitaminosis D during pregnancy in the Mediterranean region. Available studies confirmed the high prevalence of hypovitaminosis D among pregnant women in the Mediterranean regions (50-65% in most studies), resulting in severe skeletal and nonskeletal health events among the offspring. Reasons for this may rely on maternal darker skin pigmentation, poor dietary vitamin D intake, veiled clothing and reduced sunshine exposure, health policies and increased prevalence of obesity. Public health organizations should be aware of this phenomenon and develop specific policies to prevent hypovitaminosis D and its adverse outcomes in maternal and neonatal health. INTRODUCTIONPregnancy comprises a critical time frame in which the growing fetus is under the influence of a plethora of exogenous and endogenous factors. These factors have been hypothesized to be involved in lasting changes in the body composition, the physiology and the metabolism of the offspring. One of the biological factors is maternal vitamin D status during pregnancy. Maternal hypovitaminosis D during pregnancy has been related to several neonatal and maternal adverse health outcomes. 1 On physiological basis, the developing fetus primarily obtains the necessary amounts of vitamin D for bone mineralization and other functions through adequate maternal stores. 2 Therefore, optimizing maternal vitamin D status during pregnancy has been proposed by health organizations and nutrition specialists as the most efficient method for the prevention of this condition. 3,4 Inspite of current recommendations, 3,4 several cross-sectional observational studies conducted across Europe, including the Mediterranean regions, have shown a very high prevalence of pregnant populations with vitamin D deficiency. It is all the more surprising in that nutritional sources provide only o10% of the daily requirement of vitamin D, 3,4 the remainder coming from the synthesis of vitamin D in the skin under the effect of solar radiation. The phenomenon of a just as similar or even higher prevalence of maternal vitamin D deficiency during pregnancy in southern European countries compared with central or northern ones warrants further investigation. This article aimed at listing possible explanations for this phenomenon in an effort to guide future public health policies and vitamin D intakes during pregnancy, while also providing a

The aim of this study was to assess whether the levels of physical activity before and during early pregnancy are associated with the prevalence of gestational diabetes mellitus (GDM). The study group included 160 puerperas. Among them, 40 (25%) diagnosed as having GDM during their recent pregnancy, whereas the remaining 120 (75%) served as controls. The international physical activity questionnaire (IPAQ-Greek version) was applied twice, in an attempt to estimate the level of physical activity before and during early pregnancy. Women who were "inactive" before or during early pregnancy had odds ratio (OR) 7.9 [95% confidence interval (CI) 3.7-16.56] and 1.3 (95% CI 1.2-1.4) of developing GDM, compared to "minimally active" or "active" women, respectively. Pregnancy resulted in a decrease in the level of physical activity (P < 0.005) during early pregnancy, independently of the diagnosis of GDM and morbidity during early pregnancy. We conclude that physical inactivity before and during early pregnancy is associated with increased risk for developing GDM in late pregnancy.

Gestational diabetes mellitus (GDM) is a topic of major interest, as it affects up to 16% of pregnant women and may lead to adverse pregnancy outcomes, which, however, are preventable by appropriate treatment. The aim of the present study was to discuss basic concepts and to critically appraise recent updates on practical issues in the field of GDM. GDM pathophysiology, long-term complications including "fetal programming" and GDM diagnosis are discussed, while clinical practice guidelines on follow-up, medical nutrition therapy, oral hypoglycemic agents and insulin treatment are also reviewed. GDM comprises a serious yet preventable public health problem and prevention by lifestyle changes, early detection and adequate treatment can lead to better health outcomes for both mothers with GDM and their offspring.

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