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Association between early pregnancy vitamin A levels and adverse pregnancy outcomes: a prospective cohort study
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DOI：10.1186/s12884-026-09797-5.png)
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Abstract
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Vitamin A plays a critical role during pregnancy, supporting fetal development, maternal immune function, and antioxidant defense. However, both deficiency and excess of vitamin A have been associated with adverse pregnancy outcomes (APOs). This prospective cohort study investigated the association between serum vitamin A concentrations during early pregnancy and the occurrence of APOs, with a particular focus on potential nonlinear relationships. A total of 379 pregnant women were included. Multivariable logistic regression models were employed to evaluate associations between vitamin A levels and both individual adverse pregnancy outcomes and composite maternal outcomes (miscarriage, gestational diabetes mellitus, and postpartum hemorrhage) and composite fetal outcomes (preterm birth, neonatal asphyxia, macrosomia, and low birth weight), adjusting for key covariates. Nonlinear dose–response patterns were examined using restricted cubic spline analysis. Among the 379 participants, the median maternal age was 29.0 years and the median body mass index was 22.2 kg/m2. Overall, 131 women (34.6%) experienced at least one APO. Specifically, 62 (16.4%) had gestational diabetes mellitus, 34 (9.0%) experienced postpartum hemorrhage, and 33 (8.7%) had macrosomia. In fully adjusted models, higher maternal vitamin A concentrations were associated with higher odds of composite outcomes, with odds ratios of 1.36 (95% confidence interval [CI]: 1.06, 1.77) for maternal outcomes and 1.45 (95% CI: 1.11, 1.90) for fetal outcomes per standard deviation increase. Significant associations persisted for macrosomia and postpartum hemorrhage after full adjustment, whereas the association with gestational diabetes mellitus was attenuated and no longer statistically significant. The main evidence was derived from composite outcomes, with gestational diabetes mellitus and macrosomia accounting for the largest proportions of the maternal and fetal composite outcomes, respectively. However, none of the individual associations remained statistically significant after false discovery rate correction. Restricted cubic spline analyses indicated a nonlinear association, with a steeper increase in odds above approximately 1.50 µmol/L (0.43 mg/L). Stratified analyses further indicated that this association was more pronounced among women enrolled at ≥ 10 gestational weeks. These findings suggest that relatively higher maternal vitamin A concentrations within the physiological range were associated with higher odds of APOs, primarily for composite outcomes.
Keywords:
Vitamin A
Pregnancy
Maternal nutrition
Adverse pregnancy outcomes
First trimester
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