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Effect of Maternal Vitamin D Supplementation on Preterm Birth among Pregnant Women in Nigeria

Abstract

Preterm birth remains an important public health concern in Nigeria and is a major contributor to neonatal morbidity, mortality, and long-term developmental complications. Infants born before 37 completed weeks of gestation are at increased risk of respiratory difficulties, infections, feeding problems, impaired growth, neurological complications, and prolonged hospitalization. Maternal nutritional status during pregnancy may influence pregnancy outcomes, and vitamin D has been implicated in maternal and fetal health, immune regulation, placental function, and maintenance of pregnancy. Maternal vitamin D supplementation may therefore provide an opportunity to improve maternal nutritional status and potentially reduce the risk of preterm birth. However, vitamin D deficiency, inadequate dietary intake, limited access to supplements, poor adherence, insufficient antenatal nutritional counselling, and socioeconomic barriers may affect maternal supplementation in Nigeria. Against this background, this study investigates the effect of maternal vitamin D supplementation on preterm birth among pregnant women in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of nutritional deficiencies, perceived benefits of supplementation, perceived barriers, and cues to action may influence adherence to vitamin D supplementation. The Social Ecological Model emphasizes the influence of individual, household, community, healthcare, nutritional, socioeconomic, and environmental factors on maternal nutrition and pregnancy outcomes. The Health Systems Framework emphasizes antenatal service delivery, health workforce, availability of nutritional supplements, health information, financing, governance, and accessibility as important components of effective maternal nutritional healthcare. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal vitamin D supplementation may influence preterm birth among pregnant women in Nigeria. The study will adopt a quantitative analytical cohort or retrospective cohort research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities in Nigeria. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible deliveries. Maternal vitamin D supplementation will be assessed using indicators such as receipt of vitamin D supplements during pregnancy, timing of supplementation initiation, dosage, duration of supplementation, adherence, frequency of use, availability of supplements, antenatal nutritional counselling, and documentation of supplementation. Preterm birth will be assessed using gestational age at delivery, with preterm birth defined as delivery before 37 completed weeks of gestation. Additional pregnancy outcomes, including very preterm birth and birth weight, may be assessed to provide further context. Data will be collected using structured questionnaires, antenatal care records, maternal health records, supplement prescription or distribution records, laboratory records where available, delivery registers, and newborn records. Descriptive statistics will be used to summarize maternal characteristics, vitamin D supplementation patterns, adherence, gestational age, and pregnancy outcomes. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of maternal vitamin D supplementation on preterm birth. Where a cohort design is adopted, the incidence of preterm birth among women receiving adequate vitamin D supplementation may be compared with that among women receiving inadequate or no supplementation, while relevant maternal, nutritional, socioeconomic, and pregnancy-related factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that adequate maternal vitamin D supplementation is associated with a lower risk of preterm birth among pregnant women in Nigeria. Women who receive and adhere to appropriate vitamin D supplementation during pregnancy are expected to have a lower likelihood of delivering before 37 completed weeks compared with women with inadequate or no supplementation. Adequate vitamin D status may support maternal health, immune function, placental function, and normal pregnancy development. However, the relationship between vitamin D supplementation and preterm birth may also be influenced by maternal infections, malaria, hypertension, nutritional status, maternal age, socioeconomic conditions, multiple pregnancy, previous preterm birth, and other obstetric complications. Limited access to supplements, poor adherence, inadequate nutritional counselling, and late initiation of antenatal care may reduce the potential benefits of supplementation. The study therefore expects timely and appropriately managed maternal vitamin D supplementation, together with quality antenatal care and comprehensive maternal nutrition services, to contribute to reducing the risk of preterm birth in Nigeria. The study is expected to contribute to the literature on maternal vitamin D supplementation, vitamin D deficiency, preterm birth, maternal nutrition, antenatal care, pregnancy outcomes, maternal health, newborn health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, healthcare facilities, maternal and child health programmes, obstetricians, midwives, nutritionists, community health workers, development partners, and policymakers regarding strategies for strengthening maternal nutritional care. The study will also provide evidence-based recommendations for improving maternal nutritional assessment, increasing access to appropriate vitamin D supplementation, strengthening antenatal nutritional counselling, improving adherence to supplementation, addressing barriers to maternal nutritional care, and integrating evidence-based maternal nutrition interventions into broader antenatal and maternal health programmes across Nigeria.

Keywords: Maternal vitamin D supplementation, preterm birth, vitamin D deficiency, maternal nutrition, pregnancy outcomes, antenatal care, maternal health, gestational age, newborn health, Nigeria, public health.