Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Ultraviolet radiation and effects on humans: the paradigm of maternal vitamin D production during pregnancy

Subjects

Abstract

Current evidence indicates that neonates born of mothers with vitamin D deficiency during pregnancy have greater risk for developing hypocalcemia, rickets and extra-skeletal disorders. Despite the classic knowledge that ultraviolet-B (UVB) exposure is the most efficient way for a future mother to obtain optimal vitamin D concentrations, no current consensus or clinical recommendations exist regarding the duration and timing of UVB exposure for pregnant women. This article offers a narrative review of available data regarding how UVB exposure affects maternal vitamin D production during pregnancy, along with a discourse on clinical implications of this public health issue. Future studies would benefit from adopting UVB exposure estimates to recommend appropriate UVB exposure to pregnant women. Doing so could provide a more holistic and practical approach in managing maternal hypovitaminosis D during pregnancy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ross AC, Manson JE, Abrams SA, Aloia JF, Brannon PM, Clinton SK et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 2011; 96: 53–58.

    Article  CAS  Google Scholar 

  2. Rosen CJ, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE et al. The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 2012; 33: 456–492.

    Article  CAS  Google Scholar 

  3. Binkley N, Novotny R, Krueger D, Kawahara T, Daida YG, Lensmeyer G et al. Low vitamin D status despite abundant sun exposure. J Clin Endocrinol Metab 2007; 92: 2130–2135.

    Article  CAS  Google Scholar 

  4. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96: 1911–1930.

    Article  CAS  Google Scholar 

  5. Grant WB, Wimalawansa SJ, Holick MF, Cannell JJ, Pludowski P, Lappe JM et al. Emphasizing the health benefits of vitamin D for those with neurodevelopmental disorders and intellectual disabilities. Nutrients 2015; 7: 1538–1564.

    Article  CAS  Google Scholar 

  6. vanSchoor NM, Lips P . Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011; 25: 671–680.

    Article  CAS  Google Scholar 

  7. Lapillonne A . Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses 2010; 74: 71–75.

    Article  CAS  Google Scholar 

  8. Nassar N, Halligan GH, Roberts CL, Morris JM, Ashton AW . Systematic review of first-trimester vitamin D normative levels and outcomes of pregnancy. Am J Obstet Gynecol 2011; 205: 208.

    Article  CAS  Google Scholar 

  9. Thorne-Lyman A, Fawzi WW . Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol 2012; 26: 75–90.

    Article  Google Scholar 

  10. Moon R, Harvey N, Cooper C . Endocrinology in pregnancy: influence of maternal vitamin D status on obstetric outcomes and the foetal skeleton. Eur J Endocrinol 2015; 173: R69–R83.

    Article  CAS  Google Scholar 

  11. Wagner CL, Baggerly C, McDonnell SL, Baggerly L, Hamilton SA, Winkler J et al. Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery. J Steroid Biochem Mol Biol 2015; 148: 256–260.

    Article  CAS  Google Scholar 

  12. Perez-Lopez FR . Low maternal vitamin D status during pregnancy requires appropriate therapeutic intervention. Int J Gynaecol Obstet 2012; 116: 4–5.

    Article  Google Scholar 

  13. United Nations Environment Programme, Environmental Effects Assessment Panel, Andrady A, Aucamp PJ, Bais AF, Ballaré CL, Björn LO et al. Environmental effects of ozone depletion and its interactions with climate change: progress report, 2009 Photochem Photobiol Sci 9: 275–294.

  14. Gallagher RP, Lee TK, Bajdik CD, Borugian M . Ultraviolet radiation. Chronic Dis Can 2010; 29: 51–68.

    PubMed  Google Scholar 

  15. Godar DE, Pope SJ, Grant WB, Holick MF . Solar UV doses of young Americans and vitamin D3 production. Environ Health Perspect 2012; 120: 139–143.

    Article  CAS  Google Scholar 

  16. Juzeniene A, Brekke P, Dahlback A . Solar radiation and human health. Rep Prog Phys 2011; 74: 1–56.

    Article  Google Scholar 

  17. Saraiva GL, Cendoroglo MS, Ramos LR, Araújo LM, Vieira JG, Kunii I et al. Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of Sao Paulo (23 degrees 34'S), Brazil. Osteoporos Int 2005; 16: 1649–1654.

    Article  CAS  Google Scholar 

  18. Holick MF, Chen TC, Lu Z, Sauter E . Vitamin D and skin physiology: a D-lightful story. J Bone Miner Res 2007; 22: V28–V33.

    Article  CAS  Google Scholar 

  19. Bais AF, Lubin D . Surface Ultraviolet Radiation: Past and Future. In: Scientific Assessment of Ozone Depletion: 2002, Global Ozone Research and Monitoring Project Report No. 50, 572 pp, World Meteorology Organisation: Geneva, Switzerland, 7.1–7.54.

  20. World Health Organization (WHO) Global Solar UV Index, A Practical Guide. 2002. Available at: http://www.who.int/pehuv/publications/publications.htm.

  21. Engelsen O . The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients 2010; 2: 482–495.

    Article  CAS  Google Scholar 

  22. Holick MF . Environmental factors that influence the cutaneous production of vitamin D. Am J Clin Nutr 1995; 61: 638S–645S.

    Article  CAS  Google Scholar 

  23. Faurschou A, Beyer DM, Schmedes A, Bogh MK, Philipsen PA, Wulf HC . The relation between sunscreen layer thickness and vitamin D production after ultraviolet B exposure: a randomized clinical trial. Br J Dermatol 2012; 167: 391–395.

    Article  CAS  Google Scholar 

  24. Rice SA, Carpenter M, Fityan A, Vearncombe LM, Ardern-Jones M, Jackson AA et al. Limited exposure to ambient ultraviolet radiation and 25-hydroxyvitamin D levels: a systematic review. Br J Dermatol 2015; 172: 652–661.

    Article  CAS  Google Scholar 

  25. Webb AR . Who, what, where and when-influences on cutaneous vitamin D synthesis. Prog Biophys Mol Biol 2006; 92: 17–25.

    Article  CAS  Google Scholar 

  26. Fitzpatrick TB . The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 1988; 124: 869–871.

    Article  CAS  Google Scholar 

  27. Bogh MK . Vitamin D production after UVB: aspects of UV-related and personal factors. Scand J Clin Lab Invest Suppl 2012; 243: 24–31.

    PubMed  Google Scholar 

  28. Jablonski NG . Human skin pigmentation as an example of adaptive evolution. Proc Am Philos Soc 2012; 156: 45–57.

    PubMed  Google Scholar 

  29. Jablonski NG . The evolution of human skin colouration and its relevance to health in the modern world. J R Coll Physicians Edinb 2012; 42: 58–63.

    Article  CAS  Google Scholar 

  30. Fioletov VE, McArthur LJ, Mathews TW, Marret L . On the relationship between erythemal and vitamin D action spectrum weighted ultraviolet radiation. J Photochem Photobiol B 2009; 95: 9–16.

    Article  CAS  Google Scholar 

  31. Stalgis-Bilinski KL, Boyages J, Salisbury EL, Dunstan CR, Henderson SI, Talbot PL . Burning daylight: balancing vitamin D requirements with sensible sun exposure. Med J Aust 2011; 194: 345–348.

    PubMed  Google Scholar 

  32. Macdonald HM . Contributions of sunlight and diet to vitamin D status. Calcif Tissue Int 2013; 92: 163–176.

    Article  CAS  Google Scholar 

  33. Sayre RM, Dowdy JC, Shepherd JG . Variability of pre-vitamin D3 effectiveness of UV appliances for skin tanning. J Steroid Biochem Mol Biol 2010; 121: 331–333.

    Article  CAS  Google Scholar 

  34. Nair-Shalliker V, Clements M, Fenech M, Armstrong BK . Personal sun exposure and serum 25-hydroxy vitamin D concentrations. Photochem Photobiol 2013; 89: 208–214.

    Article  CAS  Google Scholar 

  35. Kimlin MG, Olds WJ, Moore MR . Location and vitamin D synthesis: is the hypothesis validated by geophysical data? J Photochem Photobiol B 2007; 86: 234–239.

    Article  CAS  Google Scholar 

  36. Webb AR, Holick MF . The role of sunlight in the cutaneous production of vitamin D3. Annu Rev Nutr 1988; 8: 375–399.

    Article  CAS  Google Scholar 

  37. Sayers A, Tilling K, Boucher BJ, Noonan K, Tobias JH . Predicting ambient ultraviolet from routine meteorological data; its potential use as an instrumental variable for vitamin D status in pregnancy in a longitudinal birth cohort in the UK. Int J Epidemiol 2009; 38: 1681–1688.

    Article  Google Scholar 

  38. Thieden E, Jørgensen HL, Jørgensen NR, Philipsen PA, Wulf HC . Sunbed radiation provokes cutaneous vitamin D synthesis in humans—a randomized controlled trial. Photochem Photobiol 2008; 84: 1487–1492.

    Article  CAS  Google Scholar 

  39. de Gruijl FR . Sufficient vitamin D from casual sun exposure? Photochem Photobiol 2011; 87: 598–601.

    Article  CAS  Google Scholar 

  40. Holick MF . Vitamin D deficiency: what a pain it is. Mayo Clin Proc 2003; 12: 1457–1459.

    Article  Google Scholar 

  41. Dowdy JC, Sayre RM, Holick MF . Holick's rule and vitamin D from sunlight. J Steroid Biochem Mol Biol 2010; 121: 328–330.

    Article  CAS  Google Scholar 

  42. Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A et al. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys 2007; 460: 213–217.

    Article  CAS  Google Scholar 

  43. Gillie O . Sunlight robbery: a critique of public health policy on vitamin D in the UK. Mol Nutr Food Res 2010; 54: 1148–1163.

    CAS  PubMed  Google Scholar 

  44. Webb AR, Kift R, Berry JL, Rhodes LE . The vitamin D debate: translating controlled experiments into reality for human sun exposure times. Photochem Photobiol 2011; 87: 741–745.

    Article  CAS  Google Scholar 

  45. Grant WB, Holick MF . Benefits and requirements of vitamin D for optimal health: a review. Altern Med Rev 2005; 10: 94–111.

    PubMed  Google Scholar 

  46. Thieden E, Philipsen PA, Heydenreich J, Wulf HC . Vitamin D level in summer and winter related to measured UVR exposure and behavior. Photochem Photobiol 2009; 85: 1480–1484.

    Article  CAS  Google Scholar 

  47. Samanek AJ, Croager EJ, Gies P, Milne E, Prince R, McMichael AJ et al. Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres. Med J Aust 2006; 184: 338–341.

    PubMed  Google Scholar 

  48. Rhodes LE1, Webb AR, Fraser HI, Kift R, Durkin MT, Allan D et al. Recommended summer sunlight exposure levels can produce sufficient (> or =20 ng/ml) but not the proposed optimal (> or =32 ng/ml) 25(OH)D levels at UK latitudes. J Invest Dermatol 2010; 130: 1411–1418.

    Article  CAS  Google Scholar 

  49. Edvardsen K, Brustad M, Engelsen O, Aksnes L . The solar UV radiation level needed for cutaneous production of Vitamin D in the face. A study conducted among subjects living at a high latitude [68 °N]. Photochem Photobiol Sci 2007; 6: 57–62.

    Article  CAS  Google Scholar 

  50. Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ . Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr 2003; 77: 204–210.

    Article  CAS  Google Scholar 

  51. Bogh MK, Schmedes AV, Philipsen PA, Thieden E, Wulf HC . Vitamin D production after UVB exposure depends on baseline vitamin D and total cholesterol but not on skin pigmentation. J Invest Dermatol 2010; 130: 546–553.

    Article  CAS  Google Scholar 

  52. Glossmann HH . Origin of 7-dehydrocholesterol (provitamin D) in the skin. J Invest Dermatol 2010; 130: 2139–2141.

    Article  CAS  Google Scholar 

  53. Juzeniene A, Moan J . Beneficial effects of UV radiation other than via vitamin D production. Dermatoendocrinol 2012; 4: 109–117.

    Article  CAS  Google Scholar 

  54. Unna PG Die Histopathologie der Hautkrankheiten. In: Orth J (ed). Lehrbuch der speziellen pathologischen Anatomie. August Hirschwald: Berlin, Germany, 1984, pp 839–842..

  55. Reichrath J, Reichrath S . Hope and challenge: the importance of ultraviolet (UV) radiation for cutaneous vitamin D synthesis and skin cancer. Scand J Clin Lab Invest Suppl 2012; 243: 112–119.

    PubMed  Google Scholar 

  56. Norman AW . From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr 2008; 88: 491S–499S.

    Article  CAS  Google Scholar 

  57. Grant WB, Garland CF, Holick MF . Comparisons of estimated economic burdens due to insufficient solar ultraviolet irradiance and vitamin D and excess solar UV irradiance for the United States. Photochem Photobiol 2005; 81: 1276–1286.

    Article  CAS  Google Scholar 

  58. Grant WB . In defense of the sun: an estimate of changes in mortality rates in the United States if mean serum 25-hydroxyvitamin D levels were raised to 45 ng/mL by solar ultraviolet-B irradiance. Dermatoendocrinol 2009; 1: 207–214.

    Article  CAS  Google Scholar 

  59. Haggarty P, Campbell DM, Knox S, Horgan GW, Hoad G, Boulton E et al. Vitamin D in pregnancy at high latitude in Scotland. Br J Nutr 2013; 109: 898–905.

    Article  CAS  Google Scholar 

  60. Wuertz C, Gilbert P, Baier W, Kunz C . Cross-sectional study of factors that influence the 25-hydroxyvitamin D status in pregnant women and in cord blood in Germany. Br J Nutr 2013; 110: 1895–1902.

    Article  CAS  Google Scholar 

  61. Jiang L, Xu J, Pan S, Xie E, Hu Z, Shen H . High prevalence of hypovitaminosis D among pregnant women in southeast China. Acta Paediatr 2012; 101: e192–e194.

    Article  Google Scholar 

  62. Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL . Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26: 2341–2357.

    Article  CAS  Google Scholar 

  63. Çuhacı-Çakır B, Demirel F . Effects of seasonal variation and maternal clothing style on vitamin D levels of mothers and their infants. Turk J Pediatr 2014; 56: 475–481.

    PubMed  Google Scholar 

  64. Vandevijvere S, Amsalkhir S, Van Oyen H, Moreno-Reyes R . High prevalence of vitamin D deficiency in pregnant women: a national cross-sectional survey. PLoS One 2012; 7: e43868.

    Article  CAS  Google Scholar 

  65. Drincic AT, Armas LA, Van Diest EE, Heaney RP . Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 2012; 20: 1444–1448.

    Article  CAS  Google Scholar 

  66. Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ et al. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet 2006; 367: 36–43.

    Article  CAS  Google Scholar 

  67. Karras SN, Anagnostis P, Paschou SA, Kandaraki E, Goulis DG . Vitamin D status during pregnancy: time for a more unified approach beyond borders? Eur J Clin Nutr 2015; 69: 874–877.

    Article  CAS  Google Scholar 

  68. Lee A, Garbutcheon-Singh KB, Dixit S, Brown P, Smith SD . The influence of age and gender in knowledge, behaviors and attitudes towards sun protection: a cross-sectional survey of Australian outpatient clinic attendees. Am J Clin Dermatol 2015; 16: 47–54.

    Article  Google Scholar 

  69. Lodén M, Beitner H, Gonzalez H, Edström DW, Akerström U, Austad J et al. Sunscreen use: controversies, challenges and regulatory aspects. Br J Dermatol 2011; 165: 255–262.

    Article  Google Scholar 

  70. Beltran AJ, Wu J, Laurent O . Associations of meteorology with adverse pregnancy outcomes: a systematic review of preeclampsia, preterm birth and birth weight. Int J Environ Res Public Health 2014; 11: 91–172.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S N Karras.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Anastasiou, A., Karras, S., Bais, A. et al. Ultraviolet radiation and effects on humans: the paradigm of maternal vitamin D production during pregnancy. Eur J Clin Nutr 71, 1268–1272 (2017). https://doi.org/10.1038/ejcn.2016.188

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2016.188

This article is cited by

Search

Quick links