Ethnic disparities in the dietary requirement for Vitamin D during pregnancy: Considerations for nutrition policy and research

Despite the inverse association between skin colour and efficiency of cutaneous Vitamin D synthesis, in addition to the widely accepted racial disparity in Vitamin D status, populations of ethnic minority are understudied in terms of setting target serum 25-hydroxyvitamin D concentrations and corresponding dietary requirements for Vitamin D. In minority groups, prevention of Vitamin D deficiency on a population basis is challenging due to the lack of clarity surrounding the metabolism and transport of Vitamin D. Authoritative agencies have been unable to define pregnancy-specific dietary recommendations for Vitamin D, owing to an absence of sufficient evidence to confirm whether nutritional requirements for Vitamin D are altered during pregnancy. While the question of setting race- and pregnancy-specific dietary reference values for Vitamin D has not been addressed to date, endemic Vitamin D deficiency has been reported among gravidae worldwide, specifically among ethnic minorities and white women resident at high latitude. In light of the increased risk of nutritional rickets among infants of ethnic minority, coupled with growing evidence for potential non-skeletal roles of Vitamin D in perinatal health, determination of the dietary Vitamin D requirement that will prevent deficiency during pregnancy is a research priority. However, systematic approaches to establishing dietary requirements are limited by the quality of the available evidence and the under-representation of minority groups in clinical research. This review considers the evidence for racial differences in Vitamin D status and response to Vitamin D supplementation, with particular application to pregnancy-specific requirements among ethnic minorities resident at high latitudes.