Vitamin D deficiency was nearly universal among pregnant women delivering in Nablus
At a governmental hospital in Nablus, vitamin D deficiency in pregnancy reached a level that leaves little room for interpretation. Among 193 women admitted for delivery, the median serum 25-hydroxyvitamin D concentration was 7.9 ng/mL, a value that sits deep in the deficient range and well below the threshold generally used for sufficiency. The prevalence numbers were stark: 94.8% of participants were deficient, 67.4% had severe deficiency, 4.1% were insufficient, and only 1.0% met criteria for sufficiency.
The study, conducted between December 2020 and May 2021 at Rafidia Governmental Surgical Hospital, used convenience sampling and measured serum 25(OH)D before delivery by electrochemiluminescence immunoassay. Structured interviews and medical records supplied the clinical context, while prevalence estimates were reported with 95% confidence intervals. In practical terms, the cohort did not just show low vitamin D status; it showed widespread biochemical depletion at the very moment pregnancy was ending.
A median 25(OH)D level of 7.9 ng/mL is not a marginal abnormality. It signals a population in which maternal skeletal demands, fetal calcium needs, and placental transfer may all be operating under persistent substrate scarcity.
Severe deficiency dominated the cohort, but maternal predictors were limited
The most striking feature of the data was how little variation remained to explain. Severe deficiency was not significantly associated with the sociodemographic, lifestyle, or obstetric characteristics examined. In a setting where nearly everyone fell below 20 ng/mL, conventional risk stratification lost much of its discriminatory value. The biochemical deficit was broad enough to flatten the usual distinctions between age groups, obstetric histories, and other baseline features captured in the analysis.
That pattern has an important clinical implication. When a deficiency becomes nearly universal, focusing only on individual risk factors can miss the larger systems problem: inadequate supplementation, limited routine screening, and environmental or behavioral exposures that keep maternal vitamin D stores chronically low. The biology is straightforward. Vitamin D participates in calcium homeostasis and bone metabolism, but in pregnancy it also intersects with placental function, immune regulation, and fetal mineralization. A profound shortfall during late gestation may therefore represent more than a laboratory abnormality, even if the present study was not designed to prove downstream harm.
Supplement use stood out as the one measurable maternal factor with a clear relationship to vitamin D status. Only 24.9% of women reported using supplements, yet supplement use was independently associated with higher 25(OH)D concentrations, with an adjusted geometric mean ratio of 1.27 (95% CI 1.06–1.53). In a population with very low baseline values, even a modest relative increase is clinically meaningful because it suggests that routine supplementation can still move concentrations in the right direction.
Delivery and neonatal outcomes did not separate cleanly by deficiency status
The study also examined whether severe deficiency tracked with delivery and newborn outcomes. Here, the signal was weak. Severe deficiency was not statistically associated with cesarean delivery, with an adjusted prevalence ratio of 1.18 (95% CI 0.90–1.56). No statistically significant associations emerged with low birth weight, neonatal oxygen requirement, or neonatal intensive care unit admission, and the estimates were imprecise.
Those null findings should be read cautiously rather than dismissed. Cross-sectional sampling at delivery can identify biochemical status, but it is poorly suited to capture time-sensitive causal pathways or outcomes that depend on earlier gestational exposure. A woman measured at delivery may have had severe deficiency for weeks or months, or she may have recently changed supplementation habits. The newborn outcomes in this analysis also appear vulnerable to limited power, because the study was not large enough to provide narrow estimates for relatively infrequent events.
Even so, the absence of a statistically significant association is clinically useful because it prevents overclaiming. The data do not support a direct, measurable link between severe deficiency and the delivery or neonatal endpoints tested in this single-hospital cohort. What they do support is a different and simpler conclusion: widespread deficiency was present at the time of birth, and routine supplementation was uncommon.
Why the biochemical pattern matters in routine obstetric care
Pregnancy increases nutritional demand, and vitamin D deficiency in this setting can persist when supplementation is not standard, dietary intake is low, and sun exposure is limited by social or environmental factors. The nearly universal deficiency observed here suggests that antenatal care in this population may be missing a preventable micronutrient problem. Because vitamin D status can be corrected, the threshold issue is not whether the deficiency exists — it plainly does — but whether care systems are identifying and addressing it early enough.
The public health relevance extends beyond one hospital. Nablus, the West Bank, and similar settings need larger studies across seasons to understand how stable these findings are over time and whether the biochemical burden changes with sunlight exposure or care access. Seasonality matters because 25(OH)D levels can shift with ultraviolet exposure and behavioral patterns, and a single time window may either understate or overstate the broader burden.
Supplement coverage remains the most actionable gap
The clearest bedside implication is simple: supplementation coverage was low, and the population-level deficiency burden was high. In a cohort where almost every woman was deficient and two-thirds were severely deficient, improving maternal vitamin D supplementation during pregnancy is a rational response grounded in measurable need rather than speculative risk.
Future work will need to answer questions this study could not settle. Larger multicenter cohorts are needed to define whether maternal deficiency predicts cesarean delivery, neonatal intensive care use, low birth weight, or respiratory support with enough precision to guide policy. A longer observational window, ideally spanning multiple seasons and multiple sites, would also help separate persistent community deficiency from the effects of local sampling conditions. For now, the Nablus data document a severe and largely unaddressed maternal micronutrient gap at delivery, with supplementation emerging as the one modifiable factor clearly associated with better vitamin D status.