{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:57:07Z","timestamp":1785430627348,"version":"3.56.0"},"reference-count":47,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland","award":["HHSN267200603423"],"award-info":[{"award-number":["HHSN267200603423"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland","award":["HHSN267200603434"],"award-info":[{"award-number":["HHSN267200603434"]}]},{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland","award":["HHSN267200603426"],"award-info":[{"award-number":["HHSN267200603426"]}]},{"award":["HHSN267200603423"],"award-info":[{"award-number":["HHSN267200603423"]}],"id":[{"id":"https:\/\/ror.org\/04byxyr05","id-type":"ROR","asserted-by":"publisher"}]},{"award":["HHSN267200603434"],"award-info":[{"award-number":["HHSN267200603434"]}],"id":[{"id":"https:\/\/ror.org\/04byxyr05","id-type":"ROR","asserted-by":"publisher"}]},{"award":["HHSN267200603426"],"award-info":[{"award-number":["HHSN267200603426"]}],"id":[{"id":"https:\/\/ror.org\/04byxyr05","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background\/Objectives: To examine relationships between maternal-serum 25(OH)D levels at preconception and 8 weeks\u2019 gestation and the risk of vaginal bleeding and subchorionic hemorrhage during pregnancy. Methods: A secondary analysis of the EAGeR Trial, which is a prospective, multisite, randomized controlled trial that enrolled 1228 women with 1\u20132 prior pregnancy losses. Analyses were restricted to participants who became pregnant and had 25(OH)D measured at preconception (n = 747) and 8 weeks\u2019 gestation (n = 605). Vaginal bleeding and subchorionic hemorrhage were assessed via medical record extraction, which captured clinically recognized symptoms at medical visits measured at any point throughout pregnancy. Symptom severity of vaginal bleeding was assessed via time-varying self-reported symptoms across early pregnancy through 3\u20138 weeks gestation using daily diaries. Logistic regression models evaluated associations between maternal-serum 25(OH)D levels (deficient \u2264 20 ng\/mL; insufficient 21\u201329 ng\/mL; sufficient \u2265 30 ng\/mL) and vaginal bleeding and subchorionic hemorrhage, while generalized estimating equations (GEE) models were used to evaluate time-varying symptom severity of vaginal bleeding from daily diary data. Results: Those who remained 25(OH)D deficient\/insufficient had increased odds of having a subchorionic hemorrhage (aOR: 2.18; 95% CI: 1.13, 4.20) compared to those who had sufficient levels at both time points. In longitudinal GEE models, women with deficient preconception 25(OH)D had greater odds of moderate-to-heavy bleeding (vs. none) (aOR: 3.02; 95% CI: 1.13, 8.13), but no association was observed for light bleeding (aOR: 1.07; 95% CI: 0.58, 2.00). Findings were directionally similar, yet less precise when restricted to pregnancies resulting in a live birth. Conclusions: Persistently low vitamin D from preconception to early pregnancy is associated with increased risk of subchorionic hemorrhage and moderate\/heavy vaginal bleeding, highlighting the importance of vitamin D sufficiency for implantation and early placental development.<\/jats:p>","DOI":"10.3390\/nu18142339","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:55:59Z","timestamp":1784249759000},"page":"2339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Periconception Maternal-Serum Vitamin D, Vaginal Bleeding, and Subchorionic Hemorrhage in Early Pregnancy"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2121-5476","authenticated-orcid":false,"given":"Zeina M.","family":"Alkhalaf","sequence":"first","affiliation":[{"name":"Department of Family Science, School of Public Health, University of Maryland, College Park, MD 20742, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunni L.","family":"Mumford","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrique F.","family":"Schisterman","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Silver","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT 84132, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9267-4384","authenticated-orcid":false,"given":"Marie E.","family":"Thoma","sequence":"additional","affiliation":[{"name":"Department of Family Science, School of Public Health, University of Maryland, College Park, MD 20742, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"R93","DOI":"10.1530\/JOE-17-0491","article-title":"Vitamin D, the Placenta and Early Pregnancy: Effects on Trophoblast Function","volume":"236","author":"Ganguly","year":"2018","journal-title":"J. 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