الفهرس 
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Abstract
Vitamin D is a fat-soluble vitamin that plays an important role in many biological functions, including calcium metabolism and homeostasis, cellular proliferation and differentiation, and the immune system. A small amount of vitamin D is obtained through diet and the majority of vitamin D is obtained through synthesis in the skin in response to sunlight. Ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) are 2 major precursors to active vitamin D. Both precursors must undergo 2 hydroxylation reactions, first in the liver, where they are converted to 25-dihydroxyvitamin D, abbreviated as 25(OH)D, and second in the kidney, in which 25[OH]D is metabolized into the biologically active hormone called calcitriol or 1,25-dihydroxyvitamin D. Plasma levels of 25(OH)D are used to determine vitamin D status. Vitamin D deficiency is now recognized as a pandemic. Common risk factors for vitamin D deficiency include races with darker skin tones (dark complexion), living in areas of high latitude, obesity, multiparity and covering the skin with clothing. Vitamin D deficiency during pregnancy may result in important health consequences for both mother and child. Hypovitaminosis D in pregnancy is associated with multiple maternal adverse health outcomes, including recurrent pregnancy loss, pregnancy induced hypertension (PIH), gestational diabetes mellitus (GDM), primary cesarean section (CS) and postpartum depression.Vitamin D deficiency during pregnancy is associated with important consequences for the newborn, including prematurity, low birth weight (LBW), tetany and rickets. Evidence has also accumulated regarding the impact of maternal vitamin D levels on long-term health of offspring.To the best of our knowledge, there is a paucity of studies on the prevalence of vitamin D deficiency in pregnant women in Egypt, and its effect on fetomaternal outcome. This cross-sectional study was conducted at Mansoura University Hospital and Mansoura New General Hospital, Mansoura, Egypt in the period between August 2017 and December 2019. The participants of this study were 200 healthy pregnant women ages 18-40 years old irrespective of their gestational age. Women aged <18 or> 40 years taking vitamin D supplementation, suffering from (liver, kidney disease, osteoporosis and/or rheumatoid arthritis) and/or having history of gastric bypass, antiepileptic or ant tubercular treatment in the last 6 months were excluded from our study. For all women included in the study, blood samples were tested for vitamin D level. We measured serum 25-OH-D as index of overall vitamin D level. Women were categorized into vitamin D deficiency (≤ 20 ng/ml), vitamin D insufficiency (21-29 ng/ml), and vitamin D sufficiency (≥ 30 ng/ml) according to the endocrine society guidelines recommendations. This cross-sectional study determined the prevalence of vitamin D deficiency among pregnant women in Dakahlia governorate through population sample taken from two tertiary referral hospitals in Mansoura (Mansoura University Hospital and Mansoura New General Hospital). Statistical analysis of our results showed that there was significant difference between advanced maternal age>30 years old and vitamin D insufficiency; 8/11 (72.7%)sufficient, 33/37 (89.2%) insufficient and 98/152 (64.5%)deficient; (P= 0.043).Increased gravidity and parity ≥3 was associated with vitamin D deficiency and insufficiency; 3 (27.3%), 9 (81.8%) sufficient, 23 (62.2%), 34 (91.9%) insufficient and 109 (71.7%), 109 (71.7%) deficient; (P= 0.007 and 0.024) respectively. There were no significant differences between gestational age andmode of delivery and vitamin D level; (P= >0.05). There was significant difference betweentotal adverse outcome and vitamin D deficiency; (P= 0.047). By using Roc curve; sensitivity, specificity, PPV, NPV and accuracy of vitamin D level at cutoff 13.5 were (73.9%, 61%, 36.2%, 88.7% and 64% respectively)and below it, it was liable to cause total adverse outcome.