Performance of OncoE6TM Cervical Test in detecting cervical precancer lesions in HIV-positive women attending an HIV clinic in Bujumbura, Burundi: a cross-sectional study.

OBJECTIVE: New rapid and low-cost molecular tests for cervical cancer screening, such as the OncoE6 Cervical Test, are emerging and could be alternatives for low-income and middle-income countries. To this end, we evaluated the clinical performance of the OncoE6 Cervical Test in detecting cervical intraepithelial neoplasia (CIN) among HIV-infected women in Bujumbura, Burundi. METHODS: From June to December 2017, a cross-sectional study was conducted in 680 HIV-positive women at the University Hospital. Women aged 25-65 years who declared having had vaginal intercourse were consecutively recruited, and cervical specimens for OncoE6, liquid-based cytology and human papillomavirus (HPV) genotyping were obtained and visual inspection with acetic acid performed. Thereafter, participants underwent a colposcopic examination. The sensitivity, specificity, and positive and negative predictive values of the different tests were calculated with reference to 'colposcopic-histological' diagnoses, and areas under the receiver operating curves of OncoE6 and cytology tests were compared. RESULTS: The prevalence of CIN was 4.9%, and OncoE6 positivity was 3.1%. OncoE6 sensitivity varied from poor to low with increasing disease severity (42.1%, 95% CI 19.9% to 64.3% at CIN2+ threshold; and 58.3%, 95% CI 30.4% to 86.2% at CIN3+ threshold). OncoE6 had the highest specificity compared with all other tests used together. The performance of the OncoE6 test was significantly lower compared with cytology at atypical squamous cell of undetermined significance (ASCUS+) cut-off (AUC=0.68 vs 0.85, p=0.03) and low-grade squamous intraepithelial lesion (LSIL+) cut-off (AUC=0.68 vs 0.83, p=0.04) for CIN2+ diagnoses. However, the performance of the OncoE6 test was similar to that of cytology at high-grade squamous intraepithelial lesion (HSIL+) cut-off (AUC=0.68 vs 0.76; p=0.30) for CIN2+ diagnoses and was also similar to that of cytology at all cut-offs (ASCUS+, LSIL+ and HSIL+) for CIN3+ diagnoses (p1=0.76, p2=0.95 and p3=0.50, respectively). CONCLUSION: The current OncoE6 test proved to be a point-of-care test. However, given its poor performance for CIN2+ diagnoses, we do not recommend it for primary screening. We recommend to enrich it with more oncogenic HPV types, which may improve the performance of the test akin to that of cytology.

Postpartum C-Reactive Protein: A limited value to detect infection or inflammation.

BACKGROUND: During pregnancy the maternal immune system adjusts to preserve the foetoplacental unit. These adjustments lead to an increase in CRP, continuing into the postpartum. The objective of this study was to determineantepartal, peripartal and postpartal factors associated with an elevated CRP on the second postpartum day. METHODS: A retrospective quantitative, monocentric file analysis in which antepartal, peripartal and postpartal factors were collected from a convenience sample was performed. On the second day postpartum CRP was taken according to local protocol. Uni- and multi-variate analysis was performed to determine factors that are related to postpartum level of CRP. The total sample size consisted of 1400 patients. RESULTS: Multiple regression analysis indicated 11 factors related to increased CRP on the second day postpartum: gestational age (p=0.002), maternal blood leukocyte count on day 2 postpartum (p<0.001), artificial rupture of the membranes (p<0.001), fever during labor (p<0.001), indwelling urinary catheter (p=0.008), epidural anesthesia (p<0.001), fetal scalp electrode (p<0.001), primary planned caesarean (p=0.019), secondary caesarean h (p<0.001), formula feeding (p=0.030) and fever during postpartum (p=0.001). CONCLUSION: This research indicates that many antepartal, peripartal and postpartal factors are related to high postpartum CRP. CRP can not be used as a screening test test in the postpartum to discriminate between normal and pathologic inflammatory/infectious changes.

Adverse Effects of Carbetocin versus Oxytocin in the Prevention of Postpartum Haemorrhage after Caesarean Section: A Randomized Controlled Trial.

PURPOSE: To compare the incidence of nausea, vomiting, and arterial hypotension between carbetocin and oxytocin to prevent haemorrhage after caesarean section (CS). METHODS: A randomized controlled trial in term pregnant women undergoing planned CS. Groups were randomized to carbetocin or oxytocin. Blood pressure (BP), heart rate, presence of nausea/vomitus, and need for vasopressors were evaluated throughout surgery. Preoperative and postoperative haemoglobin and haematocrit levels were compared. RESULTS: Fifty-eight women were randomized (carbetocin n = 32; oxytocin n = 26). Both medications had hypotensive effect, difference in BP for carbetocin versus oxytocin: systolic (14.4 ± 2.4 mmHg versus 8.5 ± 1.8 mmHg); diastolic (7.8 ± 1.6 mmHg versus 8.9 ± 3.0 mmHg) without significant difference between the drugs (p = 0.1 and p = 0.7). Both groups had similar needs for vasopressors. The presence of nausea was not rare, but the difference was not statistically significant (p = 0.4). Average blood loss was slightly lower in the carbetocin group but not statistically significant (p = 0.8). CONCLUSION: In planned CS, a possible clinical significant lower incidence of nausea after carbetocin was noted but this was not statistically significant. There were no differences regarding BP, heart rate, the need for vasopressor, and blood loss. The study was registered in the International Journal of Clinical Trials (ISRCTN 95504420, 2/2017).

Accreditation and resulting clerical duties represent commercial excesses that are ethically and scientifically unacceptable.

It is scientifically and ethically unjustified to continue hospital accreditation organized by commercial organisations such as Joint Commission International (JCI) as these harm patients and health care workers, result in needless excess costs without improved outcome and endanger the future of healthcare. All energy should go to bottom up shared decision making.

Ethnic disparities and morbidity in the Province of Antwerp, Belgium.

OBJECTIVE: This study aims to identify geographical disparities in perinatal mortality and morbidity in the province of Antwerp, Belgium. We performed a retrospective cohort study from an existing database. Data included from 1 January , 2000 to 31 December, 2009 and including all deliveries in the Province of Antwerp, Belgium. Collected outcome measures : fetal death, early and late neonatal death, preterm birth, low birth weight. Outcomes were analyzed according to postal code of the pregnant women's address. RESULTS: A total of 167.246 deliveries in sixty postal codes were analyzed and statistically significant differences (p<0.001) between postal codes for all outcome measures except for early and late neonatal death were detected. Generally postal codes tend to have either high or low prevalences for all perinatal outcomes and two postal code zones had a significantly worse perinatal outcome on all fields. Major differences in perinatal outcome exist within the well-defined area of the relatively small province of Antwerp, Belgium. CONCLUSION: Perinatal outcome is strongly influenced by maternal postal code even within a relatively affluent European region demonstrating persistent health inequalities and suggesting further research is necessary to explain these differences and create interventions to diminish inequalities.

The value of postpartum ultrasound for the diagnosis of retained products of conception: A systematic review.

BACKGROUND: The goal of this review is to evaluate the value of ultrasound for detection of retained products of conception (RCOP) after delivery. METHODS: A systematic search was performed using 'postpartum', 'retained placenta', 'retained products' and 'ultrasound' resulting 82 publications, after screening titles and abstracts, 30 remained. RESULTS: On gray scale ultrasound, one must be focus on a thickened endometrial echo complex (EEC) with a cut off value of 10 mm and on an intracavitary mass. If these features are not visible, RPOC is rare. However, these findings are neither specific nor conclusive for RPOC and can even be seen in a normal postpartum uterus. Detection of hypervascularity in a thickened EEC or intracavitary mass with color Doppler ultrasound is very sensitive for RPOC but still not specific nor can it exclude RPOC. MRI seems best in differentiating RPOC, arteriovenous malformations and gestational trophoblastic disease. CONCLUSION: There is no consensus on a standardised method for postpartum ultrasound. More research and standardization are necessary to differentiate of normal and pathological findings in the postpartum uterus.

A preliminary study for the treatment of cervical colposcopic lesions with the biological compound AV2.

OBJECTIVE: To evaluate the efficacy of Anti Viral 2 (AV2) in the regression of moderate and severe colposcopic lesions, when com- pared to placebo. MATERIALS AND METHODS: Women, aged over 18 years with a colposcopic diagnosis of moderate to severe dysplasia were randomized to receive either two applications of AV2 or placebo within four days. Both examining physician and patients were blinded to the treatment option. Follow-up colposcopy was performed on days 11, 2 1, and 60. RESULTS: A total of 50 patients were enrolled in this study. There was no statistically significant difference in screening entry criteria between the two groups. The results showed that the application of AV2 yielded a reduction of more than 50% for 21 out of 28 (75%) patients who received the active treatment versus a 0% for the comparable placebo group (p < 0.00 1). CONCLUSIONS: The authors conclude that AV2 can have a place in the treatment of colposcopically-detected cervical lesions. Due to the proven broad spectrum antiviral activity of AV2, a plausible explanation is that the lesions regress due to deactivation of the virus. Further trials with larger numbers and detailed cytology and histology are needed to confirm these results.

Intussusception in pregnancy after gastric bypass: a case report.

Laparoscopic Roux-en-Y gastric bypass (RYGB) remains the gold standard procedure in obesity surgery and is mostly performed in young women of reproductive age. Since the worldwide prevalence of obesity is increasing and fertility improves after surgery, more complications in the pregnant population will emerge. The differential diagnosis of acute abdominal pain in patients with a history of gastric bypass is rather broad and includes mainly anastomotic ulcers, leaks, and small bowel obstructions. Early diagnosis and treatment of these complications is of utmost importance and should be performed on a multidisciplinary basis. Whether surgery should be performed by laparoscopy or laparotomy remains subject of discussion. We report a case of a 29-year-old pregnant woman at 33 + 5 weeks gestational age, presenting with an intussusception after RYGB. A successful surgical reduction was performed by laparotomy.

An exploration of attitudes towards breast cancer screening in orthodox Jewish women in Antwerp--Belgium.

OBJECTIVE: To explore determinants of participation in breast cancer screening in orthodox Jewish women living in Antwerp, Belgium, and to uncover their opinions and attitudes towards screening, and thereby to detect ways to optimize participation. STUDY DESIGN: Focus group discussions were performed during the last months of 2011 and the first half of 2012 to explore motivation to participate or not in breast cancer screening. Groups consisted of five to seven women. Inclusion criteria were: being female, considering oneself as orthodox Jewish, aged between 50 and 69 years. RESULTS: Three focus group discussions with in a total of 20 women had taken place. All participants in the focus group discussions had a screening mammography taken on a regular base. All participants agreed that the social cohesion between Jewish orthodox women and the importance that is given to healthcare within the Jewish tradition are important contributors to their participation in a breast cancer screening program. Pain, lack of information during the exam, lack of confidence in the quality of the exam, perceived problems when the examining doctor/technician is male, and fear of the results are mentioned as barriers. The participants, however, state that these were not important enough to result in non-participation. Barriers could be diminished by information sessions specifically aimed at orthodox Jewish women. CONCLUSION: This qualitative research demonstrates a generally positive attitude of orthodox Jewish women living in Antwerp, Belgium, towards mammographic breast cancer screening. Increased and repeated structured information sessions are likely to improve breast cancer awareness in this population.

Delayed-interval delivery can save the second twin: evidence from a systematic review.

BACKGROUND: In case of preterm birth in twins, it is not well established if the second twin benefits from a delayed-interval delivery. OBJECTIVE: The main objective of this systematic review is to evaluate survival benefit of the second twin from delayed interval delivery compared to the first twin. Secondly, we will evaluate the survival benefit of the procedure when performed equal to or after 24 weeks gestational age of the first born. METHODS: Delayed interval delivery was defined as every attempt to perform a delayed interval delivery with at minimum placement of a high ligature of the umbilical cord and a delay of delivery of at least 24 hours. Based on the PRISMA method, a systematic review was performed. Controlled and observational studies reporting at least 3 cases of delayed interval delivery in dichorionic diamniotic twin pregnancy describing the outcome of the first and the second twin were included. Case reports and papers on triplet or higher order pregnancies were excluded. Primary data included gestational age and outcome of the first and second born. Metadata concern management strategies (tocolysis, antibiotics, cerclage), neonatal data (sex, birth weight and morbidity) and maternal complications. The methodological quality of included studies was assessed using the "IHE quality appraisal checklist for assessing the quality of case series". Meta-analysis was performed by computing relative risk (RR) with its 95% confidence interval (CI) using the random-effects model. Statistical heterogeneity was tested using the I2 and Chi2 statistics. Since there is no control group for the secondary outcomes, these are presented by narrative synthesis. RESULTS: Mortality data were extracted from 13 articles, reporting a total of 128 cases of delayed interval delivery. In the analysis, the second born had a significantly lower mortality risk compared to the first born (relative risk = 0.44, 95% confidence interval = 0.34 - 0.57, P<0.0001, I2= 0%, P=0.70). For the analysis of mortality of the second born foetus versus the first born when the first delivery was at ≥24 weeks of gestational age, 12 articles were included. In the analysis 4 reports were excluded since there were no events (no mortality) in both groups (first and second born) making analysis impossible. For the 36 cases included, the second born had a significantly lower mortality risk compared to the first born if delivery of the first born occurred at ≥ 24 weeks gestational age (relative risk=0.37, 95% confidence interval= 0.17 - 0.82, P=0.014, I2=0%, P=0.82). CONCLUSIONS AND IMPLICATIONS: In carefully selected twin pregnancies the survival of the second born twin may improve with delayed interval delivery, also if the first was born at or after 24 weeks. Management protocols in the studies included vary, making it difficult to propose a uniform strategy for delayed interval delivery. Families must be informed about the possibility that a nonviable infant would survive to a periviable gestational age with a risk of severe sequels after birth as well as the possibility of maternal complications.

Flemish obstetricians' personal preference regarding induction of labor and mode of delivery in term births.

INTRODUCTION: In a 2002 survey, 2% of Flemish gynecologists preferred elective cesarean section for themselves or their partner. This study aims to determine actual preference regarding induction of labor and mode of delivery in term cephalic or breech births for gy- necologists or their partners. MATERIALS AND METHODS: An anonymous postal questionnaire was sent to all gynecologists and trainees in Flanders. RESULTS: Response rate was 28.2 % (241/852). In case of an uncomplicated cephalic singleton pregnancy, 39 gynecologists (16.2%) preferred cesarean section. Most (n=134, 66.5%) chose induction at 41 weeks, 26 (13%) at 40 weeks, 37 (18%) at 42 weeks, 26 (13%) at 40 weeks, three (1.5%) preferred induction before 40 weeks and two (1%) would wait until after 42 weeks. Concerning term breech, 30% (n=72) opted for vaginal delivery and 70% (n = 169) for planned cesarean section. Ninety-nine (41%) gynecologists pre- ferred to attempt external version first. Only 115 (47.7 %) gynecologists felt professionally capable to assist vaginal breech delivery them- selves; about one-third (n=96; 38%) had performed less than ten vaginal breech deliveries in their career. CONCLUSIONS: Flemish gynecologists are still in favor of vaginal delivery for themselves in terms of cephalic position, but an increasing number favor planned cesarean section. Most Flemish gynecologists opt for cesarean section for themselves or their partners in case of term breech and state that they do not feel capable in assisting vaginal breech delivery for their patients.

Factors contributing to the low participation rate of Turkish women to a breast cancer screening program in Antwerp, Belgium.

OBJECTIVES: To explore possible factors explaining a low participation rate to breast cancer screening for Turkish women living in Antwerp, Belgium, and to develop ways to increase participation rate. MATERIAL AND METHODS: The authors used focus group discussions with Turkish women to explore their reasons to participate or not to participate in breast cancer screening. Groups consisted of four to six women. Inclusion criteria were: being female, having a Turkish origin, and age between 50 and 69 years. For each focus group, one Turkish women was invited and asked to invite five other women meeting the inclusion criteria. RESULTS: Three focus group discussions with in total 17 women have taken place. Six women had participated to all consecutive invitations for breast cancer screening. One woman had participated once, but not the next time she was invited. Ten women had never participated to screening mammography, although some of them had undergone diagnostic mammography. In all three focus groups, insufficient knowledge of the Dutch language, the unavailability of a professional interpreter, being careless about healthcare, and a negative influence of the husband, were the main reasons not to participate in breast cancer screening. Invitation letters are not read because they are in a language the woman does not understand. Less frequently mentioned obstacles were being on a holiday or being sick on the day of the scheduled mammography, fear of pain, considering an examination useless when not having any symptoms, being anxious for a positive result, and the physical distance to the screening center. Receiving an invitation in Turkish and knowing that a person speaking Turkish will be available at the screening center were proposed as possible measures to improve participation. CONCLUSION: The single most important reason why Turkish women living in Antwerp, Belgium, do not participate in breast cancer screening was a language problem; other reasons were a lack of knowledge concerning breast cancer screening and not worrying about breast cancer. The language barrier in this population of older women can possible be overcome by Turkish speaking personnel at the screening centers.

The use of intravenous magnesium in non-preeclamptic pregnant women: fetal/neonatal neuroprotection.

PURPOSE: To review the effect of intravenous magnesium in obstetrics on fetal/neonatal neuroprotection. METHODS: A systematic review of published studies. RESULTS: Five randomized trials and 4 meta-analyses have shown a significant 32% reduction of cerebral palsy when administering magnesium sulfate in case of preterm delivery. The pathophysiologic mechanism is not fully unraveled: modulation of the inflammatory process, both in the mother and the fetus, and downregulation of neuronal stimulation seem to be involved. After long-term high-dose intravenous administration of magnesium, maternal and neonatal adverse effects such as maternal and neonatal hypotonia and osteoporosis and specific fetal/neonatal cerebral lesions have been described. In case of administration for less than 48 h at 1 g/h and a loading dose of 4 g, these toxic amounts are not achieved. American, Canadian and Australian guidelines recommend the use of intravenous magnesium in any threatening delivery at less than 32 weeks. The "number needed to treat" to avoid 1 cerebral palsy is between 15 and 35. CONCLUSIONS: Intravenous magnesium significantly reduces the risk for cerebral palsy in preterm birth. Open questions remain the optimal dosing schedule, whether or not repeating when delivery has been successfully postponed and a new episode of preterm labor occurs. Some concern has been raised on a too optimistic value for random error which might have led to over-optimistic conclusions in classic meta-analysis. Randomized trials comparing different doses and individual patient data meta-analysis might resolve these issues.

Sexual function in women after vaginal surgery with synthetic mesh material.

OBJECTIVE: To prospectively assess the impact of surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) with vaginal synthetic mesh on female sexual function and satisfaction. MATERIALS AND METHODS: Forty-four women treated by vaginal surgery for SUI and POP between October 2009 and October 2011 were asked to fill in questionnaires at baseline and at six months after surgery to determine the impact on their sexual function and satisfaction. The questionnaires used for assessment were the 19-item Female Sexual Function Index (FSFI) and the Dutch Seksueel Functioneren Algemeen (General sexual function) or SFA-questionnaire. RESULTS: The questionnaire was completed by 27 patients (61.4%) at baseline; Nineteen reported being sexually active and eight were not. At six months follow-up, the questionnaire was returned by eight patients. In the studied population, an overall improvement of sexual function at six months follow-up was found. All six FSFI-domains: desire, arousal, lubrication, orgasm, satisfaction, and pain seemed to slightly improve. CONCLUSION: The authors found that there was an overall improvement of sexual function after vaginal surgery with synthetic mesh for POP and SUI.

Vitamin B12 and folic acid status of term pregnant women and newborns in the Antwerp region, Belgium.

OBJECTIVE: Descriptive study on maternal serum vitamin B12 and folic acid in term pregnancy and in umbilical cord blood that was performed in an inner city hospital with a mixed ethnic population in the region of Flanders in Belgium. MATERIALS AND METHODS: A prospective cohort study that took place from April 1 until May 31, 2011. Plasma folic acid and vitamin B12 were measured in maternal and umbilical cord blood from all term uncomplicated deliveries in a single regional hospital. Data on age, previous obstetric history, ethnicity, nutritional intake, and use of vitamin supplements were registered. RESULTS: Data were collected from 110 patients, mean maternal serum vitamin B12 was 243.9 pmol/l and mean folic acid level was 43.0 nmol/l. Using a cutoff of respectively 150 pmol/l for vitamin B12 and 7.1 nmol/l for folic acid, 13% of the women were classified as vitamin B12-deficient and 23% were deficient for folic acid. Vitamin B12 deficiency was only seen in autochthonous Belgian women. A correlation between the maternal and umbilical cord levels was noted (R = 0.7 for vitamin B12, R = 0.85 for folic acid), but none of the umbilical cord levels demonstrated deficiency. Number of previous pregnancies and intake of supplements had no influence. CONCLUSION: Pregnant women in Antwerp, Belgium, frequently show vitamin B12 and folic acid deficiency, although a correlation exists with lower umbilical cord levels, the present limited data did not demonstrate any case of deficiency in umbilical cord blood. The frequency is highest in the autochthonous population and is not influenced by intake of vitamin supplements.

Pregnancy at late premenopausal age: outcome of pregnancies at 45 years and older in Flanders, Belgium.

To describe the obstetric outcome in women at ages ≥ 45. A retrospective cohort study on a large existing database covering all deliveries in the Flanders region, Belgium, was performed, comparing obstetric outcomes at age 25, 35, 40 and 45 or older, for the period 2005-2010. In the period studied, 421 women gave birth at maternal age ≥ 45 vs 3,405, 15,206, 22,586 at ages 40, 35 and 25, respectively. With advancing maternal age, a significant linear increase for low birth weight (< 2,500 g) and preterm delivery (< 37, < 35 weeks and < 29 weeks), maternal hypertension and diabetes, both primary and secondary caesarean section, was noted. Between ages 40 and ≥ 45, both fetal and early neonatal death demonstrated a significant rise from 4.9/1,000 and 1.8/1,000 to 26/1,000 and 9.5/1,000, respectively. With advancing maternal age, a gradual but not statistically significant decline in the proportion of male fetuses was noted, from 51.6% at 25, to 47.2% in the oldest group. Multivariate analysis confirmed advanced maternal age to be a significant factor in low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality. In Flanders, mothers at age 45 and older have a significantly increased risk for low birth weight, preterm delivery, hypertension, diabetes, caesarean section and perinatal mortality.

Regional gray matter volume differences and sex-hormone correlations as a function of menstrual cycle phase and hormonal contraceptives use.

During the menstrual cycle, hormone-driven functional and morphological changes occur in the female brain. The influence of hormonal contraceptives on these changes has received only little attention in the medical literature. The purpose of our study is to measure regional gray matter volume changes as a function of the cycle phase and use of hormonal contraceptives, in relation to blood concentrations of sex hormones. We performed a prospective study in 30 healthy young women; 15 women had a natural menstrual cycle and 15 were using monophasic combined hormonal contraceptives. MRI examinations were acquired at 2 specific time-points in the cycle (follicular and luteal phase). MRI studies included a T1-weighted, isotropic, high-resolution 3-D gradient echo acquisition, for the purpose of performing voxel based morphometry. Peripheral venous blood samples were obtained to determine concentrations of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and progesterone. We found a highly significant negative correlation of regional gray matter volume in the anterior cingulate cortex with estradiol concentrations. To the best of our knowledge, this result has not been described before, and was only present in the natural cycle group, not in women using hormonal contraceptives. The anterior cingulate cortex is involved in emotion processing and there is literature describing behavioral alternations with changing hormone levels. Our findings provide a structural, morphological basis to support these data. Therefore, we advise neuroscientists to take into account the menstrual cycle phase and use of hormonal contraceptives, in order to avoid obtaining heterogeneous data sets, leading to a significant loss of accuracy and precision.

Vitamin D levels in maternal serum and umbilical cord blood in a multi-ethnic population in Antwerp, Belgium.

UNLABELLED:  OBJECTIVE: To describe the status of vitamin D levels in maternal and umbilical cord blood in term pregnant woman in a mixed ethnic population in an inner-city European maternity. METHODS: A single centre prospective cohort descriptive study including all uncomplicated singleton term pregnancies from April 1, 2011 until May 31, 2011. Plasma 25-hydroxy vitamin D level was determined in maternal and umbilical cord blood and data on age, previous obstetric history, ethnicity, nutritional intake and use of vitamin supplements were registered. RESULTS: Complete data were collected in 94 patients. Mean maternal serum vitamin D was 16.6 ng/mL. Using a cut-off of 20 ng/mL, 66% of women were classified as deficient. Deficiency was present in all ethnic groups, but lower levels were noted in North-African, Central-African and Asian women. A strong correlation between maternal and umbilical cord levels was noted (R = 0.91). Number of previous pregnancies and intake of supplements had no influence. CONCLUSION: The majority of low risk pregnant women showed vitamin D deficiency which was strongly correlated with umbilical cord levels. The prevalence was highest in the immigrant non-European population and was not influenced by intake of vitamin supplements. It can therefore be questioned whether the proposed cut-off values are appropriate.