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Association of maternal serum vitamin D, calcium, and magnesium levels with cervical ripening outcomes in pregnant women undergoing misoprostol induction: a prospective cohort study

Year: 2026

Type: article

Abstract: OBJECTIVES: This study aimed to evaluate the association between maternal serum levels of vitamin D, calcium, and magnesium and the success of cervical ripening in pregnant women undergoing misoprostol induction. MATERIALS AND METHODS: A prospective cohort study was conducted among 212 nulliparous pregnant women who received misoprostol for labor induction at Al-Zahra Hospital in Rasht, Iran, between 2022 and 2023. Based on their clinical response to misoprostol, participants were classified as responsive (n = 106) or unresponsive (n = 106). Serum concentrations of vitamin D, calcium, and magnesium were obtained before induction. These values were then analyzed in relation to cervical ripening outcomes, which were assessed using the Bishop score and the time interval to delivery. RESULTS: Serum magnesium levels were below 1.8 mg/dl in 20.8% of participants, and serum calcium levels were below 8.5 mg/dl in 28.8%. The majority of participants (76.4%) had low vitamin D levels. Significant differences in serum vitamin D, calcium, and magnesium levels were observed between groups with successful and unsuccessful cervical ripening (P < 0.05). Multiple logistic regression analysis revealed that higher serum levels of vitamin D, calcium, and magnesium were independently associated with increased likelihood of successful response to misoprostol treatment (P < 0.05). CONCLUSIONS: Maternal vitamin D, calcium, and magnesium status appear to influence the body's readiness to respond to labor induction. Optimizing these micronutrient levels may improve clinical outcomes and support safer, more effective induction of labor.

Source: European journal of medical research

DOI: 10.1186/s40001-025-03737-3