Role of Folic Acid, Vitamin D, and Progesterone in Pregnancy and Threatened Abortion


  • Shaimaa Jassim College of Science/ University of Thi-Qar
  • Raid M. H. Al-Salih College of Science/ University of Thi-Qar



The most frequent early pregnancy problem threatened abortion, affects 20% of pregnancies. Vaginal bleeding may be present, together with or without abdominal cramps. Women who are getting older, smoking, being overweight or obese, having PCOS, and having had an abortion in the past are danger signs for a potential abortion. The Physiology of the disease has been linked to alterations in cytokine concentrations or weakened maternal immunity. By taking the clinical history into account, determine the therapy options and provide crucial information for the prognosis, the physical examination, the biochemistry of the mother's serum, and the results of the ultrasound. The most popular advice is to stay in bed, but its usefulness is not well supported. Progesterone, vitamin D, and folic acid are further alternatives.


J. Y. S. Siew et al., “The randomised controlled trial of micronised progesterone and dydrogesterone (TRoMaD) for threatened miscarriage,” Eur. J. Obstet. Gynecol. Reprod. Biol., vol. 228, pp. 319–324, 2018.

Q.-T. Feng, “The benefits of higher LMR for early threatened abortion: a retrospective cohort study,” PLoS One, vol. 15, 2020.

Feng, Q. T., Chen, C., Yu, Q. Y., Chen, S. Y., Huang, X., Zhong, Y. L., ... & Gao, J. The benefits of higher LMR for early threatened abortion: a retrospective cohort study. PLoS One, 15(4), e0231642.‏ 2020.

E. Hendriks, H. Macnaughton, and M. C. Mackenzie, “First trimester bleeding: evaluation and management,” American family physician, vol. 99, pp. 166–174, 2019.

A. Wijesiriwardana, S. Bhattacharya, and A. Shetty, “Obstetric outcome in women with threatened miscarriage in the first trimester,” Obstet Gynecol, vol. 107, pp. 557–562, 2006.

A. Dongol, S. Mool, and P. Tiwari, “Outcome of pregnancy complicated by threatened abortion,” Kathmandu Univ Med J (KUMJ), vol. 9, no. 33, pp. 41–44, 2011.

S. Quenby, “Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss,” The Lancet, vol. 397, pp. 1658–1667, 2021.

U. B. Akpan et al., “The Influence of Threatened Miscarriage on Pregnancy Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary Hospital,” Nigerian Tertiary Hospital. Cureus, no. 11, 2022.

F. M. Basama and F. Crosfill, “The outcome of pregnancies in 182 women with threatened miscarriage,” Arch Gynecol Obstet, vol. 270, no. 2, pp. 86–90, 2004.

L. S. Benson et al., “Early pregnancy loss management in the emergency department vs outpatient setting,” JAMA Network Open, vol. 6, no. 3, pp. e232639–e232639, 2023.

M. Molasaraie, “The Role of Using Cell Phones and Internet on women’s risk of Miscarriage: a Case-control Study,” Journal of Midwifery & Reproductive Health, vol. 11, no. 3, 2023.

Y. Baharav et al., “The impact of extreme heat exposure on pregnant people and neonates: A state of the science review,” J. Midwifery Womens. Health, vol. 68, no. 3, pp. 324–332, 2023.‏

J. Zhou, “Maternal pregnancy-related anxiety and children’s physical growth: the Ma’anshan birth cohort study,” BMC Pregnancy and Childbirth, vol. 23, 2023.

R. Freedman, “Choline, folic acid, Vitamin D, and fetal brain development in the psychosis spectrum,” Schizophrenia Research, vol. 247, pp. 16–25, 2022.

K. Moss et al., “Nutrient adequacy in endurance athletes,” Int. J. Environ. Res. Public Health, vol. 20, no. 8, 2023.

Shokoohi, Mostafa, et al. "Social determinants of health and self-rated health status: a comparison between women with HIV and women without HIV from the general population in Canada." PloS one 14.3 (2019): e0213901.

M. L. Dreher and N. A. Ford, “A comprehensive critical assessment of increased fruit and vegetable intake on weight loss in women,” Nutrients, vol. 12, 2020.

M. A. Patti, J. M. Braun, T. E. Arbuckle, and A. J. MacFarlane, “Associations between folic acid supplement use and folate status biomarkers in the first and third trimesters of pregnancy in the Maternal-Infant Research on Environmental Chemicals (MIREC) Pregnancy Cohort Study,” Am. J. Clin. Nutr., vol. 116, no. 6, pp. 1852–1863, 2022.

S. Cooper, M. Graham, C.-L. Kuo, R. Khangura, A. Schmidt, and S. Bakaysa, “The relationship between food security and gestational diabetes among pregnant women,” AJP Rep., vol. 12, no. 3, pp. e131–e138, 2022..‏

W. J. Craig, “The safe and effective use of plant-based diets with guidelines for health professionals,” Nutrients, vol. 13, 2021.‏

Folate, Acid Questions & Answers, New Zealand Ministry of Health. 2012

A. Camier, “Social inequalities in prenatal folic acid supplementation: results from the ELFE cohort,” Nutrients, vol. 11, 2019.

R. D. Riley, Prognosis research in healthcare: concepts, methods, and impact. Oxford University Press, 2019.

C. H. Ugo, E. C. Ekara, and O. C. Chukwudi, “Knowledge, attitude and practices (KAP) of preconceptional folic acid supplementation among pregnant women (18-45 years) attending antenatal clinic in Alex Ekwueme Federal University Teaching hospital Abakaliki, Ebonyi State, Nigeria,” Nigeria. Saudi J Med, vol. 7, no. 9, pp. 485–500, 2022.‏

Grogan, David. Cultural planning handbook: An essential Australian guide. Routledge, 2020.‏

EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) et al., “Scientific advice related to nutrient profiling for the development of harmonised mandatory front-of-pack nutrition labelling and the setting of nutrient profiles for restricting nutrition and health claims on foods,” EFSA J., vol. 20, no. 4, p. e07259, 2022.‏

A. Alimuddin, “Mind Matters: A Critical Look at Malaysia’s Postnatal Depression Policy for Women’s Mental Health,” Women’s Health Reports, vol. 4, pp. 381–386, 2023.‏

M. Pratt, “A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions,” Systematic Reviews, vol. 9, pp. 1–25, 2020.‏

Shulpekova, Y., Nechaev, V., Kardasheva, S., Sedova, A., Kurbatova, A., Bueverova, E., & Ivashkin, V. The concept of folic acid in health and disease. Molecules, pp. 26(12), 3731, 2021

M. J. Barry, “Folic acid supplementation to prevent neural tube defects: US Preventive Services Task Force reaffirmation recommendation statement,” JAMA, vol. 330, pp. 454–459, 2023.

S. Yoon, “Lifestyle factors and Parkinson disease risk: Korean nationwide cohort study with repeated health screening data,” Neurology, vol. 98, pp. e641–e652, 2022.‏

S. Y. Yoon, Y. H. Park, H. J. Lee, D. R. Kang, and Y. W. Kim, “Lifestyle factors and Parkinson disease risk: Korean nationwide cohort study with repeated health screening data: Korean nationwide cohort study with repeated health screening data,” Neurology, vol. 98, no. 6, pp. e641–e652, 2022.

Y. Zhang, “Atmospheric microplastics: A review on current status and perspectives,” Earth-Science Reviews, vol. 203, 2020.

K. D. Cashman, “Vitamin D deficiency: defining, prevalence, causes, and strategies of addressing,” Calcified tissue international, vol. 106, pp. 14–29, 2020.

J.-K. Lee, “Vitamin D status and clinical implications in the adult population of Malaysia: a position paper by the Malaysian Vitamin D Special Interest Group,” Osteoporosis International, pp. 1–14, 2023.

A. Vestergaard, “Vitamin D in pregnancy (GRAVITD)-a randomised controlled trial identifying associations and mechanisms linking maternal Vitamin D deficiency to placental dysfunction and adverse pregnancy outcomes-study protocol,” BMC Pregnancy and Childbirth, vol. 23, pp. 1–10, 2023.‏

A. J. Aul et al., “Population-based incidence of potentially life-threatening complications of hypocalcemia and the role of vitamin D deficiency,” The Journal of pediatrics, vol. 211, pp. 98–104, 2019.‏

N. K. Hyde, “Maternal vitamin D in pregnancy and offspring bone measures in childhood: the vitamin D in pregnancy study,” Bone, vol. 124, pp. 126–131, 2019.

S. Gilani and P. Janssen, “Maternal Vitamin D Levels During Pregnancy and Their Effects on Maternal-Fetal Outcomes: A Systematic Review,” Journal of Obstetrics and Gynaecology Canada, vol. 42, no. 9, pp. 1129–1137, 2020.‏

J. Ahmed and K. Kebede Kumsa Sadeta, “Magnitude and factors associated with appropriate complementary feeding practice among mothers of children 6-23 months age in Shashemene town, Oromia-Ethiopia: Community based cross sectional study,” PloS one, vol. 17, 2022.

Bivona, G., Agnello, L., Bellia, C., Iacolino, G., Scazzone, C., Lo Sasso, B., & Ciaccio, M. Non-skeletal activities of vitamin D: from physiology to brain pathology. Medicina, 55(7), 341, 2019

G. Tapia et al., “Maternal and newborn vitamin D-binding protein, vitamin D levels, vitamin D receptor genotype, and childhood type 1 diabetes,” Diabetes Care, vol. 42, no. 4, pp. 553–559, 2019.

J. Sangüesa et al., “Prenatal and child vitamin D levels and allergy and asthma in childhood,” Pediatr. Res., vol. 93, no. 6, pp. 1745–1751, 2023.‏

C. Palacios, L. K. Kostiuk, and J. P. Peña-Rosas, “Vitamin D supplementation for women during pregnancy,” Cochrane Database Syst. Rev., vol. 7, p. CD008873, 2019.‏

M. R. Senosi, H. M. Fathi, N. M. A. Baki, O. Zaki, A. M. Magdy, and T. A. Gheita, “Bone mineral density, vitamin D receptor (VDR) gene polymorphisms, fracture risk assessment (FRAX), and trabecular bone score (TBS) in rheumatoid arthritis patients: connecting pieces of the puzzle,” Clin. Rheumatol., vol. 41, no. 5, pp. 1333–1342, 2022.

H.-K. Joh, S.-S. Hwang, B. Cho, C. S. Lim, and S.-E. Jung, “Effect of sun exposure versus oral vitamin D supplementation on serum 25-hydroxyvitamin D concentrations in young adults: A randomized clinical trial,” Clin. Nutr., vol. 39, no. 3, pp. 727–736, 2020.‏

M. García-Sáenz et al., “Understanding progestins: From basics to clinical applicability,” J. Clin. Med., vol. 12, no. 10, 2023.‏

Fedotcheva, T. A., Fedotcheva, N. I., & Shimanovsky, N. L., Progesterone as an anti-inflammatory drug and immunomodulator: new aspects in hormonal regulation of the inflammation. Biomolecules, 12(9), 1299, 2022.‏

S. Malik and K. Krishnaprasad, “Natural micronized progesterone sustained release (SR) and luteal phase: role redefined!!,” J Clin Diagn Res, vol. 10, no. 2, pp. E01-E4, 2016.

Bernard, N, et al. "Use of antidepressants and anxiolytics in early pregnancy and the risk of preeclampsia and gestational hypertension: a prospective study." BMC pregnancy and childbirth 19.1: 1-9, 2019

W. C. Duncan, “The inadequate corpus luteum,” Reproduction and Fertility, vol. 2, no. 1, pp. C1–C7, 2021.‏

A. K. Nayak, S. Mishra, S. Mishra, R. Patnaik, and I. Mohapatra, “Randomised Control Study of Misoprostol and Mifepristone versus Misoprostol Alone in Second Trimester Termination of Pregnancy,” The Journal of Obstetrics and Gynecology of India, pp. 1–6, 2023.‏

R. Parveen, M. Khakwani, S. Tabassum, and S. Masood, “Oral versus vaginal micronized progesterone for the treatment of threatened miscarriage,” Pak. J. Med. Sci. Q., vol. 37, no. 3, pp. 628–632, 2021.

A. Coomarasamy et al., “A randomized trial of progesterone in women with bleeding in early pregnancy,” Obstet. Anesth. Dig., vol. 39, no. 4, pp. 210–211, 2019.

L. Li et al., “Effect of progestogen for women with threatened miscarriage: a systematic review and meta-analysis,” BJOG, vol. 127, no. 9, pp. 1055–1063, 2020.

U. B. Akpan, C. J. Akpanika, U. Asibong, K. Arogundade, A. E. Nwagbata, and S. Etuk, “The influence of threatened miscarriage on pregnancy outcomes: A retrospective cohort study in a Nigerian tertiary hospital,” Cureus, vol. 14, no. 11, p. e31734, 2022.


Article Dates

Published: 2023-12-22

How to Cite

Jassim, S., & Raid M. H. Al-Salih. (2023). Role of Folic Acid, Vitamin D, and Progesterone in Pregnancy and Threatened Abortion. University of Thi-Qar Journal of Science, 10(2), 27–32.