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The Importance of Vitamin D Supplementation During PregnancyVitamin D – also known as the “sunshine vitamin” – yields many health benefits; it promotes bone health, boosts immunity, and even helps to prevent some forms of depression. A less commonly known fact is that Vitamin D also plays a role in promoting a healthy pregnancy. Both expectant and breastfeeding moms can positively impact their infants’ health by obtaining an adequate amount of Vitamin D. Vitamin D deficiency during pregnancyIn a society where we spend much of our time inside, it is common to be deficient in Vitamin D. Vitamin D deficiency during pregnancy occurs frequently, but is completely preventable. While most nutrients in circulation increase during pregnancy, hemodilution may cause Vitamin D concentrations to decrease as early as 10 weeks gestation. Therefore, most pregnant women have low Vitamin D blood levels. Adequate Vitamin D levels during pregnancy promote bone development in utero, and therapeutic levels often help moms feel more energetic. Boosting Vitamin D levels may also help curb some of the normally expected emotions such as pre-labor anxiety and postpartum blues. While the complete role of Vitamin D during pregnancy is still in the discovery phase, some small, limited studies correlate Vitamin D deficiency with low birth weight, preeclampsia, and gestational diabetes. Larger studies need to be completed to confirm these possible correlations. Maternal & infant Vitamin D deficiencyMaternal Vitamin D deficiency is more likely to occur in the winter months and among those who use regularly use sunscreen, cover most of their skin, and/or have heavily pigmented skin. Moms who take a daily Vitamin D supplement while breastfeeding can help prevent infant deficiency. Breastfeeding alone, however, is not enough to prevent rickets (weak, soft bones in children). It is also important to discuss infant Vitamin D supplementation if you are breastfeeding. Most pediatricians recommend a daily Vitamin D supplement for all breastfed infants. Vitamin D sources & supplementationAlthough sunlight is the best source of Vitamin D, many women experience unprotected sun exposure due to heightened awareness of the risk of skin cancer. Foods like fatty fish ( such as wild caught salmon) are a good natural food source of Vitamin D, but frequent fish consumption causes concern for elevated mercury intake during pregnancy. In the United States, we are fortunate to have access to dairy foods which are fortified with Vitamin D. However, consuming fortified foods alone will not reverse Vitamin D deficiency. The most measurable and accurate way to remedy a depleted Vitamin D level is with supplementation. The recommended form of Vitamin D supplement during pregnancy is D3. This is the natural form of Vitamin D our bodies make from sunlight. Daily prenatal vitamins containing Vitamin D may not be enough to treat a deficiency during pregnancy. Most sources state 2,000-4,000 IU per day is safe during pregnancy.Talk to your provider about monitoring Vitamin D levels and developing a recommended daily amount based on your individual needs. Both you and your baby will benefit from it! Number 495 (Reaffirmed 2021) Committee on Obstetric Practice This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. ABSTRACT: During pregnancy, severe maternal vitamin D deficiency has been associated with biochemical evidence of disordered skeletal homeostasis, congenital rickets, and fractures in the newborn. At this time, there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency. For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum 25-hydroxyvitamin D levels can be considered and should be interpreted in the context of the individual clinical circumstance. When vitamin D deficiency is identified during pregnancy, most experts agree that 1,000–2,000 international units per day of vitamin D is safe. Higher dose regimens used for treatment of vitamin D deficiency have not been studied during pregnancy. Recommendations concerning routine vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials. Vitamin D is a fat-soluble vitamin obtained largely from consuming fortified milk or juice, fish oils, and dietary supplements. It also is produced endogenously in the skin with exposure to sunlight. Vitamin D that is ingested or produced in the skin must undergo hydroxylation in the liver to 25-hydroxyvitamin D (25-OH-D), then further hydroxylation primarily in the kidney to the physiologically active 1,25-dihydroxyvitamin D. This active form is essential to promote absorption of calcium from the gut and enables normal bone mineralization and growth. During pregnancy, severe maternal vitamin D deficiency has been associated with biochemical evidence of disordered skeletal homeostasis, congenital rickets, and fractures in the newborn 1 2. Recent evidence suggests that vitamin D deficiency is common during pregnancy especially among high-risk groups, including vegetarians, women with limited sun exposure (eg, those who live in cold climates, reside in northern latitudes, or wear sun and winter protective clothing) and ethnic minorities, especially those with darker skin 3 4 5. Newborn vitamin D levels are largely dependent on maternal vitamin D status. Consequently, infants of mothers with or at high risk of vitamin D deficiency are also at risk of vitamin D deficiency 5 6. For the individual pregnant woman thought to be at increased risk of vitamin D deficiency, the serum concentration of 25-OH-D can be used as an indicator of nutritional vitamin D status. Although there is no consensus on an optimal level to maintain overall health, most agree that a serum level of at least 20 ng/mL (50 nmol/L) is needed to avoid bone problems ref07 8 9 10. Based on observations of biomarkers of vitamin D activity, such as parathyroid hormone, calcium absorption, and bone mineral density, some experts have suggested that vitamin D deficiency should be defined as circulating 25-OH-D levels less than 32 ng/mL (80 nmol/L) 11. An optimal serum level during pregnancy has not been determined and remains an area of active research. In 2010, the Food and Nutrition Board at the Institute of Medicine of the National Academies established that an adequate intake of vitamin D during pregnancy and lactation was 600 international units per day 12. Most prenatal vitamins typically contain 400 international units of vitamin D per tablet. Summarizing recent observational and interventional studies, the authors of a recent clinical report from the Committee on Nutrition of the American Academy of Pediatrics suggested that a daily intake higher than that recommended by the Food and Nutrition Board may be needed to maintain maternal vitamin D sufficiency 13. Although data on the safety of higher doses are lacking, most experts agree that supplemental vitamin D is safe in dosages up to 4,000 international units per day during pregnancy or lactation 12. At this time there is insufficient evidence to support a recommendation for screening all pregnant women for vitamin D deficiency. For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum 25-OH-D levels can be considered and should be interpreted in the context of the individual clinical circumstance. When vitamin D deficiency is identified during pregnancy, most experts agree that 1,000–2,000 international units per day of vitamin D is safe. Higher dose regimens used for the treatment of vitamin D deficiency have not been studied during pregnancy. Recommendations concerning routine vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials. At this time, there is insufficient evidence to recommend vitamin D supplementation for the prevention of preterm birth or preeclampsia.
Copyright July 2011 by the American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to: Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400. ISSN 1074-861X Vitamin D: screening and supplementation during pregnancy. Committee Opinion No. 495. American College of Obstetricians and Gynecologists. Obstet Gynecol 2011;118:197–8. |
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