Pregnancy support- Vitamin Deficiencies

Vitamin D - updated: 03 November 2008

Vitamin D deficiency in recently pregnant women

Rev Med Liege. 2008 Feb;63(2):87-91

Cavalier E, Delanaye P, Morreale A, Carlisi A, Mourad I, Chapelle JP, Emonts P

We have evaluated the prevalence of the 25-hydroxy vitamin D (25VTD) deficiency in recently pregnant women and new mothers in the area of Liege, Belgium. The study took place in November 2006. Twenty four women who underwent a positive pregnancy test and 65 new mothers were enrolled. The level of 25VTD did not differ between the two groups. Only 12% of the pregnant women and 14% of the new mothers (>12 ng/ml) had an optimal level of 25VTD (>30 ng/ ml). We also observed a severe 25VTD deficiency in 21% of pregnant women and 32% of new mothers. Our results showed that more than 80% of pregnant women and new mothers in the area of Liege presented a deficiency in 25VTD. In Belgium, daily vitamin supplementation of pregnant women is common, but the level of vitamin D3 concentration range from 10 microg (400 UI) to zero microg. In our area, vitamin D production in the skin is not always important enough to achieve optimal levels. Our data show that vitamin D supplementation of pregnant women is not enough and that 25VTD deficiency is not diagnosed in this high-risk population. Children born from deficient mothers will present a higher risk of suffering from bone mineral diseases as well as other pathologies, as type 1 diabetes or neurological disorders. Of course, this insufficiency will also have an impact on mother's bone reserve, but these mothers will also be at higher risk for preeclampsia.

Publication Types:

• Clinical Trial

Maternal vitamin D intake and mineral metabolism in mothers and their newborn infants

Br Med J. 1980 Jul 5;281(6232):11-4

Cockburn F, Belton NR, Purvis RJ, Giles MM, Brown JK, Turner TL, Wilkinson EM, Forfar JO, Barrie WJ, McKay GS, Pocock SJ.

Pregnant women receiving daily supplements of 400 IU (10 microgram) of vitamin D2 from the 12th week of pregnancy had plasma calcium concentrations higher at 24 weeks but similar at delivery to those in control pregnant women who did not receive the supplements. Infants of the women receiving the supplements had higher calcium, lower phosphorus, and similar magnesium concentrations on the sixth day of life and a lower incidence of hypocalcaemia than infants of the control women. Plasma concentrations of 25-hydroxycholecalciferol, which showed a seasonal variation, were higher in mothers and infants in the treated group. Cord-blood calcium, magnesium, phosphorus, and 25-hydroxycholecalciferol concentrations correlated with maternal values at delivery. Breast-fed infants had higher calcium and magnesium and lower phosphorus and 25-hydroxycholecalciferol concentrations than artificially fed infants. A defect of dental enamel was found in a high proportion of infants (many of whom had suffered from hypocalcaemia) born to the control women. These results suggest that vitamin D supplementation during pregnancy would be beneficial for mothers, whose intake from diet and skin synthesis is appreciably less than 500 IU of vitamin D daily.

Alterations in vitamin D metabolites and minerals in diabetic pregnancy

Gynecol Obstet Invest. 1988;25(2):99-105

Kuoppala T.

Vitamin D metabolites and minerals involved in bone metabolism were studied in 68 control mothers, 14 gestational diabetics and 68 insulin-dependent diabetics during pregnancy and at delivery. 25(OH)D and 1,25(OH)2D concentrations were significantly (p less than 0.001) lower in insulin-dependent diabetics than in the control or gestational diabetic groups. A similar difference was also observed between infants. 24,25(OH)2D, phosphorus and magnesium values were similar in all groups. Corrected calcium values were significantly lower in both mothers (p less than 0.001) and infants (p less than 0.05) in the insulin-dependent group than in the other two groups. Postpartum, 10% of infants of diabetic mothers received calcium therapy. Our results show alterations in vitamin D and mineral metabolism in pregnant insulin-dependent diabetics and their newborn infants and indicate observation during pregnancy and after delivery

High prevalence of vitamin D deficiency in pregnant non-Western women in The Hague, Netherlands

Am J Clin Nutr. 2006 Aug;84(2):350-3; quiz 468-9

van der Meer IM, Karamali NS, Boeke AJ, Lips P, Middelkoop BJ, Verhoeven I, Wuister JD.

BACKGROUND: Vitamin D deficiency is common in dark-skinned persons living in northern countries. Vitamin D deficiency during pregnancy may have serious consequences for both mother and child. OBJECTIVE: The objective was to ascertain the prevalence of vitamin D deficiency in pregnant women of several ethnic backgrounds who were living in The Hague, a large city in the Netherlands. DESIGN: Midwives whose practice was visited by a large number of non-Western immigrants added the assessment of serum 25-hydroxyvitamin D [25(OH)D] to the standard blood test given to women who visited the practice during week 12 of pregnancy. Subsequently, the Municipal Health Service collected additional data from the midwives' files (June 2002 through March 2004): background variables, use of tobacco or alcohol or drugs, and infectious diseases. The women were grouped ethnically as Western, Turkish, Moroccan, and other non-Western. RESULTS: The vitamin D concentrations of 358 women were found in the midwives' files. Of these women, 29% were Western, 22% were Turkish, and 19% were Moroccan. Mean serum 25(OH)D concentrations in Turkish (15.2 +/- 12.1 nmol/L), Moroccan (20.1 +/- 13.5 nmol/L), and other non-Western women (26.3 +/- 25.9 nmol/L) were significantly (P

Publication Types:

• Review

Vitamin D deficiency during pregnancy: an ongoing epidemic

American Journal of Clinical Nutrition, Vol. 84, No. 2, 273, August 2006

Bruce W Hollis and Carol L Wagner

In this issue of the Journal, van der Meer et al (1) report a high prevalence of vitamin D deficiency during pregnancy in non-Western women in the Netherlands. These investigators found in their study that >50% of women with darker pigment were vitamin D deficient, whereas only 8% of Western women were defined as deficient. Even at first glance, this is a truly remarkable statistic. However, the actual percentage is far greater than reported. The reason for this is quite simple—the authors of this study were very conservative in their definition of vitamin D deficiency. They defined deficiency as circulating 25-hydroxyvitamin D [25(OH)D] concentrations <25 nmol/L (10 ng/mL). As far as we are concerned, this is an old definition of vitamin D deficiency, and many investigators now define deficiency as < 80 nmol (32 ng/mL) circulating 25(OH)D/L (2, 3). This deficiency cutoff is now based on an array of biomarkers that are adversely affected by nutritional vitamin D deficiency rather than on Gaussian distributions of 25(OH)D concentrations in populations, as were used in the past (2).

Vitamin D Deficiency in Pregnancy: Bringing the Issues to Light

The American Society for Nutrition J. Nutr. 137:305-306, February 2007

Marjorie L. McCullough

In this issue of The Journal of Nutrition, Bodnar et al. (1) provide compelling evidence that 1) pregnant women and their neonates living in the northern U.S. are at risk of vitamin D deficiency, 2) this problem is worse for blacks than whites, 3) seasonal variation contributes little to vitamin D status among black women and their neonates, and 4) current formulations of prenatal vitamin supplements may be inadequate to achieve desired serum 25 hydroxy vitamin D [25(OH) D] (storage form of vitamin D) concentrations. The authors analyzed a random subsample of banked maternal and cord serum from 200 white and 200 black participants in the Pregnancy Exposures and Pre-eclampsia Prevention Study, conducted through Pittsburgh clinics. Early in pregnancy, 45% of black mothers (compared with 2% of white mothers) were classified as vitamin D deficient, and insufficiency was common among women of both racial and ethnic groups. By the time of delivery, mothers' vitamin D status improved, but only slightly. The prevalence of vitamin D deficiency for neonates was even greater than that of their mothers. This is particularly striking given that the vast majority of all women reported taking prenatal vitamins by the end of the study period.

Publication Types:

• Epidemiology and Surveillance Research

Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level

American Journal of Clinical Nutrition, Vol. 73, No. 2, 288-294, February 2001

Reinhold Vieth, Pak-Cheung R Chan and Gordon D MacFarlane

Background: The Food and Nutrition Board of the National Academy of Sciences states that 95 µg vitamin D/d is the lowest observed adverse effect level (LOAEL). Objective: Our objective was to assess the efficacy and safety of prolonged vitamin D3 intakes of 25 and 100 µg (1000 and 4000 IU)/d. Efficacy was based on the lowest serum 25-hydroxyvitamin D [25(OH)D] concentration achieved by subjects taking vitamin D3; potential toxicity was monitored by measuring serum calcium concentrations and by calculating urinary calcium-creatinine ratios. Design: Healthy men and women (n = 61) aged 41 ± 9 y ( ± SD) were randomly assigned to receive either 25 or 100 µg vitamin D3/d for 2–5 mo, starting between January and February. Serum 25(OH)D was measured by radioimmunoassay. Results: Baseline serum 25(OH)D was 40.7 ± 15.4 nmol/L ( ± SD). From 3 mo on, serum 25(OH)D plateaued at 68.7 ± 16.9 nmol/L in the 25-µg/d group and at 96.4 ± 14.6 nmol/L in the 100-µg/d group. Summertime serum 25(OH)D concentrations in 25 comparable subjects not taking vitamin D3 were 46.7 ± 17.8 nmol/L. The minimum and maximum plateau serum 25(OH)D concentrations in subjects taking 25 and 100 µg vitamin D3/d were 40 and 100 nmol/L and 69 and 125 nmol/L, respectively. Serum calcium and urinary calcium excretion did not change significantly at either dosage during the study. Conclusions: The 100-µg/d dosage of vitamin D3 effectively increased 25(OH)D to high-normal concentrations in practically all adults and serum 25(OH)D remained within the physiologic range; therefore, we consider 100 µg vitamin D3/d to be a safe intake.

Publication Types:

• Review

Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety

Am J Clin Nutr. 1999 May;69(5):842-56

Vieth R.

For adults, the 5-microg (200 IU) vitamin D recommended dietary allowance may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism. Other benefits of vitamin D supplementation are implicated epidemiologically: prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension. Total-body sun exposure easily provides the equivalent of 250 microg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. Sailors in US submarines are deprived of environmentally acquired vitamin D equivalent to 20-50 microg (800-2000 IU)/d. The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D [25(OH)D] response that is surprisingly flat up to 250 microg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 microg (4000 IU)/d is required. Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 microg (10000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of > or = 1000 microg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 microg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 microg (2000 IU)/d is too low by at least 5-fold.

Publication Types:

• Review