Vitamin D supplementation during

pregnancy : Hype Vs. Truth

BAIDYA JLDEPARTMENT OF OBSTETRICS &

GYNAECOLOGYAGMC

Back ground of lecture

Recent enthusiasm of VIT. D supplementation products marketing by numerous Pharmaceutical companies

Laboratory industries with new basket of investigations

Physicians’ curiosity about new disease diagnosis & management

Recent emerging role of VIT D in Obstetrics

Literature search

Medline, Pub med, Cochrane review

English language

Only review articles

From 2010 to 2015

Key words: Vitamin D, deficiency, India, supplementation,

Pregnancy & Lactation

About 26,90,000 results (0.54 seconds)

Objectives of lecture

Introduction

Vitamin D sources

Who at risk of deficiency

Role of vitamin D in pregnancy

Hype

Truth

Remarks & recommendation

Questions that will be answered?

What are the clinical criteria for vitamin D deficiency in pregnant women?

Adverse maternal & neonatal outcome associated with deficiency?

What is optimal type,dose,regime and route of administration of vitamin D supplementation in pregnancy?

Does maternal supplementation lead to an improvement in outcomes

Is supplementation likely to be cost effective

sources

Who at risk of deficiency in pregnancy?

Asian, African American Winter atmosphere Limited sun screen Obesity Extensive clothing covering Malabsorption syndrome Faulty dietary habits

We all remember

?

A decade ago……

“Bone building sun shine steroid hormone had known

for its classical action on bone health & calcium

homeostasis”

What's are the non classical action?

In 21st Century

Non classical /non skeletal actions

In pregnancy … it is believed …

Pre-eclampsia Incidence of Caesarean Section Bacterial Vaginosis Preterm Birth LBW New born length Neonatal complications

Hypocalcaemia; Tetany Birth asphyxia Laryngomalacia Bronchiolitis

Let us seeHype & Truth

VDD associated with Pre-eclampsia

Daily intake 200 IU Vitamin D is inadequate

Vitamin D supplementation simple & cost effective,

without toxicity

Supplementation for all pregnant & lactating mother

Suggested routine screening & supplementation if found

deficient

Opined……

Supplementation is safe & recommended for all

Low Vitamin D concentration linked adverse maternal & foetal outcomes

Supplementation or treatment MAY have some short or long term health benefits

Focused research on potential benefits & optimal dosing of Vitamin D use

3 categories of supplementation

General: 10 mcg (400 units ) per day

High risk: 1000 units a day; 800 units of vitamin D & Calcium in women who at risk of developing Pre-eclampsia

Treatment: D3 20 K or D2 10 K weekly for 4 to 6 wks., followed by standard supplementation

HYPE

Drawn a conclusion….

High incidence of VDD in India: 5 to 50 %

Vitamin D status is crucial for optimal maternal &

foetal outcome

Target Vitamin D level to be maintained 30 ng/ml

Supplementation of Vitamin D across all trimester &

beyond is need of the hour

Truth

One of the largest review article

Most acceptable systematic review & meta-analysis: fundamental

conclusion Evidence to support a positive relation ship between maternal

vitamin D status & offspring birth weight and offspring bone mass

Positive effect of maternal vitamin D supplementation on neonatal calcium concentration

Dose requirement, duration and target groups to be supplemented remain unclear

Fertil Steril. 2015 May;103(5):1278-88.e4. doi: 10.1016/j.fertnstert.2015.02.019. Epub 2015 Mar 23.

Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Pérez-López FR1, Pasupuleti V2, Mezones-Holguin E3, Benites-Zapata VA4, Thota P2, Deshpande A5, Hernandez AV6.

Vitamin D supplementation associated with increased circulating 25(OH)VIT D 3 level, birth weight & birth length

Not associated with maternal & neonatal outcomes

Vitamin D supplementation during pregnancy for the prevention of pre-

eclampsia

WHO recommendationsVitamin D supplementation is not recommended during pregnancy to

prevent the development of pre-eclampsia and its complications.

Latest update 24th

August 2015

e-Library of Evidence for Nutrition Actions

(eLENA)

Unresolved issues

Optimizing the biochemical assessment of vitamin D status Healthy vitamin D level in pregnancy Routine screening for vitamin D sufficiency Routine supplementation; cost effectiveness Positive impact on maternal health Direct relation with neonatal & infantile health; long term

follow up of mothers & children

Resolved issues

Supplementation increases vitamin D status in mother & new born

Important nutrients during pregnancy for skeletal benefits of mother & new born

Questions that are answered?

What are the clinical criteria for vitamin D deficiency in pregnant women?

Adverse maternal & neonatal outcome associated with deficiency? What is optimal type,dose,regime and route of administration of

vitamin D supplementation in pregnancy? Does maternal supplementation lead to an improvement in

outcomes Is supplementation likely to be cost effective

Recommendations

Vitamin D supplementation is not recommended during pregnancy to prevent development of pre-eclampsia and its complications (strong recommendation)

Limited evidence available to suggest benefits and harms of the use of Vitamin D supplementation

Interventions during routine ANC is not recommended (conditional recommendation)

Remarks Documented deficiency may be corrected by 200 IU

vitamin D per day

May be given alone or as a part of micronutrient supplements

The benefits of this intervention for other maternal or birth outcomes are unclear

Limited evidence on safety of vitamin D supplementation during pregnancy

“”

Everything we hear is an opinion, not a fact. Everything we see is a perspective, not the truth MARCUS AURELIUS

thanks