If a woman starts pregnancy with a lack of Vitamin D and continues to be deficient throughout pregnancy she is at an increased risk of complications.
A lack of Vitamin D has been linked to an increased risk of pre-eclampsia, insulin resistance, gestational diabetes mellitus and of needing emergency C-section. She is also more likely to suffer from anaemia and bacterial vaginosis, which is associated with pre-term delivery and miscarriage, and also post-natal depression.
I will look at the evidence for the effect of Vitamin D levels for each of these complications in more details in future blogs, but for now every midwife, doctor and nurse should be sensitive to the recent advice sent out by the Chief Medical Officers of England, Wales, Northern Ireland and Scotland.
This has also recently been endorsed by NICE at: http://www.nice.org.uk/newsroom/features/MakingSurePregnantAndBreastfeedingWomenReceiveVitaminD.jsp
This advice is that every pregnant woman should take 10 micrograms of Vitamin D3 every day. This is also measured as 400 IU ( International Units ).
The first question that everyone asks is: “Is it safe ?”
However, the more important question is: “Is it enough ?”
The Canadian Paediatric Society currently advises every pregnant woman to take 50 micrograms ( 2,000 IU ) of Vitamin D3 per day
Professor Bruce Hollis has been running trials since 2005 in which he has given pregnant women 100 micrograms ( 4,000 IU ) per day.
This has proven to be totally safe and very effective. Babies were bigger and healthier and the pregnancy was easier in many ways, with reduced pre-eclampsia and less gestational diabetes.
In 1999 Professor Reinhold Vieth wrote: “If there is published evidence of toxicity in adults from an intake of 250 micrograms ( 10,000 IU ) per day, and that is verified by the 25(OH)D concentration, then I have yet to find it.”
Both these experts spoke at a scientific conference about Vitamin D & Obstetrics held at the Wellcome Trust in London in May 2011. www.vitamindassociation.org/events ( Select May 17 )
If a white-skinned woman goes into the mid-day summer sun in the UK in her bikini she will receive the equivalent of about 20,000 IU within 15 minutes. An Asian woman might need 30-60 minutes and an African woman would need 1-2 hours to receive the same effect, because the melanin in their skin acts as a sun screen.
The take-home message is:
Every pregnant woman should take Vitamin D – and it is safe
The question that every midwife, doctor and nurse should be asking is: “what is the correct target blood serum level for a pregnant woman and how much Vitamin D does she need to reach this level”
Watch this space !