Vitamin D Insufficiency and the Best Dosage of Vitamin D Supplementation in Pregnant Ladies - Research Paper Example

The Optimal Dosage of Vitamin D Supplementation Necessary For Pregnant Women Introduction During pregnancy, the fetus depends entirely on the mother for its nutrition. Furthermore, the need for important minerals and vitamins such as vitamin D increases as the pregnancy progresses from the first trimester to years after birth. Numerous studies have been conducted indicating that poor vitamin D status among mothers and offspring can lead to the development of diseases and distressing conditions (McAree, Jacobs, Manickavasagar, Sivalokanathan, Brennan, Bassett & Blair, 2013). Vitamin D may be obtained from certain foods and added to others. Additionally, vitamin D is acquired when one exposes their skin to the sunlight and ultraviolet rays that strike the skin triggering the synthesis of the vitamin. For pregnant mothers, this vitamin is quite essential, not only for their welfare, but also for the well-being of their unborn babies. This is because of the numerous benefits that are achieved from the consumption of vitamin D, such as, the maintenance of adequate serum calcium and phosphate concentrations in the body. This, in turn, allows for the attainment of normal bone mineralization, and prevention of conditions such as hypocalcaemia among pregnant women and their offspring (Perampalam, Ganda, Chow, Opie, Hickman, Shadbolt & Nolan, 2011). Pregnant women who are vitamin D deficient place their unborn offspring and themselves at risk for developing serious health complications. Based on a study by the US National Institute of Health, the presence of sufficient vitamin D in the body of a pregnant woman has been found to augment the development of her bones, and remodel her osteoclasts and osteoblasts. If she is vitamin D deficiency for an extensive period, the bones and body frame of a pregnant woman may become brittle, thin, and misshapen. According to Mohamed, Rowan, Fong & Loy (2014), vitamin D deficiency among infants is determined by the maternal status of vitamin D in the second trimester. For the fetus, a deficiency in the supply of vitamin D into their bodies may result in them developing diseases such as rickets upon being born. The metabolism of vitamin D takes place during the last trimester in which the bone mass is enhanced. Vitamin D is indispensable for the mineralization of the fetal skeletons and is a major contributor to the attainment of an increased bone mass (Wagner & Greer, 2008). According to a study by Haliloglu et al., (2011), bone turnover in pregnant women and infants is enhanced with the increased consumption of vitamin D3 supplementation (Mithal & Kalra, 2014). The insufficiency of vitamin D in the body of the mother may also increase the risk of developing conditions such as osteoporosis, depression, and severe myopathy. Mohamed, Rowan, Fong & Loy (2014) also found that vitamin D deficiency could result in maternal osteomalacia, preeclampsia, gestational diabetes, small birth size, impairment of fetal growth and development of bones, and the likelihood of respiratory diseases development among the infants (Grant, Stewart, Scragg, Milne, Rowden, Ekeroma & Camargo, 2014). Vitamin D supplementation may however be helpful for expectant females as it has been shown to reduce high blood pressure, recurrent pregnancy loss, and pre-term deliveries. As such, vitamin D supplementation would act as a long-term health strategy for the pregnant women. Considering the aforementioned importance of vitamin D for healthy pregnancies, the major focus of this paper shall be to identify the optimal dosage of vitamin D supplementation for pregnant women. This is based on recent studies that have been conducted by various organizations advocating for continued and increased supplementation, especially considering that vitamin D deficiency among pregnant women has persisted to this day (Ginde, Sullivan, Mansbach & Camargo Jr, 2010). According to a study by Ginde, Sullivan, Mansbach & Camargo (2010), vitamin D insufficiency is common among adolescent girls and women of childbearing age. Young women need enough vitamin D for their own growth and overall health, but vitamin D sufficiency is also important for an expecting mother and the healthy development of her fetus. Misra, Pacaud, Petryk, Collett-Solberg & Kappy (2008) thus believe that proper guidelines need to be provided to clinicians for use in the evaluation, prevention, and treatment of vitamin D insufficiency among expecting women. The objective of this research paper shall be to review the literature regarding vitamin D supplementation for pregnant women, and identify the dosage considered as optimal for preventing deficiency among mothers and offspring. The prevalence of vitamin D insufficiency among pregnant women may be attributed to scientific evidence presenting that the recommended daily allowances (RDA) for pregnant women for vitamin D (currently set at 400 IU per day) is grossly insufficient. This leads to the main question of what the recommended dosage of vitamin D supplementation should be for pregnant women. Haliloglu et al. (2011) conducted an experiment to investigate the need for increased vitamin D supplementation in pregnant women from Turkey. The authors stated their research question in the article’s title as follows: “Should routine vitamin D supplementation be increased in pregnant women?” A randomized-control design was used for the study, which measured the serum concentration of 25(OH) vitamin D3 in both pregnant women and healthy but non-pregnant women. Four of the pregnant women were found to be vitamin D deficient during their 32nd week of gestation while 10 of the women were deficient in the post gestation period. Serum vitamin D levels were less than 4 ng/mL in 10 percent of the pregnant women and in 33 percent during the postpartum period of the women. In the control group, 20 percent of the females had an unsatisfactory level of vitamin D, while 30 percent were vitamin D deficient. The authors of this study also associated vitamin D supplementation with bone resorption. Based on the outcomes, the investigators recommended an increase in supplementation of the vitamin D for pregnant women. According to a study by Perampalan et al. (2011), pregnant participants were given a dose of 500 IU D3 per day for a period of one week. Nevertheless, the authors established that vitamin D insufficiency persisted among the participants at ≤ 25 nmol/L, Thus it was determined that 500 IU per day was inadequate to prevent the vitamin D insufficiency among pregnant women, and that a higher dose of about 1000 IU per day would ensure sufficiency for both the mother and the fetus. Such a result came from a similar test done with an increase in dosage, considering that the initial 500 IU used had proved insufficient. Shakiba and Iranmanesh (2013) investigated vitamin D requirements in women, and focused on determining the threshold level of the vitamin in the body of an expecting mother, which would also be a level adequate for sufficient supply of the vitamin to her fetus. The research question sought to determine the optimal dosage of vitamin D supplementation for pregnant women in order to maintain a minimum serum 25(OH)D level of >20ng/mL in neonates. An experimental design was used in the study, and the placement of each of the 51 participating mothers into one of the three treatment groups was done through a randomized approach. For each of the three groups, a different dosage of vitamin D supplementation was given. Intervention group A received 50,000 IU/month of vitamin D3 and group B received 100,000 IU/month of vitamin D3, both starting from the second trimester of pregnancy. Group C was first treated with 200,000 IU, which was also done at the start of the second trimester in which vitamin D3 followed by supplementation with 50,000 IU/month was used. By the end of the study, a supplement dosage of 50,000 IU per month was found to ensure a sufficient level of the vitamin (> 20 ng/ml) in the women’s fetuses. Thus, the authors concluded that the current recommendation for vitamin D supplementation for pregnant women should be increased to 50,000 IU per month from 1000 IU per day. Ideally, 100,000 IU used was indeed too much in its use per month, and, therefore an unsafe amount for use. Hillis et al. (2011) also investigated the effectiveness and safety of vitamin D supplementation for pregnant women. The authors sought to investigate if there is a significant difference in the effectiveness of vitamin D supplementation based on the quantity used. The study utilized a randomized controlled design with supplementation dosage as the intervention. Three different groups received supplements of 400 IU, 2000 IU and 4000 IU per day. Associated risk of supplementation was also different across the groups, except between the group that received 2000 IU and the group that received 4000 IU. This associated risk was estimated at a ratio of 1.31, at 95% confidence interval and p=0.085. The authors thus recommended 4000 IU per day of vitamin D supplementation to be the dosage that would provide adequate amount of the vitamin to both pregnant mothers and nursing infants. Another study, by Grant et al. (2014) focused on determining the vitamin D dose necessary to achieve a serum 25-hydroxyvitamin D (25(OH)D) concentration of ≥20 ng/mL during infancy. A randomized control design was used in the study. Pregnant women and their infants were assigned to either a control group, low-level vitamin D intervention or a high-level vitamin D intervention. Vitamin D intervention works between the range of 25–75 nmol/L. As such, a range that works below the 25nmol/L is considered low, whereas any value higher than 75 nmol/L is considered an excess. Serum measurements were then taken from the women at their 36th week of gestation, and also from infants at two, four, and six months of age. Before intervention, 54 % of the women in the control group, 64% of the women in the low-dose group, and 55% of the women in the high-dose group had a vitamin D serum level of >20 ng/mL. At 36 weeks of gestation, a significant difference was seen in the proportion of participants with vitamin D serum level ≥20 ng/mL in the control group and in the treatment groups, with higher levels in treatment groups. A substantial difference was also seen between the control group and treatment groups for infant participants at two and four months during those assessment periods. More infants in the treatment groups were found to have serum levels ≥20 ng/mL. No significant difference was seen, however, between the control and treatment groups at six months. Thus, the authors concluded that vitamin D supplementation at a dose of 1000 or 2000 IU per day during pregnancy, and then 400 or 800 IU during infancy increased the vitamin D level of infants to a (25(OH)D) level ≥20 ng/mL. They further noted that the higher level of supplementation in pregnant women and infants sustains the level of vitamin D in infants for a longer period (Grant et al., 2014). A pregnant mother should strive to eat healthily and vary her diet in order to ensure adequate intake of various minerals and vitamins including vitamin D. However, occasionally foods may not provide enough of the needed nutrition, and supplementation may be necessary. (Charatcharoenwitthaya, Nanthakomon, Somprasit, Chanthasenanont, Chailurkit, Pattaraarchachai & Ongphiphadhanakul, 2013). Considering that there are very few foods that contain vitamin D naturally, pregnant mothers are often required to supplement vitamin D in pill form. Statistically, about 40-60% of the American populations, including pregnant women are vitamin D deficient, the reason being the shortage in vitamin D containing foods (Holick, Binkley, Bischoff-Ferrari, Gordon, Hanley, Heaney & Weaver, 2011). Women who take vitamin D supplements will increase their chances of managing their pregnancies well, and prevent preterm labors and infections. Furthermore, as evidenced by the aforementioned studies, it appears that a dosage of at least 1000 IU per day during pregnancy, and 400-800 IU per day after pregnancy, is adequate for maintaining both the health of the mother, her fetus, and her infant. References 1- Charatcharoenwitthaya, N., Nanthakomon, T., Somprasit, C., Chanthasenanont, A., Chailurkit, L. O., Pattaraarchachai, J., & Ongphiphadhanakul, B. (2013). Maternal vitamin D status, its associated factors and the course of pregnancy in Thai women. Clinical endocrinology, 78(1), 126-133. 2- Ginde, A. A., Sullivan, A. F., Mansbach, J. M., & Camargo Jr, C. A. (2010). Vitamin D insufficiency in pregnant and nonpregnant women of childbearing age in the United States. American journal of obstetrics and gynecology, 202(5), 436-e1. 3- Grant, C. C., Stewart, A. W., Scragg, R., Milne, T., Rowden, J., Ekeroma, A., & Camargo, C. A. (2014). Vitamin D during pregnancy and infancy and infant serum 25-hydroxyvitamin D concentration. Pediatrics, 133(1), e143-e153. 4- Haliloglu, B., Ilter, E., Aksungar, F. B., Celik, A., Coksuer, H., Gunduz, T., & Ozekici, U. (2011). Bone turnover and maternal 25 (OH) vitamin D3 levels during pregnancy and the postpartum period: should routine vitamin D supplementation be increased in pregnant women? European Journal of Obstetrics & Gynecology and Reproductive Biology, 158(1), 24-27. 5- Hillis, L. D., Smith, P. K., Anderson, J. L., Bittl, J. A., Bridges, C. R., Byrne, J. G., & Winniford, M. D. (2011). 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary. Journal of the American College of Cardiology, 58(24), 2584. 6- Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., ... & Weaver, C. M. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 96(7), 1911-1930. 7- Hollis, B. W. (2005). Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. The Journal of nutrition, 135(2), 317-322. 8- Karim, S. A., Nusrat, U., & Aziz, S. (2011). Vitamin D deficiency in pregnant women and their newborns as seen at a tertiary-care center in Karachi, Pakistan. International Journal of Gynecology & Obstetrics, 112(1), 59-62. 9- Kazemi, A., Sharifi, F., Jafari, N., & Mousavinasab, N. (2009). High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. Journal of Womens Health, 18(6), 835-839. 10- McAree, T., Jacobs, B., Manickavasagar, T., Sivalokanathan, S., Brennan, L., Bassett, P., ... & Blair, M. (2013). Vitamin D deficiency in pregnancy–still a public health issue. Maternal & child nutrition, 9(1), 23-30. 11- Misra, M., Pacaud, D., Petryk, A., Collett-Solberg, P. F., & Kappy, M. (2008). Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics, 122(2), 398-417. 12- Mithal, A., & Kalra, S. (2014). Vitamin D supplementation in pregnancy. Indian journal of endocrinology and metabolism, 18(5), 593. 13- Mohamed, H. J. J., Rowan, A., Fong, B., & Loy, S. L. (2014). Maternal Serum and Breast Milk Vitamin D Levels: Findings from the Universiti Sains Malaysia Pregnancy Cohort Study. PloS one, 9(7), e100705. doi:10.1371/journal.pone.0100705. 14- Shakiba, M., & Iranmanesh, M. R. (2013). Vitamin D requirement in pregnancy to prevent deficiency in neonates: a randomised trial. Singapore medical journal, 54(5), 285-288. 15- Wagner, C. L., & Greer, F. R. (2008). Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics, 122(5), 1142-1152. 16- Perampalam, S., Ganda, K., Chow, K. A., Opie, N., Hickman, P. E., Shadbolt, B., ... & Nolan, C. J. (2011). Vitamin D status and its predictive factors in pregnancy in 2 Australian populations. Australian and New Zealand Journal of Obstetrics and Gynaecology, 51(4), 353-359. doi: 10.1111/j.1479-828X.2011.01313.x Read More