Vitamin D deficiency has long been associated with poor bone development and has been identified as the cause of rickets. Although the incidence of rickets has declined with the current daily recommendations of vitamin D intake, the prevalence and additional consequences of low serum vitamin D levels have not been recognized until recently.1,2 The measurement of serum vitamin D in pregnancy has helped researchers establish the prevalence of vitamin D deficiency and elucidate adverse maternal and fetal outcomes associated with it.3 Prevention of these diseases and reduction of the risk for childhood illnesses that are linked to early vitamin D deficiency are possible with greater understanding of vitamin D physiologic components, risk factors for vitamin D deficiency, and methods of supplementation to attain optimal levels in pregnant and lactating women
Vitamin D is a prohormone that is derived from cholesterol. The nutritional forms of vitamin D include D3 (cholecalciferol), which is generated in the skin of humans and animals, and vitamin D2 (ergocalciferol), which is derived from plants; both forms can be absorbed in the gut and used by humans. Controversy exists as to whether D2 or D3 is more effective in maintaining circulating levels of vitamin D in nonpregnant individuals, and specific data during pregnancy is unknown.4,5 In this review when we refer to vitamin D, we imply either vitamin D2 or D3. Vitamin D occurs naturally in fish and some plants but is not found in significant amounts in meat, poultry, dairy products (without fortification), or the most commonly eaten fruits and vegetables. The Food and Nutrition Board’s current recommendation for adequate intake of vitamin D is 200 IU/d for both pregnant and nonpregnant individuals aged 0–50 years.6 Wild salmon (3.5 oz) provides 600–1000 IU; farmed salmon has approximately 25% of this amount per serving.7 The same amount of mackerel, sardines, or tuna fish provides 200–300 IU. Cod liver oil (1 tsp) provides 600–1000 IU. One of the few plant sources of vitamin D is shiitake mushrooms, which provide 1600 IU.
The document discusses the importance of nutrition during pregnancy. It notes that optimal nutrition prior to and during pregnancy promotes healthy fetal growth and development and reduces risk of diseases later in life. The fetus relies on maternal nutrition for growth and development. Key nutrients discussed include carbohydrates, proteins, fats, vitamins and minerals. Guidelines are provided around healthy eating, nutrient requirements, and gestational weight gain during pregnancy.
Importance of vitamin d in pregnancy and lactationAzam Jafri
Vitamin D deficiency is a widespread problem in pregnant women and nursing mothers. It has been linked to reduced fetal growth, lower bone mineral accrual in offspring, weaker immune function and bone development in children, shorter gestation periods, lower birth weight, increased risk of asthma and rickets in infants. A single high dose of vitamin D3 given in the sixth or seventh month of pregnancy can help prevent deficiencies in mothers and babies.
This study examined the effects of daily antenatal micronutrient supplementation on biochemical indicators of micronutrient status and infection in pregnant women in rural Nepal. Blood samples were taken from pregnant women before and during supplementation to analyze concentrations of various micronutrients and markers of infection. Supplementation with folic acid alone or with iron decreased folic acid deficiency and improved status of some other micronutrients, but adding additional micronutrients like zinc did not further improve status. Multiple micronutrient supplementation most improved micronutrient status but had little effect on infection markers. The study suggests antenatal micronutrient supplementation can help address deficiencies in this population.
This document discusses vitamin D in pregnancy. It covers the physiology of vitamin D, risks of deficiency like preeclampsia, low birthweight, and neonatal hypocalcemia. It recommends screening high-risk women like those with limited sun exposure or high BMI and supplementing deficient women with 1000-2000IU of vitamin D daily during pregnancy. Vitamin D supplementation is considered safe and may provide benefits, though more research is still needed on optimal dosing.
Laminine LPGN - lekarstven spravochnik USA 2015vili9
Laminine is a dietary supplement containing a proprietary blend called OPT9. OPT9 contains fertilized avian egg extract, along with marine and phyto proteins. The document discusses several clinical studies that showed Laminine had positive effects on cholesterol, blood pressure, cortisol levels, and wound healing. It recommends 1-4 capsules per day for adults and notes that people with egg allergies should consult a physician before taking Laminine.
The document summarizes a study that investigated the effects of iron supplementation alone and in combination with vitamins on hematological status, oxidative stress, and erythrocyte membrane fluidity in anemic pregnant women. 164 anemic pregnant women were randomly assigned to receive placebo, iron alone, iron with folic acid, or iron with folic acid, retinol, and riboflavin for 2 months. The study found that supplementation significantly increased hemoglobin and ferritin levels and decreased oxidative stress markers in all treatment groups compared to placebo. Erythrocyte membrane fluidity also increased with supplementation.
Nutritional supplement on multiple pregnancymothersafe
Nutritional supplement recommendations for multiple pregnancies include:
1) Women with twin or triplet pregnancies should receive the same dietary, lifestyle, and supplement advice as women with singletons.
2) Women with multiples have a higher risk of anemia and should have their iron and folate levels checked at 20-24 weeks and 28 weeks.
3) A balanced diet with adequate calories is important, along with supplements of folic acid, iron, vitamin D, and DHA omega-3 fatty acids.
4) The optimal diet for multiples is uncertain due to lack of research evidence, but general guidelines are provided.
The document discusses the importance of nutrition during pregnancy. It notes that optimal nutrition prior to and during pregnancy promotes healthy fetal growth and development and reduces risk of diseases later in life. The fetus relies on maternal nutrition for growth and development. Key nutrients discussed include carbohydrates, proteins, fats, vitamins and minerals. Guidelines are provided around healthy eating, nutrient requirements, and gestational weight gain during pregnancy.
Importance of vitamin d in pregnancy and lactationAzam Jafri
Vitamin D deficiency is a widespread problem in pregnant women and nursing mothers. It has been linked to reduced fetal growth, lower bone mineral accrual in offspring, weaker immune function and bone development in children, shorter gestation periods, lower birth weight, increased risk of asthma and rickets in infants. A single high dose of vitamin D3 given in the sixth or seventh month of pregnancy can help prevent deficiencies in mothers and babies.
This study examined the effects of daily antenatal micronutrient supplementation on biochemical indicators of micronutrient status and infection in pregnant women in rural Nepal. Blood samples were taken from pregnant women before and during supplementation to analyze concentrations of various micronutrients and markers of infection. Supplementation with folic acid alone or with iron decreased folic acid deficiency and improved status of some other micronutrients, but adding additional micronutrients like zinc did not further improve status. Multiple micronutrient supplementation most improved micronutrient status but had little effect on infection markers. The study suggests antenatal micronutrient supplementation can help address deficiencies in this population.
This document discusses vitamin D in pregnancy. It covers the physiology of vitamin D, risks of deficiency like preeclampsia, low birthweight, and neonatal hypocalcemia. It recommends screening high-risk women like those with limited sun exposure or high BMI and supplementing deficient women with 1000-2000IU of vitamin D daily during pregnancy. Vitamin D supplementation is considered safe and may provide benefits, though more research is still needed on optimal dosing.
Laminine LPGN - lekarstven spravochnik USA 2015vili9
Laminine is a dietary supplement containing a proprietary blend called OPT9. OPT9 contains fertilized avian egg extract, along with marine and phyto proteins. The document discusses several clinical studies that showed Laminine had positive effects on cholesterol, blood pressure, cortisol levels, and wound healing. It recommends 1-4 capsules per day for adults and notes that people with egg allergies should consult a physician before taking Laminine.
The document summarizes a study that investigated the effects of iron supplementation alone and in combination with vitamins on hematological status, oxidative stress, and erythrocyte membrane fluidity in anemic pregnant women. 164 anemic pregnant women were randomly assigned to receive placebo, iron alone, iron with folic acid, or iron with folic acid, retinol, and riboflavin for 2 months. The study found that supplementation significantly increased hemoglobin and ferritin levels and decreased oxidative stress markers in all treatment groups compared to placebo. Erythrocyte membrane fluidity also increased with supplementation.
Nutritional supplement on multiple pregnancymothersafe
Nutritional supplement recommendations for multiple pregnancies include:
1) Women with twin or triplet pregnancies should receive the same dietary, lifestyle, and supplement advice as women with singletons.
2) Women with multiples have a higher risk of anemia and should have their iron and folate levels checked at 20-24 weeks and 28 weeks.
3) A balanced diet with adequate calories is important, along with supplements of folic acid, iron, vitamin D, and DHA omega-3 fatty acids.
4) The optimal diet for multiples is uncertain due to lack of research evidence, but general guidelines are provided.
Vitamin D is essential for pregnancy and low levels can lead to complications. It is synthesized from sun exposure and obtained through diet and supplements. During pregnancy, vitamin D levels increase substantially to support fetal growth and development. Deficiency has been associated with preeclampsia, gestational diabetes, preterm birth, and low birthweight. Supplementation is recommended for at-risk groups to help prevent complications.
Vitamin D deficiency is common worldwide. It is important to measure 25-hydroxyvitamin D levels to assess vitamin D status, with levels below 30 ng/mL considered deficient. For children and adults who are deficient, treatment with high dose vitamin D is recommended for 8 weeks, followed by maintenance therapy. Supplementation of at least 400 IU of vitamin D daily is recommended for pregnant women to prevent deficiency. While sunlight exposure produces vitamin D, excess sun exposure should be avoided due to skin cancer risks.
Vitamin D deficiency is common in critically ill neonates. A study found serum 25-OH vitamin D levels were significantly lower in critically ill neonates compared to healthy newborns, with no correlation to disease severity except in pneumonia cases. The study recommended measuring 25-OH vitamin D levels in critically ill neonates and ensuring adequate maternal vitamin D intake during pregnancy and lactation, as well as vitamin D supplementation for breastfed infants. Guidelines for treating vitamin D deficiency in children include daily or weekly high dose vitamin D supplementation for 4-8 weeks, followed by maintenance doses, while insufficiency is managed with biweekly or monthly lower dose supplementation.
Vitamin d insufficiency and deficiency in children and adolescentsAzad Haleem
Vitamin D insufficiency and deficiency can occur in children and adolescents. The document discusses the forms and pathways of vitamin D in the body. Risk factors for deficiency include dark skin, limited sun exposure, exclusive breastfeeding, obesity, and genetic disorders. Deficiency can lead to rickets in children or osteomalacia. Diagnosis is made by measuring 25-hydroxyvitamin D levels in the blood. Treatment involves vitamin D supplementation, with dosage depending on age and severity of deficiency. Monitoring of vitamin D levels is important during and after treatment.
Vitamin D deficiency is of concern now a days, it has important role in skeletal and non skeletal functions of the body. Good sunlight exposure, consumption of vitamin D rich foods, chemotherapy with vitamin D and supplements of vitamin D has shown positive effect on various non skeletal diseases like cancer, diabetes, diarrhoea, tuberculosis etc. Although Indians are blessed with ample sunlight, still 70 to 100% population is suffering from the vitamin D deficiency. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India. Fortification of staple foods with vitamin D is the most viable population based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency
This document discusses the importance of nutrition for a healthy pregnancy and baby. It covers key nutrients needed like protein, iron, folate, vitamins A, C, B6, B12, calcium, and omega-3 fatty acids. The roles and sources of these nutrients are described. Nutritional needs vary in the three trimesters, with energy and nutrients especially important in the 2nd and 3rd trimesters to support rapid fetal growth. Both under-eating and over-eating can impact pregnancy outcomes. Maintaining a healthy diet and weight gain during pregnancy is important for the health of both mother and baby.
Vitamin D3 and DHA play important roles in pregnancy. Vitamin D3 deficiency has been associated with increased risk of preeclampsia, gestational diabetes, low birth weight, preterm delivery, and impaired neonatal immunity. It is recommended that pregnant women take a daily supplement of 10 micrograms of vitamin D3. DHA is important for brain and eye development of the fetus. Ensuring adequate DHA through diet or supplements can help reduce risks of preterm birth and improve infant cognitive development and immune response. Supplementation with DHA during pregnancy and lactation has shown benefits.
This document discusses vitamin D deficiency in children. It covers vitamin D metabolism, sources, benefits, and deficiency. Regarding deficiency, it defines it as a 25-hydroxyvitamin D level below 20 ng/mL. Common causes include lack of sun exposure and low dietary intake. Signs and symptoms can include bone pain, muscle weakness, fatigue, and bone deformities like rickets. Laboratory findings show low vitamin D levels while radiological findings reveal issues with bone mineralization. Prevention focuses on supplementation and treatment involves higher dose vitamin D, like 50,000 IU weekly for 8-12 weeks.
This document discusses vitamin D deficiency in children. It covers vitamin D metabolism, sources, benefits, and deficiency. Regarding deficiency, it defines it as a 25-hydroxyvitamin D level below 20 ng/mL. Common causes include lack of sun exposure and low dietary intake. Signs and symptoms can include bone pain, muscle weakness, fatigue, and bone deformities like rickets. Laboratory findings show low vitamin D levels while radiological findings reveal issues with bone mineralization. Prevention focuses on supplementation and treatment involves higher dose vitamin D, like 50,000 IU weekly for 8-12 weeks.
Vitamin D deficiency is very common globally, including in Saudi Arabia where prevalence is around 90-95%. Vitamin D is important for bone and skeletal health and development during childhood, as it regulates calcium and phosphorus balance and bone mineralization. Beyond skeletal benefits, vitamin D has roles in reducing infection risk, autoimmune disease, asthma, COPD and cancer. Deficiency is diagnosed through blood tests measuring vitamin D levels, with normal being 30-100 ng/ml. Deficiency can cause rickets or osteomalacia and is often due to lack of sun exposure or intake of vitamin D sources like fortified foods. Prevention involves sun exposure, intake of vitamin D foods or supplements. Treatment requires high dose vitamin D
This document discusses vitamins, specifically vitamin D. It defines vitamins and describes the classification of fat-soluble and water-soluble vitamins. The document focuses on vitamin D, describing its sources, metabolism, functions, recommended dietary allowance, and disorders related to deficiencies or excess, including rickets. Rickets is discussed in detail, outlining its morphology, etiology, clinical features involving the head, chest, back, extremities, and hypocalcemic symptoms. Oral manifestations of rickets involving dentition, bone, and soft tissue are also summarized.
This document discusses vitamin D metabolism and requirements during pregnancy and lactation. It covers:
1) Vitamin D metabolism, including sources, conversion to active forms in the liver and kidneys, and role of vitamin D binding protein.
2) Increased vitamin D levels and requirements during pregnancy to support fetal development. Supplementation guidelines recommend 1500-2000 IU/day to maintain optimal levels.
3) Associations between vitamin D deficiency and gestational diabetes and preeclampsia, though the evidence is mixed and relationships may be indirect. Maintaining sufficient vitamin D status may help reduce risks of complications.
• Bio Tech's D3Natal contains 5000IU of Vitamin
D3 (cholecalciferol)
• The current RDA is grossly inadequate at
450mcg/day (UPMC study; Lisa Bodner, PhD,
M.P.H, M.D.)
• The ONLY prenatal with adequate and newly
recommended IU levels between 4000-6000IU
• Vitamin D3 is water-soluble and dissolves
instantly
Vitamin D3 regulates calcium absorption
from the intestines, maintains normal blood
levels of calcium and phosphorus, an
promotes bone formation
• More benefits of Vitamin D3 are coming to
light and affects nearly every disease state
from diabetes to cancer
• The main source of Vitamin D3 is sunlight
People with dark skin, limited exposure to
sunlight, and those who wear sunscreen
need to supplement Vitamin D in their
diets
• Adequate blood levels for Vitamin D
range between 50-125 nanomoles per
liter (nmpol/L)
• -60% of the population is "D deficient"
(Zellman,WebMD)
• Vitamin D3 vs.Vitamin D2 (Key Studies)
° "Vitamin D2 is Much Less Effective than Vitamin D3" (Arman, Hollis, Heaney 2004)
Conclusion: Vitamin D2 potency is less than 1/3 the potency of Vitamin D3 with a shorter duration of action
° "Vitamin D3 Is More Potent than Vitamin D2 in Humans" (Heaney, Recker, Grote, Horst, Armas 201 I)
Conclusion: Vitm in D3 is ~87% more potent in raising and maintaining serum 25(OH)D concentrations and produces 2-3 fold greater storage of Vitamin D3 over D2
Low levels of Vitamin D during pregnancy are associated with poor fetal/infant skeletal formation and growth as well as poor tooth mineralization
• Over 50 Universities, Hospitals and Clinics utilize Bio-Tech Vitamin D3 for their research
• Vitamin D3 is not a Rx. Vitamin D2 is available via Rx only
• Lactation and Vitamin D3
• A reassessment of current Vitamin D intake for mothers is critical as current recommendations result in a high degree of Vitamin D deficiency, especially in the African American population.
• Current recommendations of 200-400 ILJ/d for pregnant and lactating women are grossly inadequate, especially in minority populations. A growing body a research suggests that dosing with over 2000 ID/d is required to maintain robust normal levels.
• Studies that introduce high doses ofVitamin D (2000IU to 4000IU) improve the nutritional status of both mother and infant.
This document discusses the importance of maternal nutrition for fetal development and lifelong health outcomes. It defines an optimum fetus and lists the benefits of achieving this. Key factors that influence fetal growth such as gestational age, maternal weight gain, and nutrition are examined. The link between maternal nutrition and fetal status is established through evidence from wartime famines. The roles of specific nutrients including iron, calcium, magnesium, vitamin D, folate, antioxidants, and omega-3s are outlined. Food-borne infections and the ideal diet for pregnant women are also addressed.
The document discusses nutrition requirements during pregnancy and lactation. It recommends increased calorie, protein, vitamin and mineral intake during these stages. Key recommendations include 300 extra calories per day during pregnancy, 10-12 kg total weight gain, and extra 20-30g protein during lactation. Deficiencies of iron, iodine, calcium and vitamin D can lead to complications. A balanced diet with milk, fruits and vegetables can meet nutritional demands.
Positive Homeopathy is a leading chain of clinics across India providing effective services in treating all types of diseases through Homeopathy. Know More!
This infant is likely suffering from vitamin K deficiency bleeding, also known as hemorrhagic disease of the newborn. Key points:
- Vitamin K is essential for the production of clotting factors in the liver. Breastfed newborns are at higher risk as human milk is low in vitamin K.
- All newborns are given a vitamin K shot after birth to prevent this condition, as their liver is not mature enough yet to produce sufficient clotting factors.
- Presentation is bleeding from various sites like umbilical cord, gastrointestinal tract or intracranially in severe cases.
- Treatment is vitamin K supplementation either orally or via injection depending on severity of bleeding. Repe
The nutritional requirements of infants and children include proteins, fats, carbohydrates, vitamins, water, and minerals. Human milk is considered the best natural food for infants due to its ease of digestion, optimal nutrient proportions, protection from infection, and promotion of mother-infant bonding. Successful breastfeeding depends on adequate maternal nutrition, rest, emotional well-being, and frequent nursing. A well-balanced child's diet typically derives 15% of calories from protein, 35% from fat, and 50% from carbohydrates.
Management of anaemia in pregnancy BY DR ALKA MUKHERJEE DR APURVA MUKHERJEE N...alka mukherjee
Prenatal vitamins typically contain iron. Taking a prenatal vitamin that contains iron can help prevent and treat iron deficiency anemia during pregnancy. In some cases, your health care provider might recommend a separate iron supplement. During pregnancy, you need 27 milligrams of iron a day.
Good nutrition also can prevent iron deficiency anemia during pregnancy. Dietary sources of iron include lean red meat, poultry and fish. Other options include iron-fortified breakfast cereals, prune juice, dried beans and peas.
The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, calcium can decrease iron absorption.
How is iron deficiency anemia during pregnancy treated?
If you are taking a prenatal vitamin that contains iron and you are anemic, your health care provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (hematologist). If the cause is iron deficiency, additional supplemental iron might be suggested. If you have a history of gastric bypass or small bowel surgery or are unable to tolerate oral iron, you might need intravenous iron administration. Oral iron is recommended as the first line treatment, with repeated checking of Hb at 2 to 3 weeks after starting treatment to assess compliance, correct administration and response to treatmentOnce Hb reaches the normal range, it is recommended that iron replacement should continue for three months and until at least six weeks postpartumIntravenous (IV) iron is recommended for women who could not tolerate or respond to oral iron, and for those with moderately severe to severe anemia (Hb ≤ 90 g/LHb be measured within 24 to 48 hours after delivery in women with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatallyOral iron is recommended for women with Hb <100 g/L postpartum, who are hemodynamically stable, asymptomatic or mild symptomatic
Anemia signs and symptoms include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headache
Keep in mind, however, that symptoms of anemia are often similar to general pregnancy symptoms. Regardless of whether or not you have symptoms, you'll have blood tests to screen for anemia during pregnancy. If you're concerned about your level of fatigue or any other symptoms, talk to your health care provider.
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
More Related Content
Similar to Vita d in pregnancy & lactation by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
Vitamin D is essential for pregnancy and low levels can lead to complications. It is synthesized from sun exposure and obtained through diet and supplements. During pregnancy, vitamin D levels increase substantially to support fetal growth and development. Deficiency has been associated with preeclampsia, gestational diabetes, preterm birth, and low birthweight. Supplementation is recommended for at-risk groups to help prevent complications.
Vitamin D deficiency is common worldwide. It is important to measure 25-hydroxyvitamin D levels to assess vitamin D status, with levels below 30 ng/mL considered deficient. For children and adults who are deficient, treatment with high dose vitamin D is recommended for 8 weeks, followed by maintenance therapy. Supplementation of at least 400 IU of vitamin D daily is recommended for pregnant women to prevent deficiency. While sunlight exposure produces vitamin D, excess sun exposure should be avoided due to skin cancer risks.
Vitamin D deficiency is common in critically ill neonates. A study found serum 25-OH vitamin D levels were significantly lower in critically ill neonates compared to healthy newborns, with no correlation to disease severity except in pneumonia cases. The study recommended measuring 25-OH vitamin D levels in critically ill neonates and ensuring adequate maternal vitamin D intake during pregnancy and lactation, as well as vitamin D supplementation for breastfed infants. Guidelines for treating vitamin D deficiency in children include daily or weekly high dose vitamin D supplementation for 4-8 weeks, followed by maintenance doses, while insufficiency is managed with biweekly or monthly lower dose supplementation.
Vitamin d insufficiency and deficiency in children and adolescentsAzad Haleem
Vitamin D insufficiency and deficiency can occur in children and adolescents. The document discusses the forms and pathways of vitamin D in the body. Risk factors for deficiency include dark skin, limited sun exposure, exclusive breastfeeding, obesity, and genetic disorders. Deficiency can lead to rickets in children or osteomalacia. Diagnosis is made by measuring 25-hydroxyvitamin D levels in the blood. Treatment involves vitamin D supplementation, with dosage depending on age and severity of deficiency. Monitoring of vitamin D levels is important during and after treatment.
Vitamin D deficiency is of concern now a days, it has important role in skeletal and non skeletal functions of the body. Good sunlight exposure, consumption of vitamin D rich foods, chemotherapy with vitamin D and supplements of vitamin D has shown positive effect on various non skeletal diseases like cancer, diabetes, diarrhoea, tuberculosis etc. Although Indians are blessed with ample sunlight, still 70 to 100% population is suffering from the vitamin D deficiency. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India. Fortification of staple foods with vitamin D is the most viable population based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency
This document discusses the importance of nutrition for a healthy pregnancy and baby. It covers key nutrients needed like protein, iron, folate, vitamins A, C, B6, B12, calcium, and omega-3 fatty acids. The roles and sources of these nutrients are described. Nutritional needs vary in the three trimesters, with energy and nutrients especially important in the 2nd and 3rd trimesters to support rapid fetal growth. Both under-eating and over-eating can impact pregnancy outcomes. Maintaining a healthy diet and weight gain during pregnancy is important for the health of both mother and baby.
Vitamin D3 and DHA play important roles in pregnancy. Vitamin D3 deficiency has been associated with increased risk of preeclampsia, gestational diabetes, low birth weight, preterm delivery, and impaired neonatal immunity. It is recommended that pregnant women take a daily supplement of 10 micrograms of vitamin D3. DHA is important for brain and eye development of the fetus. Ensuring adequate DHA through diet or supplements can help reduce risks of preterm birth and improve infant cognitive development and immune response. Supplementation with DHA during pregnancy and lactation has shown benefits.
This document discusses vitamin D deficiency in children. It covers vitamin D metabolism, sources, benefits, and deficiency. Regarding deficiency, it defines it as a 25-hydroxyvitamin D level below 20 ng/mL. Common causes include lack of sun exposure and low dietary intake. Signs and symptoms can include bone pain, muscle weakness, fatigue, and bone deformities like rickets. Laboratory findings show low vitamin D levels while radiological findings reveal issues with bone mineralization. Prevention focuses on supplementation and treatment involves higher dose vitamin D, like 50,000 IU weekly for 8-12 weeks.
This document discusses vitamin D deficiency in children. It covers vitamin D metabolism, sources, benefits, and deficiency. Regarding deficiency, it defines it as a 25-hydroxyvitamin D level below 20 ng/mL. Common causes include lack of sun exposure and low dietary intake. Signs and symptoms can include bone pain, muscle weakness, fatigue, and bone deformities like rickets. Laboratory findings show low vitamin D levels while radiological findings reveal issues with bone mineralization. Prevention focuses on supplementation and treatment involves higher dose vitamin D, like 50,000 IU weekly for 8-12 weeks.
Vitamin D deficiency is very common globally, including in Saudi Arabia where prevalence is around 90-95%. Vitamin D is important for bone and skeletal health and development during childhood, as it regulates calcium and phosphorus balance and bone mineralization. Beyond skeletal benefits, vitamin D has roles in reducing infection risk, autoimmune disease, asthma, COPD and cancer. Deficiency is diagnosed through blood tests measuring vitamin D levels, with normal being 30-100 ng/ml. Deficiency can cause rickets or osteomalacia and is often due to lack of sun exposure or intake of vitamin D sources like fortified foods. Prevention involves sun exposure, intake of vitamin D foods or supplements. Treatment requires high dose vitamin D
This document discusses vitamins, specifically vitamin D. It defines vitamins and describes the classification of fat-soluble and water-soluble vitamins. The document focuses on vitamin D, describing its sources, metabolism, functions, recommended dietary allowance, and disorders related to deficiencies or excess, including rickets. Rickets is discussed in detail, outlining its morphology, etiology, clinical features involving the head, chest, back, extremities, and hypocalcemic symptoms. Oral manifestations of rickets involving dentition, bone, and soft tissue are also summarized.
This document discusses vitamin D metabolism and requirements during pregnancy and lactation. It covers:
1) Vitamin D metabolism, including sources, conversion to active forms in the liver and kidneys, and role of vitamin D binding protein.
2) Increased vitamin D levels and requirements during pregnancy to support fetal development. Supplementation guidelines recommend 1500-2000 IU/day to maintain optimal levels.
3) Associations between vitamin D deficiency and gestational diabetes and preeclampsia, though the evidence is mixed and relationships may be indirect. Maintaining sufficient vitamin D status may help reduce risks of complications.
• Bio Tech's D3Natal contains 5000IU of Vitamin
D3 (cholecalciferol)
• The current RDA is grossly inadequate at
450mcg/day (UPMC study; Lisa Bodner, PhD,
M.P.H, M.D.)
• The ONLY prenatal with adequate and newly
recommended IU levels between 4000-6000IU
• Vitamin D3 is water-soluble and dissolves
instantly
Vitamin D3 regulates calcium absorption
from the intestines, maintains normal blood
levels of calcium and phosphorus, an
promotes bone formation
• More benefits of Vitamin D3 are coming to
light and affects nearly every disease state
from diabetes to cancer
• The main source of Vitamin D3 is sunlight
People with dark skin, limited exposure to
sunlight, and those who wear sunscreen
need to supplement Vitamin D in their
diets
• Adequate blood levels for Vitamin D
range between 50-125 nanomoles per
liter (nmpol/L)
• -60% of the population is "D deficient"
(Zellman,WebMD)
• Vitamin D3 vs.Vitamin D2 (Key Studies)
° "Vitamin D2 is Much Less Effective than Vitamin D3" (Arman, Hollis, Heaney 2004)
Conclusion: Vitamin D2 potency is less than 1/3 the potency of Vitamin D3 with a shorter duration of action
° "Vitamin D3 Is More Potent than Vitamin D2 in Humans" (Heaney, Recker, Grote, Horst, Armas 201 I)
Conclusion: Vitm in D3 is ~87% more potent in raising and maintaining serum 25(OH)D concentrations and produces 2-3 fold greater storage of Vitamin D3 over D2
Low levels of Vitamin D during pregnancy are associated with poor fetal/infant skeletal formation and growth as well as poor tooth mineralization
• Over 50 Universities, Hospitals and Clinics utilize Bio-Tech Vitamin D3 for their research
• Vitamin D3 is not a Rx. Vitamin D2 is available via Rx only
• Lactation and Vitamin D3
• A reassessment of current Vitamin D intake for mothers is critical as current recommendations result in a high degree of Vitamin D deficiency, especially in the African American population.
• Current recommendations of 200-400 ILJ/d for pregnant and lactating women are grossly inadequate, especially in minority populations. A growing body a research suggests that dosing with over 2000 ID/d is required to maintain robust normal levels.
• Studies that introduce high doses ofVitamin D (2000IU to 4000IU) improve the nutritional status of both mother and infant.
This document discusses the importance of maternal nutrition for fetal development and lifelong health outcomes. It defines an optimum fetus and lists the benefits of achieving this. Key factors that influence fetal growth such as gestational age, maternal weight gain, and nutrition are examined. The link between maternal nutrition and fetal status is established through evidence from wartime famines. The roles of specific nutrients including iron, calcium, magnesium, vitamin D, folate, antioxidants, and omega-3s are outlined. Food-borne infections and the ideal diet for pregnant women are also addressed.
The document discusses nutrition requirements during pregnancy and lactation. It recommends increased calorie, protein, vitamin and mineral intake during these stages. Key recommendations include 300 extra calories per day during pregnancy, 10-12 kg total weight gain, and extra 20-30g protein during lactation. Deficiencies of iron, iodine, calcium and vitamin D can lead to complications. A balanced diet with milk, fruits and vegetables can meet nutritional demands.
Positive Homeopathy is a leading chain of clinics across India providing effective services in treating all types of diseases through Homeopathy. Know More!
This infant is likely suffering from vitamin K deficiency bleeding, also known as hemorrhagic disease of the newborn. Key points:
- Vitamin K is essential for the production of clotting factors in the liver. Breastfed newborns are at higher risk as human milk is low in vitamin K.
- All newborns are given a vitamin K shot after birth to prevent this condition, as their liver is not mature enough yet to produce sufficient clotting factors.
- Presentation is bleeding from various sites like umbilical cord, gastrointestinal tract or intracranially in severe cases.
- Treatment is vitamin K supplementation either orally or via injection depending on severity of bleeding. Repe
The nutritional requirements of infants and children include proteins, fats, carbohydrates, vitamins, water, and minerals. Human milk is considered the best natural food for infants due to its ease of digestion, optimal nutrient proportions, protection from infection, and promotion of mother-infant bonding. Successful breastfeeding depends on adequate maternal nutrition, rest, emotional well-being, and frequent nursing. A well-balanced child's diet typically derives 15% of calories from protein, 35% from fat, and 50% from carbohydrates.
Similar to Vita d in pregnancy & lactation by dr alka mukherjee dr apurva mukherjee nagpur m.s. india (20)
Management of anaemia in pregnancy BY DR ALKA MUKHERJEE DR APURVA MUKHERJEE N...alka mukherjee
Prenatal vitamins typically contain iron. Taking a prenatal vitamin that contains iron can help prevent and treat iron deficiency anemia during pregnancy. In some cases, your health care provider might recommend a separate iron supplement. During pregnancy, you need 27 milligrams of iron a day.
Good nutrition also can prevent iron deficiency anemia during pregnancy. Dietary sources of iron include lean red meat, poultry and fish. Other options include iron-fortified breakfast cereals, prune juice, dried beans and peas.
The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, calcium can decrease iron absorption.
How is iron deficiency anemia during pregnancy treated?
If you are taking a prenatal vitamin that contains iron and you are anemic, your health care provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (hematologist). If the cause is iron deficiency, additional supplemental iron might be suggested. If you have a history of gastric bypass or small bowel surgery or are unable to tolerate oral iron, you might need intravenous iron administration. Oral iron is recommended as the first line treatment, with repeated checking of Hb at 2 to 3 weeks after starting treatment to assess compliance, correct administration and response to treatmentOnce Hb reaches the normal range, it is recommended that iron replacement should continue for three months and until at least six weeks postpartumIntravenous (IV) iron is recommended for women who could not tolerate or respond to oral iron, and for those with moderately severe to severe anemia (Hb ≤ 90 g/LHb be measured within 24 to 48 hours after delivery in women with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatallyOral iron is recommended for women with Hb <100 g/L postpartum, who are hemodynamically stable, asymptomatic or mild symptomatic
Anemia signs and symptoms include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headache
Keep in mind, however, that symptoms of anemia are often similar to general pregnancy symptoms. Regardless of whether or not you have symptoms, you'll have blood tests to screen for anemia during pregnancy. If you're concerned about your level of fatigue or any other symptoms, talk to your health care provider.
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Early pregnancy loss by dr alka mukherjee dr apurva mukherjee nagpur ms indiaalka mukherjee
Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management.
Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1. In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.
Pprom by dr alka mukherjee dr apurva mukherjee nagpur indiaalka mukherjee
Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.
In most cases of PPROM, the cause is not known.
These things may increase risk:
• Having a preterm birth in a previous pregnancy
• Having an infection in your reproductive system
• Vaginal bleeding during pregnancy
• Smoking during pregnancy
Symptoms can occur a bit differently in each pregnancy. They can include:
• A sudden gush of fluid from your vagina
• Leaking of fluid from your vagina
• A feeling of wetness in your vagina or underwear
Call your healthcare provider right away if you have these symptoms.
The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.
Diagnosis
• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.
• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.
• ultrasound exam. This is done to check the amount of amniotic fluid around baby.
Public education on breast cancer hindi by dr alka mukherjee nagpur ms i...alka mukherjee
Abnormal lump — Breast cancer can be discovered when a lump or other change in the breast or armpit is found by a woman herself or by her healthcare provider. In addition to a lump, other abnormal changes may include dimpling of the skin, a change in the size or shape of one breast, retraction (pulling in) of the nipple when it previously pointed outward, or a discoloration of the skin of the breast not related to infection or skin conditions such as psoriasis or eczema.Mammogram — A mammogram is a very low-dose X-ray of the breast. The breast tissue is compressed for the X-ray, which decreases the thickness of the tissue and holds the breast in position, so the radiologist can find abnormalities more accurately. Each breast is compressed between two panels and X-rayed from two directions (top-down and side-to-side) to make sure all the tissue is examined. Mammograms are currently the best screening modality to detect breast cancer. Some mammograms capture images digitally, offering better clarity, the ability to adjust the image, and a decreased likelihood that the woman will need to return on a different day for repeat pictures.
Cancer cervix awareness in hindi by dr alka mukherjee nagpur ms indiaalka mukherjee
Cervical cancer occurs when the cells in the cervix grow abnormally or out of control. The cervix is part of the female reproductive system. The exact cause of cervical cancer is unknown. Certain strains of the human papillomavirus (HPV), a sexually transmitted disease, cause the majority of cervical cancer.
A new vaccine is available to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases. A pap smear test is a preventive measure that can detect precancerous or cancerous cells. Precancerous cells are 100% curable.
Telehealth medico legal aspects by dr alka mukherjee nagpur ms indiaalka mukherjee
The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.
Evolution and current practices in emergency contraceptives BY DR ALKA MUKHER...alka mukherjee
This document provides information on emergency contraceptives, including their evolution and current practices. It discusses various emergency contraceptive methods such as the Yuzpe regimen, levonorgestrel pills, mifepristone, copper IUDs, and the recently approved ulipristal acetate. It summarizes the mechanisms of action, effectiveness, appropriate timing, side effects, limitations and safety considerations of the different emergency contraceptive options. The document concludes that emergency contraception can effectively reduce unintended pregnancies and abortions if provided correctly and in a timely manner after unprotected intercourse.
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
Hague convention for inter country adoption by dr alka mukherjee nagpur ms indiaalka mukherjee
The Hague Convention on the Protection of Children and Co-operation in Respect of Intercountry Adoption (Convention) is an international agreement to safeguard intercountry adoptions. Concluded on May 29, 1993 in The Hague, the Netherlands, the Convention establishes international standards of practices for intercountry adoptions. The United States signed the Convention in 1994, and the Convention entered into force for the United States on April 1, 2008The Convention applies to all adoptions by U.S. citizens habitually resident in the United States of children habitually resident in any country outside of the United States that is a party to the Convention (Convention countries). Adopting a child from a Convention country is similar in many ways to adopting a child from a country not party to the Convention. However, there are some key differences. In particular, those seeking to adopt may receive greater protections if they adopt from a Convention country.
The Convention requires that countries who are party to it establish a Central Authority to be the authoritative source of information and point of contact in that country. The Department of State is the U.S. Central Authorityfor the Convention.
The Convention aims to prevent the abduction, sale of, or trafficking in children, and it works to ensure that intercountry adoptions are in the best interests of children.
The Convention recognizes intercountry adoption as a means of offering the advantage of a permanent home to a child when a suitable family has not been found in the child's country of origin. It enables intercountry adoption to take place when, among other steps:
1. The child has been deemed eligible for adoption by the child's country of origin; and
2. Due consideration has been given to finding an adoption placement for the child in its country of origin.
The role of judiciary & the legal procedure in an adoption case by dr alka mu...alka mukherjee
Central Adoption Resource Authority (CARA) is the nodal agency to monitor and regulate in-country and intra-country adoption and is a part of Ministry of Women and child care.
Following are the certain essential conditions in order to be eligible to adopt a child:
• The procedure for adoption is different in case of Indian citizen, NRI or a foreign citizen and a child can be adopted by any of the three.
• Irrespective of their gender or marital status, any person is eligible to adopt.
• Provided that a couple is adopting a child, they should have completed two years of stable marriage and both should agree for the adoption.
• 25 years should be the minimum age difference between the child and the adoptive parents.
WHEN CAN A CHILD BE ELIGIBLE TO BE ADOPTED?
• Any orphan, surrendered or abandoned child is legally declared free for adoption by the child welfare committee as per the guidelines of the Central Government of India.
• A child without a legal parent or a guardian or the parents are not capable of taking care of the child anymore is said to be an orphan.
• When a child is deserted or unaccompanied by parents or a guardian and the child welfare committee has declared the child to be abandoned, a child is considered to be abandoned.
• Renounce on account of physical, social and emotional factors that are beyond the control of parents or the guardian is called a surrendered child as declared by the child welfare committee.
• In case of adoption, a child requires to be “legally free”. A child is considered to be legally free if even after trying their level best the police fails to find the true parent or guardian of the child.
WHAT ARE THE NORMAL CONDITIONS TO BE FULFILLED BY PARENTS?
• The adoptive parents need to be mentally, physically and emotionally stable.
• The adoptive parents should be financially stable.
• The adoptive parents should not be suffering from any life- threatening diseases.
• Apart from cases of special needs children, couples with three or more kids are not allowed for adoption.
• A single female is allowed to adopt a child of any gender but a single male is not allowed to adopt a girl child.
• The maximum age limit of a single parents should be 55 years.
Laws , rules & regulations governing adoptions in india by dr alka mukherjee ...alka mukherjee
ADOPTION IN INDIA
The custom and practice of adoption in India dates back to the ancient times. Although the act of adoption remains the same, the objective with which this act is carried out has differed. It usually ranged from the humanitarian motive of caring and bringing up a neglected or destitute child, to a natural desire for a kid as an object of affection, a caretaker in old age, and an heir after death.[iii]
But since adoption comes under the ambit of personal laws, there has not been a scope in the Indian scenario to incorporate a uniform law among the different communities which consist of this melting pot. Hence, this law is governed by various personal laws of different religions.
Adoption is not permitted in the personal laws of Muslims, Christians, Parsis and Jews in India. Hence they usually opt for guardianship of a child through the Guardians and Wards Act, 1890.
Indian citizens who are Hindus, Jains, Sikhs, or Buddhists are allowed to formally adopt a child. The adoption is under the Hindu Adoption and Maintenance Act of 1956 that was enacted in India as a part of the Hindu Code Bills. It brought about a few reforms that liberalized the institution of adoption.
Tuberculosis in prenancy by dr alka mukherjee dr apurva mukherjee nagpur ms i...alka mukherjee
Prevention of Tuberculosis
The BCG vaccine has been incorporated into the National immunization policy of many countries, especially the high burden countries, thereby conferring active immunity from childhood. Nonimmune women travelling to tuberculosis endemic countries should also be vaccinated. It must, however, be noted that the vaccine is contraindicated in pregnancy [72].
The prevention, however, goes beyond this as it is essentially a disease of poverty. Improved living condition is, therefore, encouraged with good ventilation, while overcrowding should be avoided. Improvement in nutritional status is another important aspect of the prevention.
Pregnant women living with HIV are at higher risk for TB, which can adversely influence maternal and perinatal outcomes [73]. As much as 1.1 million people were diagnosed with the co-infection in 2009 alone [2]. Primary prevention of HIV/AIDS is, therefore, another major step in the prevention of tuberculosis in pregnancy. Screening of all pregnant women living with HIV for active tuberculosis is recommended even in the absence of overt clinical signs of the disease.
Isoniazid preventive therapy (IPT) is another innovation of the World Health Organisation that is aimed at reducing the infection in HIV positive pregnant women based on evidence and experience and it has been concluded that pregnancy should not be a contraindication to receiving IPT. However, patient's individualisation and rational clinical judgement is required for decisions such as the best time to provide IPT to pregnant women
Torch infections during pregnancy by dr alka mukherjee nagpur ms indiaalka mukherjee
TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. "TORCH" is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex. Infection with any of these agents (i.e., Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex viruses) may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and/or other symptoms and findings. Each infectious agent may also result in additional abnormalities that may be variable, depending upon a number of factors (e.g., stage of fetal development
How to develope your personality by dr alka mukherjee nagpur ms indiaalka mukherjee
Personality is what makes a person a unique person, and it is recognizable soon after birth. A child's personality has several components: temperament, environment, and character. Temperament is the set of genetically determined traits that determine the child's approach to the world and how the child learns about the world. There are no genes that specify personality traits, but some genes do control the development of the nervous system, which in turn controls behavior.
A second component of personality comes from adaptive patterns related to a child's specific environment. Most psychologists agree that these two factors—temperament and environment—influence the development of a person's personality the most. Temperament, with its dependence on genetic factors, is sometimes referred to as "nature," while the environmental factors are called "nurture."
While there is still controversy as to which factor ranks higher in affecting personality development, all experts agree that high-quality parenting plays a critical role in the development of a child's personality. When parents understand how their child responds to certain situations, they can anticipate issues that might be problematic for their child. They can prepare the child for the situation or in some cases they may avoid a potentially difficult situation altogether. Parents who know how to adapt their parenting approach to the particular temperament of their child can best provide guidance and ensure the successful development of their child's personality.
Finally, the third component of personality is character—the set of emotional, cognitive, and behavioral patterns learned from experience that determines how a person thinks, feels, and behaves. A person's character continues to evolve throughout life, although much depends on inborn traits and early experiences. Character is also dependent on a person's moral development .
Personality by dr alka mukherjee nagpur ms indiaalka mukherjee
The word personality itself stems from the Latin word persona, which refers to a theatrical mask worn by performers in order to either project different roles or disguise their identities.
At its most basic, personality is the characteristic patterns of thoughts, feelings, and behaviors that make a person unique. It is believed that personality arises from within the individual and remains fairly consistent throughout life.
While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person's behavior.
Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual's personality.
Qualitative blood loss in obstetric hemorrhage by dr alka mukherjee indiaalka mukherjee
• Quantitative methods of measuring obstetric blood loss have been shown to be more accurate than visual estimation in determining obstetric blood loss.
• Studies that have compared visual estimation to quantitative measurement have found that visual estimation is more likely to underestimate the actual blood loss when volumes are high and overestimate when volumes are low.
• Although quantitative measurement is more accurate than visual estimation for identifying obstetric blood loss, the effectiveness of quantitative blood loss measurement on clinical outcomes has not been demonstrated.
• Implementation of quantitative assessment of blood loss includes the following two items: 1) use of direct measurement of obstetric blood loss (quantitative blood loss) and 2) protocols for collecting and reporting a cumulative record of blood loss postdelivery.
Dysmenorrhea and related disorders by dr alka mukherjee dr apurva mukherjee n...alka mukherjee
Dysmenorrhea is a common symptom secondary to various gynecological disorders, but it is also represented in most women as a primary form of disease. Pain associated with dysmenorrhea is caused by hypersecretion of prostaglandins and an increased uterine contractility. The primary dysmenorrhea is quite frequent in young women and remains with a good prognosis, even though it is associated with low quality of life. The secondary forms of dysmenorrhea are associated with endometriosis and adenomyosis and may represent the key symptom. The diagnosis is suspected on the basis of the clinical history and the physical examination and can be confirmed by ultrasound, which is very useful to exclude some secondary causes of dysmenorrhea, such as endometriosis and adenomyosis. The treatment options include non-steroidal anti-inflammatory drugs alone or combined with oral contraceptives or progestins.
Dyspareunia & vulvodynia by dr alka mukherjee dr apurva mukherjee nagpur m.s....alka mukherjee
This document discusses dyspareunia (recurring pain during sexual intercourse) and vulvodynia (chronic genital pain). It describes the causes, symptoms, diagnosis, and treatment options. Dyspareunia and vulvodynia can have physical and psychological causes, and treatment may involve medications, physical therapy, cognitive behavioral therapy, and sometimes surgery. A multidisciplinary approach is often needed to properly diagnose and address the underlying causes of genital pain.
Chronic pelvic pain by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Dr. Tan's Balance Method.pdf (From Academy of Oriental Medicine at Austin)GeorgeKieling1
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
Pharmacology of Prostaglandins, Thromboxanes and Leukotrienes
Vita d in pregnancy & lactation by dr alka mukherjee dr apurva mukherjee nagpur m.s. india
1. ROLE OF VITAMIN D IN PREGNANCY &
LACTATION
DR ALKA MUKHERJEE
DR APURVA MUKHERJEE
NAGPUR M.S. INDIA
2. DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS MA(PSY)
Director & Consultant At Mukherjee Multispecialty Hospital
MMC ACCREDITATED SPEAKER
MMC OBSERVER MMC MAO – 01017 / 2016
Present Position
Director of Mukherjee Multispecialty Hospital
Hon.Secretary INTERNATIONAL COUNCIL FOR HUMAN RIGHTS
Hon.Secretary NARCHI NAGPUR CHAPTER (2018-2020)
Hon.Secretary AMWN (2018-2021)
Hon.Secretary ISOPARB (2019-2021)
Life member, IMA, NOGS, NARCHI, AMWN & Menopause
Society, India, Indian medico-legal & ethics association(IMLEA),
ISOPRB, HUMAN RIGHTS
Founder Member of South Rapid Action Group, Nagpur.
On Board of Super Specialty, GMC, IGGMC, AIIMS Nagpur,
NKPSIMS, ESIS and Treasury, Nagpur for “ WOMEN SEXUAL
HARASSMENT COMMITTEE.”
mukherjeehospital@yahoo.com
www.mukherjeehospital.com
https://www.facebook.com/
Mukherjee Multispeciality
https://www.instagram.com/
Achievement
Winner of NOGS GOLD MEDAL – 2017-18
Winner of BEST COUPLE AWARD in Social
Work - 2014
APPRECIATION Award IMA - MS
Past Position
Organizing joint secretary ENDO-GYN
2019
Vice President IMA Nagpur (2017-2018)
Vice President of NOGS(2016-2017)
Organizing joint secretary ENDO-GYN
Organizing secretary AMWICON – 2019
3. OBSTETRIC ENDOCRINOLOGY
OPPORTUNITY, CHALLENGES AND CAUTION
• Opportunity, because the antenatal period presents a window during which
endocrine and metabolic manipulation can impact not only maternal and
fetal health, but also long-term outcomes in offspring.
• Caution is necessary, too, because the same therapy may lead to unwanted
adverse effects in the innocent fetus, and have (as yet unknown) long-term
complications.
• Challenges in obstetric endocrinology - unique - ethical and practical issues
make it difficult to conduct randomized placebo controlled trials as many
situations.
• The rapidly increasing incidence of endocrine dysfunction in obstetrics, and
the public health importance - require closer attention and debate.
4. • Vitamin D is – Fat soluble vitamin
• A key modulator of calcium metabolism in children and adults.
• Because calcium demands increase in the third trimester of
pregnancy, vitamin D status becomes crucial for maternal health,
fetal skeletal growth, and optimal maternal and fetal outcomes.
• Vitamin D deficiency is common
1. Pregnant women (5-50%) and in
2. Breastfed infants (10-56%), despite the widespread use of prenatal
vitamins, because these are inadequate to maintain normal vitamin
D levels (>or=32 ng/mL).
5. Two forms of vitamin D.
Vitamin D3 (cholecalciferol) is produced from the conversion
of
7-dehydrocholesterol in skin and
vitamin D2 (ergocalciferol) is produced in mushrooms and
yeast.
• The biologically active form of vitamin D is 1,25(OH)2D -
hydroxylation of vitamin D in the liver to 25(OH)D (25-
hydroxyvitamin D), which then undergoes renal hydroxylation
to form 1,25(OH)2D.
• D. Serum 25(OH)D concentrations reflect nutritional status.
• Production of 1,25(OH)2D in the kidney is tightly regulated by
plasma parathyroid hormone (PTH) as well as serum calcium
and phosphate levels.
6. • The interaction of 1,25(OH)2D with nuclear vitamin D receptors
influences gene transcription. Nuclear receptors for 1,25(OH)2D
are present - bone, intestine, kidney, lung, muscle and skin
Major sites of action include intestine, bone, parathyroid, liver
and pancreatic beta cells
• 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.
7. • 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
• Newborn vitamin D levels are largely dependent on maternal
vitamin D status & infants of mothers with or at high risk of
vitamin D deficiency are also at risk of vitamin D deficiency
8. Vitamin D and calcium metabolism in pregnancy
• During pregnancy and lactation, significant changes in
maternal vitamin D and calcium metabolism occur to provide
the calcium that is needed for fetal bone mineral accretion.
• During the first trimester, the fetus accumulates 2–3 mg/d in
the skeleton - this rate of accumulation doubles in the last
trimester.
• The body of a pregnant woman adapts to fetal requirements
by increasing calcium absorption in early pregnancy, with
maximal absorption in the last trimester.
• Along with the transfer of calcium to the fetus, the increased
intestinal absorption is balanced by enhancing urinary calcium
excretion, thereby keeping serum ionized calcium stable
throughout pregnancy.
9. • The fetal skeleton contains 30 g of calcium, most of which is
deposited during the third trimester of pregnancy.
• Lactation is a time of relative estrogen deficiency because of
elevated prolactin levels that suppress the release of
gonadotropins and, in turn, estrogen and perhaps stimulate
the release of PTHrP.
• Estrogen deficiency leads to bone resorption and
suppression of PTH levels. PTHrP levels are elevated and act
as a surrogate for PTH, thereby allowing continued
absorption of calcium from the urine and bone resorbption.
10. Factors that contribute to vitamin D deficiency
• Historically, most people relied on sun exposure to produce vitamin D.
• Due to modern indoor living and increased knowledge of the risks of skin
cancers - limited sun exposure - limit vitamin D production.
• Factors that contribute to vitamin D deficiency during pregnancy are
mainly due to
i. lack of direct sun exposure (for various reasons),
ii. lack of vitamin D in the diet (without supplementation), or
iii. genetic factors that limit the amount of vitamin D produced by the body.
• Some major factors - limited sun exposure due to indoor working
environments, sunscreen use, dietary choices, inadequate vitamin D3
supplementation, geographical location, time of year, darker skin
pigmentation, etc.
11. VITAMIN D DEFICIENCY IN PREGNANCY
• Vitamin D deficiency and insufficiency common across the
globe with high prevalence in women - antenatal and
lactating mothers
• Vitamin D requirements are probably greater in pregnancy -
physiologically higher 1,25-dehydroxy vitamin D levels in the
second and third trimesters – though levels do not correlate
directly with 25 hydroxy vitamin D concentrations -
a) the physiological rise in the active metabolite,
b) the enhanced intestinal calcium absorption, and
c) enhanced fetal requirement of calcium (250 mg/day in the
third trimester) all signifies the importance of vitamin D
biology in pregnancy
12. VITAMIN D DEFICIENCY & EFFECT ON CALCIUM
BALANCE & BONE METABOLISM
Vitamin D and its active metabolite 1,25-dihydroxyvitamin D
(1,25(OH)2D) classical actions on calcium balance and bone
metabolism.
Insufficient 1,25(OH)2D – inadequate absorption of calcium &
phosphate from the intestine - secondary hyperparathyroidism and a
lack of new bone mineralization (rickets in children and osteomalacia
in adults).
Rickets is a childhood vitamin D insufficiency and usually develops
many months after delivery. However, the neonate is at risk of
hypocalcaemic tetany consequent on maternal hypovitaminosis D.
13.
14. a. Poor & low birthweight,
b. neonatal hypocalcemia,
c. poor postnatal growth,
d. bone fragility, and
e. increased incidence of autoimmune diseases have been
linked to low vitamin D levels during pregnancy and infancy.
Adverse health outcomes of deficiency of vitamin D
15. • Vitamin D has an increasingly
recognized repertoire of non -
classical actions –
1. Promoting insulin action and
secretion,
2. Immune modulation and
3. Lung development. It
therefore has the potential to
influence many factors in the
developing fetus.
The three main steps in vitamin D
metabolism, 25-hydroxylation, 1α-
hydroxylation, and 24-hydroxylation are
all performed by cytochrome P450 mixed-
function oxidases (CYPs). These enzymes
are located either in the endoplasmic
reticulum (ER) (e.g., CYP2R1) or in the
mitochondria (e.g., CYP27A1, CYP27B1,
and CYP24A1).
16. DUAL ADVANTAGE
• A prohormone.
• A unique aspect of
vitamin D as a nutrient is
that it can be synthesized
by the human body
through the action of
sunlight.
• These dual sources of
vitamin D make it
challenging to develop
dietary reference intake
values.
17. • Calcium levels are normal in utero when maternal vitamin D
is insufficient.
• However, when maternal calcium delivery is interrupted at
birth, the neonate may develop hypocalcaemia.
• While the developing fetus requires approximately 30 g of
calcium, the maternal gut adapts and can overcome some
vitamin D insufficiency with increased calcium transport.
18. Calcium homeostasis controls serum
calcium levels within a narrow range,
enhances calcium absorption from intestine
The vitamin D endocrine system controls
whole body calcium homeostasis,
facilitates calcium in the kidneys
Habitual dietary calcium intake and
physiologic states control vitamin D
metabolism.
Increases bone calcification &
mineralization
In excess, mobilizes bone calcium &
phosphates
Vitamin D also regulates urinary calcium
excretion and bone metabolism.
Molecular and Cellular Endocrinology
Volume 453, 15 September 2017, Pages 36-45
What is the role of
vitamin D in calcium
homeostasis?
19.
20. NORMAL VITAMIN D LEVELS IN PREGNANCY
• There is little consensus on what constitutes a ‘normal’
25(OH)D level in pregnancy.
• The Institute of Medicine - 20 ng/ml in pregnancy,
• Endocrine Society - 30 ng/ml or more
• However, using mathematical models, Holles et al. suggest
that pregnant women should have a circulating vitamin D >40
ng/ml, irrespective of how it is achieved
Am J Obstet Gynecol. 2010 May; 202(5): 429.e1–429.e9.
The recommended target range for non-pregnant adults is 32–
100 ng/mL (80–250 nmol/L), which appears to be a safe range
during pregnancy. In the United States, the current
recommendation for vitamin D intake during pregnancy is 200–
400 IU/d.
21. SYMPTOMS OF VITAMIN D DEFICIENCY
• Vitamin D deficiency is often asymptomatic.
• severe or prolonged deficiency may cause the following symptoms:
• Bone discomfort or pain in the lower back, pelvis, or lower
extremities
• Falls and impaired physical function
• Muscle aches
• Proximal muscle weakness
•Symmetric low back pain (in women)
Prior history of PIH, GDM, SMALL Size baby, previous baby having
Any musculoskeletal problem or rickets etc
Obese women
22. • The largest source of vitamin D in adults is synthesis from solar radiation;
half an hour of sunlight delivers 50 000 iu of vitamin D with white-
complexioned skin. Melanin absorbs ultraviolet B (UVB) from sunlight and
diminishes cholecalciferol production by at least 90%
• Dietary intake of vitamin D makes a relatively small contribution to overall
vitamin D status as there is little vitamin D that occurs naturally in the food
supply
What are the sources
of Vitamin D?
23. • Regular sun exposure is the most natural way
to get enough vitamin D. To maintain healthy
blood levels, aim to get 10–30 minutes of
midday sunlight, several times per week.
People with darker skin may need a little
more than this. Your exposure time
should depend on how sensitive your skin is
to sunlight.
What should be the duration & time to be spent
under Sun?
24. No exact time can be calculated, it is highly
dependent on many factors
• As a general rule, the higher the sun is in the sky (solar zenith
angle), the more vitamin D is made in the skin. By controlling
for solar zenith angle, as you wisely did, you also controlled
for factors such as latitude, season and time of day. However,
multiple other factors are at play, such as:
• Altitude, cloud cover, skin pigmentation, baseline 25(OH)D,
clothes worn
• Depth of the ozone column, oil and water content of skin,
reflective surfaces around you (albedo), amount of vitamin D
precursors in the skin
• Presence or absence of common “mutations” called single
nucleotide polymorphism (snps) of the vitamin D metabolic
machinery.
25. What is the Recommended amounts of vitamin
D during pregnancy? How much to be
supplemented in Indian pregnant women?
26. Recommended amounts of vitamin D
• Taking enough vitamin D during pregnancy is very important.
• Higher vitamin D intakes appear more effective and remain safe.
• Vitamin d recommendations
• Pregnancy And Lactation Organization
• 1500-2000 IU (38-50 Mcg) Endocrine Society
• 600 IU (15 Mcg) FDA
• 600 IU (15 Mcg) Institute Of Medicine
• *For women ages 19-50 years; **for lactation 4000-6000 iu/day is mother’s required intake if infant is not receiving 400
iu/day.
• an endocrine society clinical practice guideline https://www.Ncbi.Nlm.Nih.Gov/pubmed/21646368].
• Indian J Endocrinol Metab. 2014 Sep-Oct; 18(5): 593–596.
• doi: 10.4103/2230-8210.139204
• PMCID: PMC4171878
• PMID: 25285272
• Vitamin D supplementation in pregnancy
27. • Symptomatic or documented vitamin D deficiency in
pregnant women should be treated in the same manner as
in non-pregnant individuals.
• Daily doses of 4000 units/day are recommended for
treatment in pregnancy.
• The use of lower doses of vitamin D, as contained in most
prenatal calcium preparations (100-800 IU) cannot be
condoned in symptomatic patients, or in those with
documented low levels.
• In healthy, asymptomatic antenatal women, 1000-2000 IU
can be supplemented daily in the second and third
trimesters, without fear of vitamin D toxicity or
teratogenicity.
28. What are the risk factors for vitamin d
deficiency in pregnancy?
29. GENERAL RISK FACTORS FOR VITAMIN D DEFICIENCY
Factors
Northern latitudes, especially winter or spring
Limited sun exposure
Regular use of sunscreens
African American or dark skin
Obesity
Extensive clothing cover
Aging
Malabsorptive syndromes (cystic fibrosis, cholestatic liver
disease, inflammatory bowel disease, short gut syndrome)
30. Risk factors for vitamin D deficiency in
mothers
• Low socioeconomic status,
• Low educational status and
• Covered clothing style
• Obesity
• Reduced vitamin D concentrations are found in obese subjects.
• Pre-pregnancy obesity has been associated with lower levels of
vitamin D in both pregnant women and their neonates
J Clin Res Pediatr Endocrinol. 2018 Mar; 10(1): 44–50.
Published online 2018 Feb 26. doi: 10.4274/jcrpe.4706
31. What are the stages of vitamin D
deficiency and maternal & neonatal
adverse effects?
32. Stage
Serum 25(OH)D,
ng/mL Maternal adverse effects
Newborn infant adverse
effects
Severe
deficiency
<10 Increased risk of
preeclampsia, calcium
malabsorption, bone
loss, poor weight gain,
myopathy, higher
parathyroid hormone
levels
Small for gestational age,
neonatal hypocalcemia,
hypocalcemic seizures,
infantile heart failure,
enamel defects, large
fontanelle, congenital
rickets, rickets of infancy if
breastfed
Insufficiency 11–32 Bone loss, subclinical
myopathy
Neonatal hypocalcemia,
reduced bone mineral
density, rickets of infancy if
breastfed
Adequacy 32–100 Adequate calcium
balance, parathyroid
hormone levels
None, unless exclusively
breastfed
Toxicity >100 Hypercalcemia,
increased urine calcium
loss
Infantile idiopathic
hypercalcemia
Stages of vitamin D deficiency and adverse effects
Ann Nutr Metab 2018;72:179–192
33. The musculoskeletal manifestations of vitamin
D deficiency
Rickets and osteomalacia
Myriad metabolic, nonskeletal associations of vitamin D
deficiency
Metabolic syndrome
Immunomodulatory,
Anabolic,
Anti-infective and
Anti-tumoral potential of vitamin D.
Maternal secondary hyperparathyroidism
Osteomalacia,
Neonatal hypocalcemia and tetany,
Delayed ossification of the cranial vertex,
Enlarged size of cranial, fontanelles,
Impaired fetal bone ossification
34. Low vitamin D and adverse maternal outcomes
in pregnancy
a. Induced hypertension,
b. High blood pressure in diabetic pregnancy,
c. Gestational diabetes mellitus,
d. Recurrent pregnancy loss
e. Preterm delivery
f. Primary caesarian section
g. Postpartum depression
35. Maternal effects of vitamin D deficiency
Preeclampsia and hypertensive disorders -3–10%
1. Women with preeclampsia - lower urinary calcium excretion,
lower ionized calcium levels, higher PTH levels, and lower
1,25 (OH)2 D levels
2. Low plasma calcium levels - several common mechanisms
associated with hypertension - increasing renal renin and PTH
levels.
3. Placental defects that cause decreased synthesis of active
vitamin D - key event in the development of this disease by
contributing to decreased calcium levels.
Int J Clin Exp Med. 2015; 8(9): 16280–16286.
The probable patho-physiology of Preeclampsia and
hypertensive disorders in vitamin D deficient state
36. Vitamin D’s prenatal benefits for mothers:
Vitamin D and Preeclampsia
• Leading causes of maternal death
• Deficiency in vitamin D may increase the risk of this
complication.
• Yet despite this evidence, the American College of
Obstetricians and Gynecologists has not found sufficient
evidence to advise supplemental vitamin D3 as a nutritional
intervention to prevent preeclampsia.
37. • Type 1 diabetes mellitus (type 1 DM)
• The Diabetes Autoimmunity Study in the Young reported that
autoantibodies to islet cells are correlated inversely with maternal dietary
vitamin D intake during pregnancy.
• More direct evidence of this correlation has come from the Europe and
Diabetes study in which vitamin D supplementation during the first year of
life decreased the risk of the development of type 1 DM (odds ratio, 0.67;
95% confidence interval, 0.5–0.8).
• In a Finnish study, children who received 2000 IU of vitamin D per day
during the first year of life had an 80% reduction in the risk of the
development of type 1 DM during a follow-up period of 30 years. In
contrast, children who were vitamin D-deficient or who were suspected to
have rickets at 1 year had a 2.4-fold increased risk of the development of
type 1 DM. The high doses of vitamin D that were used in this study clearly
establish the preventive effects of this vitamin in the development of type 1
DM.
Correlation between Vitamin D
and Gestational Diabetes
38. Vitamin D and Gestational Diabetes
• One recent study shows that blood sugar balance was more
easily achieved with sufficient blood levels of vitamin D.
• Another study reported that pregnant women who
supplemented with 50,000 IU of vitamin D3 once every three
weeks (about 2400 IU/day) significantly improved their
metabolic status, including fasting blood sugar levels, and
insulin levels.
Low blood vitamin D level could increase the risk of GDM, and
vitamin D supplementation during pregnancy could
ameliorate the condition of GDM.
https://pubmed.ncbi.nlm.nih.gov/29244241/#:~:text=Conclusions%3A
%20Low%20blood%20vitamin%20D,D%20supplementation%20amelio
rates%20GDM%20condition.
39. Link between Vitamin D and C-Section
1. Complications Preeclampsia & GDM iincrease the chances of C-Section
2. Research shows an indirect link between vitamin D and this alternative
delivery method.
3. One study showed that pregnant women with deficient vitamin D blood
levels were nearly twice as likely to deliver by this method compared to
pregnant women with higher vitamin D levels.
4. Other researchers reported that this was four times more likely.
5. Similarly, pregnant women who took 50,000 IU every three weeks
(average of about 2400 IU/day along with calcium), were three times less
likely to deliver via an alternative delivery method, compared to the
placebo group.
6. Low maternal vitamin D level was associated with increased risk of
primary C-section, uterine atony and postpartum hemorrhage.
Clin Gynecol Obstet. 2018;7(2):43-51doi: https://doi.org/10.14740/jcgo473w
40. Vitamin D’s prenatal benefits for infants:
Vitamin D and Preterm Birth
1. Leading causes of infant mortality, Vitamin D deficiency has
been linked to this pregnancy complication & study suggests
that sufficient levels of vitamin D may decrease the likelihood
by 40%.
2. It’s important to note that vitamin D and calcium
supplementation may play a role in this potential complication
Indian J Med Res. 2011 Mar; 133(3): 250–252.
Vitamin D sufficiency significantly
reduces the risk for preterm birth
increase in birth weight of baby and
improving the Apgar score at birth.
Role of vitamin D in reducing the risk of preterm labour
www.ijrcog.org › index.php › ijrcog › article ›
41. Vitamin D and Size at birth
• Low birth weight,
• birth length, and
• head circumference at birth – Deficiency of vitamin D
• Research shows that higher vitamin D levels are associated
with higher infant birth weight and larger head circumference.
• Further, vitamin D deficiency may be associated with low birth
weight, smaller head circumference, and decreased birth
length
42. Vitamin D benefits beyond pregnancy
• Maternal vitamin D status during pregnancy has clear effects on
fetuses as well as on newborn infants, and even on the health of
the child later in life - supplementation during pregnancy is so
critical - clear associations between vitamin D and bone,
respiratory and blood sugar health.
• Insufficient amounts of vitamin D during pregnancy - a
reduction in bone mass in infants that can persist for at least
nine years after birth.
• Respiratory health in newborns to 3-year-olds have also been
linked to maternal vitamin D intake during pregnancy.
How does a maternal vitamin D levels impact the
long-term health of offspring?
43. Researchers reported that in a cohort of ~30,000 pregnant
women, children born to women with prenatal vitamin D levels
of <54 nmol/L (21.6 ng/mL) were twice as likely to have blood
sugar imbalance than children born to women with prenatal
vitamin D levels of >89 nmol/L (35.6 ng/mL).
44. • Childhood illness and gestational vitamin D deficiency
• Asthma
• Multiple biologic actions suggest a correlation between
vitamin D deficiency and the asthma epidemic.
• Vitamin D signaling pathways and receptor
polymorphisms may have effects on Th1-
Th2 imbalance, smooth muscle contraction, airway
inflammation, prostaglandin regulation, and airway
remodeling, all of which can impact asthma control.
45. • Clinical studies indicate an inverse association between
vitamin D intake during gestation and wheezing in their
children during the first years of life.
• Post-hoc analysis of serum samples of asthmatic children
from the Childhood Asthma Management Program study
showed that approximately 35% of patients had levels of
vitamin D <30 ng/mL and that these children had lower lung
function and greater risks for exacerbations than those with
levels >30 ng/mL.
46.
47. Vitamin D deficiency during lactation
• In the first 6–8 weeks of postnatal life, the vitamin D status of
a neonate is dependent largely on vitamin D that is acquired
through placental transfer in utero. In most infants, vitamin D
stores acquired from the mother are depleted by
approximately 8 weeks of age.
• Thereafter, vitamin D is derived from diet, sunlight, and
supplementation. In general, formula-fed babies receive
adequate vitamin D because it is added to all formulas in
amounts of 400 IU of vitamin D per liter.
48. • But the exclusively breastfed are at higher risk for vitamin D
deficiency.Human milk contains a very low concentration of
vitamin D (approximately 20–60 IU/L), which represents 1.5–
3% of the maternal level which is not sufficient to maintain
an optimal vitamin D level in the baby if exposure to sunlight
is limited.
• Breast-fed infants from vitamin D– deficient mothers
occasionally manifest life-threatening conditions such as
hypocalcemic seizures and dilated cardiomyopathy
49. Should all pregnant women be screened
for vitamin D deficiency?
When do you suggest vitamin D test to
your patients?
50. Should all women be screened for vitamin D
deficiency?
• The Royal College of Obstetricians and Gynaecologists
recommends screening for very high-risk women - those
with symptoms, brittle bones, or those with chronic
illness who may not be able to absorb vitamins from the
intestines.
Routine screening of all pregnant women for vitamin D
deficiency is not recommended, according to new
guidelines issued by the American Congress of
Obstetricians and Gynecologists (ACOG)
51.
52. Taking vitamin D and calcium
supplements together in pregnancy:
what does the evidence say?
53. Taking vitamin D and calcium supplements together in
pregnancy:
• These results warrant further research.
• Whilst there are potential harms of taking combined calcium
and vitamin D supplementation, the benefits for those
at risk of pre-eclampsia may outweigh these harms.
Vitamin D plus calcium supplementation during pregnancy
appears to reduce the risk of pre-eclampsia, while vitamin D
alone appears to reduce the risk of low birth weight and
preterm delivery. However, supplementation with vitamin D
plus calcium appears to increase the risk of preterm birth.
e-Library of Evidence for Nutrition Actions (eLENA)
54. What is your opinion about single dose &
daily dose of vitamin D in case of
deficiency state?
55. • Timing and dosing regimen are crucial for vitamin D
supplementation.
• Daily administration is supposed to be the most physiological
way to correct vitamin D deficiency, but a less frequent
administration is likely to improve patient compliance to the
treatment, and help obtain a greater mean vitamin D 25-
hydroxylation
56. VITAMIN D TOXICITY
• Excess vitamin D supplementation can lead to hypercalcemia,
but vitamin D toxicity is extremely rare.
• It generally occurs only after ingestion of large doses of
vitamin D (>10,000 IU/day) for prolonged periods in patients
with normal gut absorption or those ingesting excessive
amounts of calcium.
• Patients with vitamin D toxicity can present with clinical
symptoms of hypercalcemia, including nausea, dehydration,
and constipation, or symptoms of hypercalciuria such as
polyuria and kidney stones.
57. • The lowest reported 25(OH)D level associated with toxicity
in patients without primary hyperparathyroidism and with
normal renal function is 80 ng/ml.
• Most patients with vitamin D toxicity have levels greater
than 150 ng/ml.
• One dosing study reported that vitamin D supplementation
with 1,600 IU/day or 50,000 IU monthly was not associated
with any laboratory parameters of toxicity and even failed to
increase total 25(OH)D levels above 30 ng/mL in 19% of
participants.
58. What does the new Cochrane evidence add?
• An important new Cochrane review update (Palacios et al., 2019)
summarises the evidence base for Vitamin D supplementation in
pregnancy; it includes 30 research studies and over 3700 pregnant
women were included.
• Before this review, we knew that babies from mothers who lacked
vitamin D have poorer outcomes, but it had not been convincingly
demonstrated that supplementation improved outcomes for
those at risk.
• It showed that taking vitamin D supplements in pregnancy:
• Probably reduces the risk of getting pre-eclampsia and gestational
diabetes
• May reduce the risk of having a low-birthweight baby.
• May reduce the risk of severe bleeding after birth.
• May make no difference to the risk of preterm birth before 37
weeks
59. CONCLUSION
• As we mentioned initially, obstetric endocrinology is a field
marked by both opportunity and caution.
• With the available evidence regarding vitamin d
supplementation, and the conflicting interpretations of
whatever has been published, it becomes challenging to issue
evidence-based guidelines.
• However, the benefit of vitamin d supplementation in
pregnancy is potentially even greater than in the nonpregnant
state
• Prescribe lower doses to pregnant women than to their
nonpregnant peers, perhaps because of an unfounded fear of
side effects.
60. • Symptomatic or documented vitamin d deficiency in pregnant
women should be treated in the same manner as in non-
pregnant individuals. Daily doses of 4000 units/day are
recommended for treatment in pregnancy.
• The use of lower doses of vitamin D, as contained in most
prenatal calcium preparations (100-800 IU) cannot be
condoned in symptomatic patients, or in those with
documented low levels.
• In healthy, asymptomatic antenatal women, 1000-2000 IU can
be supplemented daily in the second and third trimesters,
without fear of vitamin D toxicity or teratogenicity. No safety
data, however, is available for the first trimester with this
dose, either.
61. • Serum alkaline phosphate, a surrogate marker of vitamin D
deficiency, cannot be used as such in pregnancy, because of
the placental secretion of this enzyme.
• 25 hydroxy vitamin D levels may be measured in each
trimester, if easily affordable. In routine practice, however,
this investigation is not necessary.
• In resource constrained settings, patients on vitamin D
therapy can be screened for hypercalcemia by checking for
calcium crystalluria.
62. Vitamin D in pregnancy Coronavirus update
All adults, including pregnant and breastfeeding women, need
10 micrograms of vitamin D each day and should consider
taking a supplement containing this amount between
September and March.