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.
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.
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.
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 regulates estrogen biosynthesis through VDR’s
Direct regulation of the expression of the aromatase gene
Maintaining extracellular calcium homoeostasis
Vitamin D increases progesterone secretion by
Granulosa cell leutinisation – HOXA10 expression
Increased 3 β- HSD mRNA levels
Vitamin D increases placental sex steriod production
Regulates human chorionic expression
Secretion from human syncitiotrophoblasts (promoter- CYP19 )
This document discusses vitamin D deficiency in India. It provides the following key points:
1. More than 80% of adults in India do not get enough vitamin D, despite India's sunny climate, due to factors like skin pigmentation and low dietary intake.
2. The most common disorders caused by vitamin D deficiency in India are osteomalacia and rickets, which are bone diseases characterized by softening of the bones.
3. Good food sources of vitamin D include cod liver oil, fatty fish like salmon and tuna, and fortified foods like milk, cereal and orange juice. However, dietary intake of vitamin D is still low for most Indians.
ROLE OF VIT D IN FEMALE REPRODUCTION. PROF ABOUBAKR ELNASHARAboubakr Elnashar
This document discusses the role of vitamin D in female reproduction. It begins by covering the production and metabolism of vitamin D, noting the two major forms and how they are converted in the liver and kidneys to their active form. It then discusses optimal vitamin D levels and biological activity, including genomic and non-genomic actions. The main section covers the role of vitamin D in female reproduction, such as its effects on sex hormones, ovarian reserve markers, endometriosis, PCOS, uterine fibroids, and IVF outcomes. It concludes that vitamin D is involved in regulating the female reproductive system and modulating gonadal function through its receptor, but more research is needed to fully understand its role in infertility treatment.
Vitamin D is an essential vitamin that must be metabolized to become biologically active. It plays an important role in calcium homeostasis, bone and muscle health, immune function, and the regulation of cell growth. The best indicator of vitamin D status is the measurement of 25-hydroxyvitamin D in the blood, as it reflects vitamin D from dietary intake and sunlight exposure. Low vitamin D levels have been associated with increased risk of various chronic diseases. Vitamin D deficiency can lead to impaired bone mineralization and increased fracture risk.
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
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.
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.
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 regulates estrogen biosynthesis through VDR’s
Direct regulation of the expression of the aromatase gene
Maintaining extracellular calcium homoeostasis
Vitamin D increases progesterone secretion by
Granulosa cell leutinisation – HOXA10 expression
Increased 3 β- HSD mRNA levels
Vitamin D increases placental sex steriod production
Regulates human chorionic expression
Secretion from human syncitiotrophoblasts (promoter- CYP19 )
This document discusses vitamin D deficiency in India. It provides the following key points:
1. More than 80% of adults in India do not get enough vitamin D, despite India's sunny climate, due to factors like skin pigmentation and low dietary intake.
2. The most common disorders caused by vitamin D deficiency in India are osteomalacia and rickets, which are bone diseases characterized by softening of the bones.
3. Good food sources of vitamin D include cod liver oil, fatty fish like salmon and tuna, and fortified foods like milk, cereal and orange juice. However, dietary intake of vitamin D is still low for most Indians.
ROLE OF VIT D IN FEMALE REPRODUCTION. PROF ABOUBAKR ELNASHARAboubakr Elnashar
This document discusses the role of vitamin D in female reproduction. It begins by covering the production and metabolism of vitamin D, noting the two major forms and how they are converted in the liver and kidneys to their active form. It then discusses optimal vitamin D levels and biological activity, including genomic and non-genomic actions. The main section covers the role of vitamin D in female reproduction, such as its effects on sex hormones, ovarian reserve markers, endometriosis, PCOS, uterine fibroids, and IVF outcomes. It concludes that vitamin D is involved in regulating the female reproductive system and modulating gonadal function through its receptor, but more research is needed to fully understand its role in infertility treatment.
Vitamin D is an essential vitamin that must be metabolized to become biologically active. It plays an important role in calcium homeostasis, bone and muscle health, immune function, and the regulation of cell growth. The best indicator of vitamin D status is the measurement of 25-hydroxyvitamin D in the blood, as it reflects vitamin D from dietary intake and sunlight exposure. Low vitamin D levels have been associated with increased risk of various chronic diseases. Vitamin D deficiency can lead to impaired bone mineralization and increased fracture risk.
Role of Calcium in pregnancy DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Rashmi Jai...Lifecare Centre
ROLE OF CALCIUM IN PREGNANCY
FOCUS :
Daily requirement of calcium according to age
Calcium metabolism in pregnancy
Calcium requirement in pregnancy
Maternal benefits
Fetal benefits
Reduction in blood lead levels
Nutrition to improve calcium
Guidelines about dietary calcium intake / supplements in pregnancy
Role of antioxidants in female infertility Dr. Jyoti AgarwalLifecare Centre
Role of antioxidants in female infertility Dr. Jyoti Agarwal
3 Concepts
Oxygen toxicity is an inherent challenge to aerobic life
Oxygen is essential for life.
Excess oxygen can have harmful effects.
When oxygen is metabolised in the body , it produces substances called FREE RADICALS which damage our cells.
Calcium and Vitamin D Supplementation in PregnancySujoy Dasgupta
lectured delivered by Dr Sujoy Dasgupta in the CME on "High Risk Pregnancy" organized by the BOGS (Bengal Obettric snd Gynaecological Society) and Wanburry Pharma
Vitamin D is a fat-soluble vitamin that is produced in the body after exposure to sunlight. It has two major forms, vitamin D3 and D2. Vitamin D acts as a hormone by binding to vitamin D receptors in tissues like bone and intestine. It helps regulate calcium and phosphate absorption and bone remodeling. Deficiencies can lead to rickets in children or osteomalacia in adults, characterized by soft, deformed bones and fractures. Sources include sunlight, fatty fish, and fortified foods. Toxicity from excess vitamin D causes hypercalcemia.
The document discusses vitamin D, including its synthesis from sun exposure, its role in various bodily processes, and its potential health benefits. Key points include:
- Vitamin D is synthesized in the skin upon exposure to sunlight and can also be obtained through food and supplements. It plays an important role in bone and immune health.
- Vitamin D receptors are found throughout the body and vitamin D has been shown to regulate gene expression, turning genes on and off. This may explain its wide-ranging effects.
- Studies suggest vitamin D may help reduce the risk of various cancers, heart disease, diabetes, respiratory infections, autoimmune diseases, and mental health conditions like depression. Optimal vitamin D levels are important
This document discusses vitamin D, including its sources, biochemical effects, and related diseases. It summarizes that vitamin D aids in calcium and phosphorus absorption in the intestine and bone mineralization. Deficiencies can cause rickets in children and osteomalacia in adults, resulting from insufficient mineralization of bones. Toxicity from oversupplementation can lead to excessive calcification.
A brief review about the role of vitamin D in health and disease. Most of the content in these slides were taken from another author with some editing to custom it for the purpose of general physician workshop scientific material. Some figures were our own data in our hospital
This document provides information on Dr. Kiran Pandey, including her qualifications, positions held, awards received, areas of special interest and number of publications. It then discusses anaemia globally and in India, presenting data on prevalence. It defines anaemia during pregnancy according to various organizations and classifications of severity. Peripheral blood smear findings and investigations for different types of anaemia are outlined. The document discusses iron deficiency anaemia in detail including causes, management and oral versus parenteral iron therapy.
The document provides an overview of vitamin D, including its history, sources, functions, deficiency, testing, and effects on bones and teeth. Vitamin D is important for calcium absorption and bone mineralization, and deficiency can lead to conditions like rickets and osteomalacia, causing bone deformities and increased risk of fractures. The document discusses various forms of vitamin D, recommended intake levels, biomarkers used to indicate status, laboratory testing methods, and dental considerations related to vitamin D deficiency.
The document discusses newer aspects of iron supplementation. It summarizes that iron amino acid chelate, or ferrous bis glycinate, has advantages over other forms of iron supplementation, including being non-buffered in the stomach, non-precipitated in the intestine, not antagonized by phytates, and having superior and dependable bioavailability due to its unique chelate design, which potentially allows for smaller doses with fewer side effects. The document examines what is known, unknown, and needs to be known about different forms of iron supplementation and their absorption parameters.
Vitamin D is a fat-soluble vitamin that is obtained through sunlight exposure and dietary sources like fatty fish and fortified foods. It plays an important role in bone and immune health by aiding in calcium absorption and bone mineralization. Testing for vitamin D levels has increased in recent years due to research linking vitamin D deficiency to diseases like cancer, heart disease, diabetes and depression. While vitamin D shows promise for many health benefits, more research is still needed to fully understand its therapeutic potential.
The document discusses vitamin D, describing it as essential for health and important for numerous functions in the body. It outlines that vitamin D helps absorb calcium for strong bones and teeth, and supports immune function, mental health, and may lower risks of various diseases. It recommends getting vitamin D through moderate sun exposure or dietary supplements, and describes an optimal vitamin D blood level range.
Calcium is essential for bone health, especially in infants. Breastfeeding provides optimal calcium, but lactating mothers can experience bone loss. The document presents a brand plan for a calcium supplement called MotherCal, positioned for lactating mothers. It highlights that MotherCal contains calcium citrate, which is better absorbed than carbonate, and also includes phosphate and vitamin D for bone health. Statistics show low rates of exclusive breastfeeding in India and need to support lactating mothers' bone health. The plan includes promotional materials to educate about breastfeeding and launch MotherCal.
Presented at Johns Hopkins Bayview Medical Center. Evidence-based research surrounding the potential association between vitamin D deficiency and risk for developing gestational diabetes among pregnant women and women of reproductive age.
Anemias during pregnancy warda [compatibility mode]Osama Warda
Anemia is common during pregnancy, affecting over 50% of pregnant women. Iron deficiency anemia is the most frequent type, followed by anemia due to blood loss. Anemia can negatively impact both mother and fetus, increasing risks of preeclampsia, placental abruption, preterm labor, stillbirths and neonatal deaths. Diagnosis is based on low hemoglobin, hematocrit or red blood cell counts. Treatment involves oral or intravenous iron supplementation. Folic acid and B12 deficiency anemias are also possible and are treated with vitamin supplementation or transfusions depending on severity. Close monitoring and management of anemias is important for optimizing pregnancy outcomes.
Vitamin D is important for human health and deficiency can lead to diseases like rickets. It is obtained through sun exposure, diet, and supplements. The document discusses vitamin D's roles in bone health, cancer prevention, cardiovascular, immune function, and other diseases. It provides recommendations for intake amounts and lists food sources of vitamin D like fatty fish, eggs, and fortified foods. Vitamin D deficiency is highly prevalent globally and putting populations at risk for various chronic conditions.
All About Vitamin D
Follow me on SlideShare ,Follow on blogger.com and linkedIn...
https://www.slideshare.net/YashLodha11/vitamin-d-247723886/edit?src=slideview
https://www.linkedin.com/in/yash-lodha-047728211/
https://www.blogger.com/blog/posts/2577104637130363155
Iron deficiency anaemia in pregnancy- evidence based approachWafaa Benjamin
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally.
Iron Depletion affects 20-40% of Egyptian women in childbearing period.
Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion.
There should be clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period.
Universal iron supplementation in pregnancy is more suitable for our local protocol.
Haemoglopinopathy screening program for pregnant women is awaited.
This document discusses the importance of calcium, vitamin D, and vitamin K2 for pregnancy nutrition. It notes that calcium is essential for fetal bone growth and development and helps reduce risks of pregnancy complications like preeclampsia. The recommended daily calcium intake increases during pregnancy. Vitamin D aids calcium absorption and vitamin K2 directs calcium to the bones. Together calcium, vitamin D and K2 support strong bones and healthy blood vessels in both mother and baby. Calcium deficiency during pregnancy can lead to issues like preeclampsia, while meeting calcium needs helps support the growth and health of both mother and fetus.
Vitamin D is important for many bodily functions beyond bone health. It acts as a hormone and is involved in processes like calcium absorption and immune function. Sources of vitamin D include fatty fish, fish liver oils, egg yolks, and exposure to sunlight. Deficiencies can cause bone diseases like rickets and osteomalacia and increase risk for various cancers and autoimmune diseases.
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.
Role of antioxidants in female infertility Dr. Jyoti AgarwalLifecare Centre
Role of antioxidants in female infertility Dr. Jyoti Agarwal
3 Concepts
Oxygen toxicity is an inherent challenge to aerobic life
Oxygen is essential for life.
Excess oxygen can have harmful effects.
When oxygen is metabolised in the body , it produces substances called FREE RADICALS which damage our cells.
Calcium and Vitamin D Supplementation in PregnancySujoy Dasgupta
lectured delivered by Dr Sujoy Dasgupta in the CME on "High Risk Pregnancy" organized by the BOGS (Bengal Obettric snd Gynaecological Society) and Wanburry Pharma
Vitamin D is a fat-soluble vitamin that is produced in the body after exposure to sunlight. It has two major forms, vitamin D3 and D2. Vitamin D acts as a hormone by binding to vitamin D receptors in tissues like bone and intestine. It helps regulate calcium and phosphate absorption and bone remodeling. Deficiencies can lead to rickets in children or osteomalacia in adults, characterized by soft, deformed bones and fractures. Sources include sunlight, fatty fish, and fortified foods. Toxicity from excess vitamin D causes hypercalcemia.
The document discusses vitamin D, including its synthesis from sun exposure, its role in various bodily processes, and its potential health benefits. Key points include:
- Vitamin D is synthesized in the skin upon exposure to sunlight and can also be obtained through food and supplements. It plays an important role in bone and immune health.
- Vitamin D receptors are found throughout the body and vitamin D has been shown to regulate gene expression, turning genes on and off. This may explain its wide-ranging effects.
- Studies suggest vitamin D may help reduce the risk of various cancers, heart disease, diabetes, respiratory infections, autoimmune diseases, and mental health conditions like depression. Optimal vitamin D levels are important
This document discusses vitamin D, including its sources, biochemical effects, and related diseases. It summarizes that vitamin D aids in calcium and phosphorus absorption in the intestine and bone mineralization. Deficiencies can cause rickets in children and osteomalacia in adults, resulting from insufficient mineralization of bones. Toxicity from oversupplementation can lead to excessive calcification.
A brief review about the role of vitamin D in health and disease. Most of the content in these slides were taken from another author with some editing to custom it for the purpose of general physician workshop scientific material. Some figures were our own data in our hospital
This document provides information on Dr. Kiran Pandey, including her qualifications, positions held, awards received, areas of special interest and number of publications. It then discusses anaemia globally and in India, presenting data on prevalence. It defines anaemia during pregnancy according to various organizations and classifications of severity. Peripheral blood smear findings and investigations for different types of anaemia are outlined. The document discusses iron deficiency anaemia in detail including causes, management and oral versus parenteral iron therapy.
The document provides an overview of vitamin D, including its history, sources, functions, deficiency, testing, and effects on bones and teeth. Vitamin D is important for calcium absorption and bone mineralization, and deficiency can lead to conditions like rickets and osteomalacia, causing bone deformities and increased risk of fractures. The document discusses various forms of vitamin D, recommended intake levels, biomarkers used to indicate status, laboratory testing methods, and dental considerations related to vitamin D deficiency.
The document discusses newer aspects of iron supplementation. It summarizes that iron amino acid chelate, or ferrous bis glycinate, has advantages over other forms of iron supplementation, including being non-buffered in the stomach, non-precipitated in the intestine, not antagonized by phytates, and having superior and dependable bioavailability due to its unique chelate design, which potentially allows for smaller doses with fewer side effects. The document examines what is known, unknown, and needs to be known about different forms of iron supplementation and their absorption parameters.
Vitamin D is a fat-soluble vitamin that is obtained through sunlight exposure and dietary sources like fatty fish and fortified foods. It plays an important role in bone and immune health by aiding in calcium absorption and bone mineralization. Testing for vitamin D levels has increased in recent years due to research linking vitamin D deficiency to diseases like cancer, heart disease, diabetes and depression. While vitamin D shows promise for many health benefits, more research is still needed to fully understand its therapeutic potential.
The document discusses vitamin D, describing it as essential for health and important for numerous functions in the body. It outlines that vitamin D helps absorb calcium for strong bones and teeth, and supports immune function, mental health, and may lower risks of various diseases. It recommends getting vitamin D through moderate sun exposure or dietary supplements, and describes an optimal vitamin D blood level range.
Calcium is essential for bone health, especially in infants. Breastfeeding provides optimal calcium, but lactating mothers can experience bone loss. The document presents a brand plan for a calcium supplement called MotherCal, positioned for lactating mothers. It highlights that MotherCal contains calcium citrate, which is better absorbed than carbonate, and also includes phosphate and vitamin D for bone health. Statistics show low rates of exclusive breastfeeding in India and need to support lactating mothers' bone health. The plan includes promotional materials to educate about breastfeeding and launch MotherCal.
Presented at Johns Hopkins Bayview Medical Center. Evidence-based research surrounding the potential association between vitamin D deficiency and risk for developing gestational diabetes among pregnant women and women of reproductive age.
Anemias during pregnancy warda [compatibility mode]Osama Warda
Anemia is common during pregnancy, affecting over 50% of pregnant women. Iron deficiency anemia is the most frequent type, followed by anemia due to blood loss. Anemia can negatively impact both mother and fetus, increasing risks of preeclampsia, placental abruption, preterm labor, stillbirths and neonatal deaths. Diagnosis is based on low hemoglobin, hematocrit or red blood cell counts. Treatment involves oral or intravenous iron supplementation. Folic acid and B12 deficiency anemias are also possible and are treated with vitamin supplementation or transfusions depending on severity. Close monitoring and management of anemias is important for optimizing pregnancy outcomes.
Vitamin D is important for human health and deficiency can lead to diseases like rickets. It is obtained through sun exposure, diet, and supplements. The document discusses vitamin D's roles in bone health, cancer prevention, cardiovascular, immune function, and other diseases. It provides recommendations for intake amounts and lists food sources of vitamin D like fatty fish, eggs, and fortified foods. Vitamin D deficiency is highly prevalent globally and putting populations at risk for various chronic conditions.
All About Vitamin D
Follow me on SlideShare ,Follow on blogger.com and linkedIn...
https://www.slideshare.net/YashLodha11/vitamin-d-247723886/edit?src=slideview
https://www.linkedin.com/in/yash-lodha-047728211/
https://www.blogger.com/blog/posts/2577104637130363155
Iron deficiency anaemia in pregnancy- evidence based approachWafaa Benjamin
Iron deficiency is the most common deficiency state in the world, affecting more than 2 billion people globally.
Iron Depletion affects 20-40% of Egyptian women in childbearing period.
Effective management is needed to prevent adverse maternal and pregnancy outcomes, including the need for red cell transfusion.
There should be clear and simple recommendations for the diagnosis, treatment and prevention of iron deficiency in pregnancy and the postpartum period.
Universal iron supplementation in pregnancy is more suitable for our local protocol.
Haemoglopinopathy screening program for pregnant women is awaited.
This document discusses the importance of calcium, vitamin D, and vitamin K2 for pregnancy nutrition. It notes that calcium is essential for fetal bone growth and development and helps reduce risks of pregnancy complications like preeclampsia. The recommended daily calcium intake increases during pregnancy. Vitamin D aids calcium absorption and vitamin K2 directs calcium to the bones. Together calcium, vitamin D and K2 support strong bones and healthy blood vessels in both mother and baby. Calcium deficiency during pregnancy can lead to issues like preeclampsia, while meeting calcium needs helps support the growth and health of both mother and fetus.
Vitamin D is important for many bodily functions beyond bone health. It acts as a hormone and is involved in processes like calcium absorption and immune function. Sources of vitamin D include fatty fish, fish liver oils, egg yolks, and exposure to sunlight. Deficiencies can cause bone diseases like rickets and osteomalacia and increase risk for various cancers and autoimmune diseases.
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.
1) Sunlight is the primary source of vitamin D for most humans as UVB rays in sunlight convert 7-dehydrocholesterol in the skin to previtamin D3 and then to vitamin D3. However, several factors influence cutaneous vitamin D production such as season, latitude, skin pigmentation, sunscreen use, and aging.
2) Vitamin D deficiency is a worldwide problem with serious health consequences including increased risk of cancers, cardiovascular disease, autoimmune diseases, hypertension, and infections. Maintaining vitamin D levels above 30 ng/mL through moderate sun exposure and dietary/supplemental intake is important for health.
3) While sun exposure is important for vitamin D production, excessive sunlight increases
1) Sunlight is the primary source of vitamin D for most humans as UVB rays in sunlight convert 7-dehydrocholesterol in the skin to previtamin D3 and then to vitamin D3. However, several factors influence cutaneous vitamin D production such as season, latitude, skin pigmentation, sunscreen use, and aging.
2) Vitamin D deficiency is a worldwide problem with serious health consequences including increased risk of cancers, cardiovascular disease, autoimmune diseases, hypertension, and infections. Maintaining vitamin D levels above 30 ng/mL through moderate sun exposure and dietary/supplemental intake is important for health.
3) Studies show vitamin D deficiency is still prevalent in populations such as Asian
Vitamina D ed Asma - Prof. Boner Attilio Università di VeronaRoberto Conte
1) Several studies show high rates of vitamin D deficiency and insufficiency among children with asthma. Low vitamin D levels are associated with worse asthma control, including increased exacerbations and hospitalizations.
2) Observational studies link higher maternal vitamin D intake during pregnancy to lower rates of wheezing and asthma in offspring. However, the evidence for a causal relationship is still insufficient.
3) Maintaining adequate vitamin D levels, especially during pregnancy and childhood, may help reduce asthma risk and severity by supporting lung development and function. Further research is still needed.
This document discusses vitamin D deficiency in children. Some key points:
- Vitamin D deficiency is very common in India, affecting 50-90% of the population, due to factors like low dietary calcium and changing lifestyles.
- Deficiency can cause hypocalcemia and rickets in children. Treatment involves vitamin D supplementation, with options for daily, weekly, or single high dose ("Stoss") therapy.
- Guidelines define deficiency as 25(OH)D levels <20 ng/mL. Treatment is recommended for levels <15 ng/mL or if clinical symptoms are present.
- Treatment regimens aim to correct deficiency and replenish stores, while monitoring calcium, phosphorus
This document reviews vitamin D deficiency and its associated comorbidities. It discusses:
1. Vitamin D's chemical properties, sources, absorption, and recommended daily intake levels.
2. The high global prevalence of vitamin D deficiency, especially in India. Populations at increased risk include those with limited sun exposure, obesity, and certain medical conditions.
3. Associations between vitamin D deficiency and increased risk of cardiovascular diseases like hypertension and angina, as well as diabetes, polycystic ovary syndrome, and various autoimmune and infectious disorders.
4. Evidence that vitamin D supplementation may help treat and prevent progression of these comorbid conditions.
This case report describes a 10-day-old boy admitted with new onset convulsions. Initial blood tests showed hypocalcemia. The cause was found to be maternal hypovitaminosis D due to a diet low in calcium and no prenatal vitamin supplements. The mother also always wore sunscreen outdoors. The baby was treated with IV calcium supplementation and oral calcium and vitamin D, and his seizures resolved within 48 hours. This case highlights the risk of neonatal hypocalcemia and seizures due to maternal vitamin D deficiency during pregnancy.
Vitamin D supplementation during pregnancy: Is it really necessary?
1) There is ongoing debate around the optimal vitamin D levels during pregnancy and definitions of vitamin D deficiency. 2) Studies have shown associations between vitamin D deficiency and adverse pregnancy outcomes like gestational diabetes and preeclampsia. 3) The placenta plays a role in vitamin D metabolism and higher placental activity of the CYP24A1 enzyme is associated with vitamin D deficiency in pregnancies with gestational diabetes. 4) While routine vitamin D screening in all pregnancies is not currently recommended, high-risk women may benefit from screening and supplementation to treat deficiency.
1) The study examined the impact of maternal vitamin D status on fetal skeletal development through 3D ultrasound measurements in 424 pregnant women.
2) It found that suboptimal maternal vitamin D status was associated with increased femur cross-sectional area and splaying in utero, resembling characteristics of rickets.
3) This suggests that maternal vitamin D insufficiency could influence fetal skeletal development and morphology early in gestation, though future studies are still needed to establish causality.
1) The study examined the impact of maternal vitamin D status on fetal skeletal development through 3D ultrasound measurements in 424 pregnant women.
2) It found that suboptimal maternal vitamin D status was associated with increased femur cross-sectional area and splaying in utero, resembling signs of rickets.
3) This suggests that ensuring optimal maternal vitamin D levels during pregnancy may be important for proper fetal skeletal development.
The document discusses vitamin D deficiency in children and its management approaches. It finds that vitamin D deficiency prevalence is around 30-90% across all age groups in India. This is a critical issue as vitamin D and calcium are important for musculoskeletal health in growing years. Infants and children are especially at risk of deficiency due to factors like minimal vitamin D in breast milk and diet, prolonged breastfeeding without supplementation, darker skin, and lack of sun exposure. Deficiency can lead to acute presentations like seizures from hypocalcemia in newborns or chronic rickets characterized by bone deformities and weakening. The document examines case studies and provides guidelines on testing, risk factors, presentations, and treatment approaches for vitamin D deficiency in children.
This document discusses a systematic review on the role of vitamin D in maternal and fetal outcomes in gestational diabetes mellitus (GDM). The review analyzed 36 studies on the effects of vitamin D supplementation in GDM pregnancies. The results showed that vitamin D supplementation improved insulin sensitivity, glucose tolerance, and pancreatic function in GDM patients with a BMI below 35. However, vitamin D supplementation had no effect on GDM outcomes in obese patients or those with genetic risk factors. The review concluded that vitamin D supplementation can help regulate blood glucose in normal-weight GDM patients but not in obese patients or those with strong genetic risk factors.
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.
This document discusses the use of vitamin D in preventing and treating non-bone diseases. It begins with an introduction and covers topics like immunomodulation related to allergy, fetal development, and the prevention and modification of diseases like asthma, COPD, allergic rhinitis, atopic dermatitis, and food allergy. It also briefly mentions autoimmunity and other diseases. The document provides information on vitamin D synthesis and metabolism and cites several studies on vitamin D levels in different populations and its effects. It concludes with a discussion of vitamin D's immunomodulatory effects in relation to allergy.
Vitamin D deficiency causes rickets in children and osteomalacia in adults. The document discusses vitamin D metabolism, forms, measurement, defining sufficiency, causes of deficiency including lack of sunlight and certain medical conditions or medications, clinical manifestations like bone pain and deformities, management including high dose oral supplementation or injections to correct deficiency followed by maintenance doses. Treatment aims to restore vitamin D levels to the sufficient range and ensure adequate calcium intake, with dosing recommendations provided for different age groups and medical conditions.
Pemberian suplemen kalsium dan vitamin D pada ibu hamil dapat mencegah risiko kejadian preeklampsia berdasarkan hasil dua penelitian sistematis. Penelitian pertama menemukan bahwa pemberian dosis rendah kalsium (<1 g/hari) secara konsisten dapat mengurangi risiko preeklampsia. Penelitian kedua menunjukkan bahwa satu penelitian yang melibatkan 400 ibu hamil menemukan bahwa pemberian 1200 IU vitamin D
HYPERHOMOCYSTIENEMIA IN PREGNANCY AND LACTATION AND ROLE OF VITAMIN B12, D3 A...DR SHASHWAT JANI
This document discusses hyperhomocysteinemia in pregnancy and lactation. It begins with an introduction to vitamin B12, its importance in pregnancy and lactation, and sources of vitamin B12. It then discusses homocysteine, hyperhomocysteinemia, and the epidemiology of hyperhomocysteinemia in India. The document outlines the links between hyperhomocysteinemia and various pregnancy complications as well as the roles of folate, vitamin B12, and methylcobalamin in pregnancy outcomes. It emphasizes that vitamin B12 deficiency is more common than folate deficiency among pregnant women in India. Throughout, it provides evidence from various studies on the effects of vitamin B12 supplementation on mothers,
My personal response to the DiabetesUK slideshow from YouTube.
I set out the reasons why I think current DiabetesUK policy is promoting diabetes incidence and maintaining diabetics dependency on drugs.
I believe DiabetesUK should be making greater efforts to educate people to lower the risk of diabetes and should also be aiming to reduce diabetics reliance on drug use.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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7. Introduction
Vitamin D and its active metabolite 1,25-dihydroxyvitamin D (1,25(OH)2D) have
classical actions on calcium balance and bone metabolism. Without sufficient
1,25(OH)2D, the intestine cannot absorb calcium and phosphate adequately, which
leads to secondary hyperparathyroidism and a lack of new bone mineralisation
(rickets in children and osteomalacia in adults).
8. 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. 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.
9. Prepregnancy obesity has been associated with lower levels of vitamin D in both
pregnant women and their neonates; 61% of women who were obese (body mass
index [BMI] ≥ 30) prior to pregnancy were found to be vitamin D deficient,
compared to 36% of women with a prepregnancy BMI of less than 25.
10. Physiology
There are 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.
This requires 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.
Although 25(OH)D has low biological activity, it is the major form of circulating
vitamin D. Serum 25(OH)D concentrations are generally thought to 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.
11. 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.
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.
Melanin absorbs ultraviolet B (UVB) from sunlight and diminishes cholecalciferol
production by at least 90%.5 Dietary vitamin D is absorbed from the intestine and
circulates in plasma bound to a vitamin D binding protein.
12. Maternal and fetal complications
Pre-eclampsia and neonatal hypocalcaemia are the most prevalent complications
of maternal hypocalcaemia and are clearly associated with substantial morbidity. A
statistical association of glucose intolerance and hypovitaminosis D has been
demonstrated.
Maternal vitamin D is important to fetal bone development.
Fetal lung development and neonatal immune conditions such as asthma may
relate in part to maternal vitamin D levels.
Although it is not clear whether maternal vitamin D supplementation will prevent
these conditions, a strategy for supplementation and treatment of maternal vitamin
D deficiency is proposed.
13. Pre-eclampsia
There is conflicting evidence whether hypovitaminosis D in pregnancy is associated
with hypertension and pre-eclampsia.
In three studies, women who developed pre-eclampsia were found to have lower
levels of vitamin D than women who did not with levels less than 50 nmol/l
associated with a five-fold increased risk of severe pre-eclampsia.
Low levels in the first half of pregnancy were related to the risk of developing pre-
eclampsia and the neonates of these mothers had a two-fold increased risk of
having vitamin D levels < 37.5 nmol/l (vitamin D deficient).
14. Low birthweight
Maternal vitamin D levels have been shown to positively correlate with birthweight
centile.
In a study from Holland, women with vitamin D deficiency had a 2.4-fold increased
risk of having an SGA baby.
Another study found that maternal vitamin D levels of < 37.5 nmol/l in the first half
of pregnancy were associated with an adjusted odds ratio of 7.5 for SGA infants in
white women, but not in black women.
Australian researchers found that mean birthweight was 200 g lower (P < 0.001) in
babies of vitamin D deficient mothers.
15. Impaired glucose tolerance in pregnancy
Hypovitaminosis D is associated with impaired glucose tolerance and diabetes in
the general population.
However, the evidence for an association between low vitamin D levels and
gestational diabetes mellitus (GDM) is conflicting.
Low concentrations of 25(OH)D have been related to the risk of developing type II
diabetes mellitus (T2DM) through effects on insulin secretion and insulin sensitivity.
16. Other complications
Vitamin D deficiency (< 37.5 nmol/l) has been associated with a four-fold increased
risk of primary caesarean section (caesarean section performed for the first time),
although this has not been demonstrated in all studies.
Vitamin D deficiency is also associated with bacterial vaginosis in pregnant women.
In conclusion, hypovitaminosis D may be associated with hypertension, pre-
eclampsia and increased caesarean section rates.
There are no randomised trials showing that vitamin D supplementation alters
these putative risks.
17. Neonatal hypocalcaemic seizures
Neonatal vitamin D levels are correlated with those of their mother, with maternal
vitamin D deficiency increasing the risk of neonatal vitamin D deficiency.
In an Australian study, hypovitaminosis D was found in 15% of pregnant women
and 11% of neonates.
Vitamin D deficiency is a major cause of hypocalcaemic seizures in neonates and
infants.
Hypocalcaemia is not uncommon in neonates and is a potentially severe problem.
Mothers of babies who suffer hypocalcaemic seizures are more likely to be vitamin
D deficient (85%) than mothers of babies who do not (50%).
In another study from Egypt, all mothers of babies with hypocalcaemic seizures
had severe vitamin D deficiency.
18. Skeletal development and growth
Hypovitaminosis D is associated with impaired growth and bone development in
the fetus.
Evidence is accruing to show that less profound maternal 25(OH)D insufficiency
may lead to suboptimal bone size and density after birth without overt rachitic
change.
This is likely to lead to an increased risk of osteoporotic fracture in later life.
A retrospective cohort study showed that children who had received supplements
with vitamin D in the first year of life had a significant increase in femoral neck
bone density at the age of 8 years compared to the group that did not receive
supplements.
19. Evidence that 25(OH)D-related changes may be detectable early in gestation has
come from the Southampton Women’s Survey.
In this cohort, fetal distal femoral metaphyseal cross-sectional area was increased
relative to femur length at 19 and 34 weeks of gestation in those babies whose
mothers had low levels of circulating 25(OH)D, changes reminiscent of those seen
in postnatal rickets.
20. Fetal lung development and childhood immune disorders
Low maternal vitamin D intake in pregnancy is associated with wheeze and asthma
in the offspring.
Low cord blood 25(OH)D concentrations have been associated with respiratory
syncytial virus bronchiolitis50 and respiratory infections.
There are plausible physiological mechanisms for an association between prenatal
vitamin D status and immune development.
21. Maternal vitamin D supplementation is associated with cord blood gene expression
of tolerogenic immunoglobulin such as immunoglobulin-like transcripts 3 and 4
(ILT3 and ILT4).
Cord blood 25(OH)D is correlated with mononuclear cell release of IFN-γand hence
Th1 cell development.
22. Screening for vitamin D deficiency in pregnancy
There are no data to support routine screening for vitamin D deficiency in
pregnancy in terms of health benefits or cost effectiveness.
There is an argument that some groups of women who are pregnant should have a
screening test: for example, on the basis of skin colour or coverage, obesity, risk of
pre-eclampsia, or gastroenterological conditions limiting fat absorption.
As the test is expensive, offering it to all at-risk women may not be cost effective
compared to offering universal supplementation, particularly as treatment is
regarded as being very safe.
23. At present, there are no data to support a strategy of measurement followed by
treatment in the general female population.
Measurement of vitamin D in a hypocalcaemic or symptomatic woman as part of
their management continues to be applicable.
This includes women with a low calcium concentration, bone pain, gastrointestinal
disease, alcohol abuse, a previous child with rickets and those receiving drugs
which reduce vitamin D.
24. Supplementation and treatment in pregnancy
Daily vitamin D supplementation with oral cholecalciferol or ergocalciferol is safe in
pregnancy.
The 2012 recommendation from UK Chief Medical Officers and NICE guidance state
that all pregnant and breastfeeding women should be informed about the
importance of vitamin D and should take 10 micrograms of vitamin D supplements
daily.
Particular care should be taken over high-risk women.
25. The recommendations are based on the classical actions of vitamin D, although
many of the nonclassical actions of vitamin D may be beneficial.
As mentioned above, the review and meta-analysis by Aghajafari et al. found
associations between vitamin D insufficiency and risk of gestational diabetes, pre-
eclampsia, bacterial vaginosis and SGA infants.
Of course this does not necessarily demonstrate that correction during pregnancy
will reduce these risks.
26. Three categories of vitamin D supplementation are recommended.
1. In general, vitamin D 10 micrograms (400 units) a day is recommended for all
pregnant women in accord with the national guidance.56 This should be available
through the Healthy Start programme
27. 2. High-riskwomen are advised to take at least 1000 units a day (women with
increased skin pigmentation, reduced exposure to sunlight, or those who are
socially excluded or obese).
The RCOG has highlighted the importance of addressing suitable advice to these
women.
Women at high risk of pre-eclampsia are advised to take at least 800 units a day
combined with calcium.
Vitamin D may be inappropriate in sarcoidosis (where there may be vitamin D
sensitivity) or ineffective in renal disease.
There may be particular benefits of vitamin D/calcium supplementation in women
at risk of pre-eclampsia.
28. 3. Treatment. For the majority of women who are deficient in vitamin D, treatment
for 4–6 weeks, either with cholecalciferol 20 000 iu a week or ergocalciferol 10 000
iu twice a week, followed by standard supplementation, is appropriate.
For women who require short-term repletion, 20 000 iu weekly appears to be an
effective and safe treatment of vitamin D deficiency. A daily dose is likely to be
appropriate to maintain subsequent repletion (1000 iu daily).
In adults, very high doses of vitamin D (300 000–500 000 iu intramuscular [IM]
bolus) may be associated with an increased risk of fractures and such high doses
are not recommended in pregnancy.
29. A 2011 study demonstrated that supplemental doses of 4000 iu cholecalciferol a
day were safe in pregnant women and most effective compared to the lower doses.
30.
31. Safety of vitamin D
In pregnancy there is enhanced intestinal calcium absorption. Vitamin D toxicity is
manifested through hypercalcaemia and hypercalciuria. Therefore, there is a
hypothetical concern that when secondary hyperparathyroidism follows vitamin D
deficiency, calcium given with vitamin D may be associated with temporary
hypercalcaemia.
However, this is self-limiting due to the associated hungry bone and has not been
demonstrated to represent a clinical problem.
32. Opinion
Treatment of vitamin D deficient women and vitamin D supplementation is safe
and is recommended for all women who are pregnant or breastfeeding. Low
vitamin D concentrations are present in a significant proportion of the population.
Women with pigmented or covered skin, obesity and immobility are at a higher
risk.
Low vitamin D concentrations have been associated with a wide range of adverse
maternal and offspring health outcomes in observational epidemiological studies.
However, despite a dearth of interventional evidence supporting
supplementation/treatment of vitamin D in randomised controlled trial settings, it
is generally accepted that supplementation/treatment is not harmful and may have
some significant short- and long-term health benefits.
Further research should focus on the potential benefits and optimal dosing of
vitamin D use in pregnancy.
33.
34. Population to be offered screening
Antenatal women who: have limited exposure to sunlight (e.g. because they are
predominantly indoors or usually protected from the sun when outdoors,1 or
prolonged hospitalisation) have dark skin1 have a pre-pregnancy BMI ≥40. 2 A
high BMI (≥40) is associated with a 24% decrease in serum 25 (OH) vit D levels than
people with a BMI <25.
35. Screening Tests
1. Arrange screening for the woman at the first antepartum visit if she is at risk of
vitamin D deficiency and has no current status available. Screening can also be
conducted at any stage of pregnancy if previously missed.
2. 2. Screening tests offered should include: 25 (OH) vitamin D serum level Serum
levels above 78nmol /L are ideal 50nmol/L is considered normal 30-50 nmol/L
is considered vitamin D insufficiency (mildly deficient) Levels below 30nmol/L
show deficiency (severe vitamin D deficiency) and need immediate follow up
36. Supplementation of Vitamin D Deficient Women
Pregnant women with Vitamin D levels <50nmol/L:
1. Levels 30-49 nmol/L: 1000IU (25 μg) / day3 plus calcium* (RDI)
2. 2. Levels <30 nmol/L: 2000IU (50 μg) / day3 plus calcium* (RDI) orally (e.g.
Bio-Logical Vitamin D3 Solution 1000iu/ 0.2mL)
3. 3. After 6 weeks of treatment, a maintenance dose of 1000 IU is recommended.
However, the vitamin D level is not required to be rechecked.
37. Pregnant women with Vitamin D level above 50nmol/L to take 400 IU vitamin D
daily as part of a pregnancy multivitamin.
3 * A recent Cochrane review found vitamin D supplementation can reduce the risk
of pre-eclampsia, low birth weight and preterm birth, however when combined
with calcium supplementation, risk for preterm birth increased.4 The RDI table
below shows the total calcium amount recommended for all pregnant and lactating
women taking into consideration all intake sources (e.g. food, vitamins).
38.
39. Exposure to at least 15-30 minutes of sunshine per day is recommended, avoiding
1100-1500hr (1700hr in the summer months) to increase vitamin D production.
Hands, face and both arms need to be exposed to the sun for adequate vitamin D
synthesis. However, deeply held religious, cultural and personal beliefs about
modesty and sun avoidance need to be respected. A yellow patient information
card on Vitamin D is available in antenatal clinic to provide to vitamin D deficient
women.
40. Diet
Dietary sources of both calcium and vitamin D along with their bioavailability must
be considered. Good dietary sources of calcium are milk and milk based foods, but
it is also available from alternative non-dairy sources such as bony fish, some fruits
and nuts and now in fortified soy beverages and breakfast cereals. Dietary vitamin
D is found in small amounts in foods and cannot be relied upon when sun
exposure is inadequate. Best sources are fish, margarine and eggs.
41.
42. For the individual pregnant woman thought to be at increased risk of vitamin D deficiency,
the serum concentration of 25-OH-D can be used as an indicator of nutritional vitamin D
status.
Although there is no consensus on an optimal level to maintain overall health, most agree
that a serum level of at least 20 ng/mL (50 nmol/L) is needed to avoid bone problems .
Based on observations of biomarkers of vitamin D activity, such as parathyroid hormone,
calcium absorption, and bone mineral density, some experts have suggested that vitamin D
deficiency should be defined as circulating 25-OH-D levels less than 32 ng/mL (80 nmol/L) .
An optimal serum level during pregnancy has not been determined and remains an area of
active research.
43. In 2010, the Food and Nutrition Board at the Institute of Medicine of the National Academies
established that an adequate intake of vitamin D during pregnancy and lactation was 600
international units per day.
For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum
25-hydroxyvitamin D levels can be considered and should be interpreted in the context of
the individual clinical circumstance. When vitamin D deficiency is identified during
pregnancy, most experts agree that 1,000–2,000 international units per day of vitamin D is
safe.
Although data on the safety of higher doses are lacking, most experts agree that
supplemental vitamin D is safe in dosages up to 4,000 international units per day during
pregnancy or lactation.
44. At this time there is insufficient evidence to support a recommendation for screening all
pregnant women for vitamin D deficiency. For pregnant women thought to be at increased
risk of vitamin D deficiency, maternal serum 25-OH-D levels can be considered and should
be interpreted in the context of the individual clinical circumstance. When vitamin D
deficiency is identified during pregnancy, most experts agree that 1,000–2,000 international
units per day of vitamin D is safe.
45. Higher dose regimens used for the treatment of vitamin D deficiency have not been studied
during pregnancy. Recommendations concerning routine vitamin D supplementation during
pregnancy beyond that contained in a prenatal vitamin should await the completion of
ongoing randomized clinical trials. At this time, there is insufficient evidence to recommend
vitamin D supplementation for the prevention of preterm birth or preeclampsia.