Evaluation of Vitamin D Supplementation Doses during Pregnancy in a Population at High Risk for Deficiency

Mutlu, Gül Yeşiltepe; Özsu, Elif; Kalaça, Sibel; Yüksel, Ayşegül; Pehlevan, Yuksel; Çizmecioğlu, Filiz Mine; Hatun, Şükrü

doi:10.1159/000358833

Cited by 26 publications

(23 citation statements)

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“…After screening the titles and abstracts, we read 56 articles. Twenty-four RCTs 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 comprising 5405 participants met the inclusion criteria. Two of these trials are from the same RCT with different outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Vitamin D supplementation was in the form of cholecalciferol in 22 RCTs 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 and in the form of ergocalciferol in 3 RCTs. 12 , 17 , 25 For the intervention group, the daily doses were 800 IU in 1 RCT, 17 1000 IU in 6 RCTs, 12 , 14 , 16 , 18 , 25 , 26 1200 IU in 1 RCT, 34 2000 IU in 7 RCTs, 15 , 18 , 20 , 26 , 29 , 34 , 35 2800 IU in 1 RCT, 13 4000 IU in 4 RCTs, 15 , 20 , 21 , 29 4400 in 1 RCT, 24 or 5000 IU in 1 RCT 33 ; the weekly doses were 35 000 IU 30 or 50 000 IU 19 ; the fortnightly dose was 50 000 IU in 2 RCTs 23 , 28 ; the monthly dose was 60 000 IU 32 ; the bimonthly dose was 60 000 IU 32 ; and the bolus doses were 60 000 IU in 3 RCTs, 22 ...…”

Section: Resultsmentioning

confidence: 99%

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Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality

et al. 2018

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Key Points Question Is vitamin D supplementation during pregnancy beneficial and safe for offspring? Findings In this systematic review and meta-analysis of 24 randomized clinical trials including 5405 individuals, vitamin D supplementation during pregnancy was associated with a lower risk of infants being small for gestational age and improved growth during infancy without an increased risk of fetal or neonatal mortality or congenital abnormality. Meaning Vitamin D supplementation during pregnancy may reduce the risk of infants being small for gestational age and improve growth during infancy without an increased risk of fetal or neonatal mortality or congenital abnormality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality

et al. 2018

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“…The estimated proportion of women reaching the target level of 20 ng/ml were 78%, 92%, 93%, in the aforementioned doses, respectively. In another three-arm study (600, 1,200 and 2,000 IU/d) from Turkey, starting at a lower baseline 25(OH)D of 9.9–11 ng/ml, the highest dose allowed for 80% of pregnant women to reach the target level of 20 ng/ml, while the other doses allowed less than 50% of the participants to do so [46]. All these findings from Western and Non-Western populations show that the increments in 25(OH)D level following supplementation seem comparable, and at least an intermediate dose of 1,000–2,000 IU daily is needed to allow to the majority of pregnant women to reach the desirable NAM (IOM) 25(OH)D level.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D replacement in children, adolescents and pregnant women in the Middle East and North Africa

et al. 2017

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Introduction Hypovitaminosis D affects one-third to two-thirds of children and pregnant women from the Middle East and North Africa (MENA) region. Objective To evaluate in infants, children, adolescents and pregnant women, from the MENA region, the effect of supplementation with different vitamin D doses on the change in 25-hydroxyvitamin D [25(OH)D] level reached, and other skeletal and non-skeletal outcomes. Methods This is a systematic review of randomized controlled trials of vitamin D supplementation conducted in the MENA region. We conducted a comprehensive literature search in 7 databases, without language or time restriction, until November 2016. Two reviewers abstracted data from the included studies, independently and in duplicate. We calculated the mean difference (MD) and 95% CI of 25(OH)D level reached when at least 2 studies were eligible in each comparison (low (< 800 IU), intermediate (800–2,000 IU) or high (> 2,000 IU) daily dose of vitamin D, or placebo). We pooled data using RevMan version 5.3. Results We identified a total of 15 eligible trials: one in infants, 4 in children and adolescents and 10 in pregnant women. In children and adolescents, an intermediate vitamin D dose (1,901 IU/d), resulted in a mean difference in 25(OH)D level of 13.5 (95% Confidence Interval (CI) 8.1;18.8) ng/ml, compared to placebo, favoring the intermediate dose (p < 0.001). The proportion of children and adolescents reaching a 25(OH)D level ≥ 20 ng/ml was 74% in the intermediate dose group. In pregnant women, four trials started supplementation at 12–16 weeks of gestation and continued until delivery, and six trials started supplementation at 20–28 weeks gestation and stopped it at delivery. The MD in 25(OH)D level reached was 8.6 (95% CI 5.3–11.9) ng/ml (p <0.001) comparing the high dose (3,662 IU/d) to the intermediate dose (1,836 IU/d), and 12.3 (95% CI 6.4–18.2) ng/ml (p <0.001), comparing the high dose (3,399 IU/d) to the low dose (375 IU/d). Comparing the intermediate (1,832 IU/d) to the low dose (301 IU/d), the MD in 25(OH)D level achieved was 7.8 (95% CI 4.5–10.8) ng/ml (p < 0.001). The proportion of pregnant women reaching a 25(OH)D level ≥ 20 ng/ml was 80–90%, 73% and 27–43% in the high, intermediate, and low dose groups, respectively. The risk of bias in the included studies, for children, adolescents and pregnant women, ranged from low to high. Conclusion In children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1,000–2,000 IU seems necessary to allow for the majority of the population to reach a desirable 25(OH)D level of 20 ng/ml. Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various clinically important outcomes.

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“…[35–38]. However, the debate about the correct dose is ongoing and IOM recommends a dose of 400–600 IU/day in all pregnancies [14].…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Vitamin D Deficiency in Native versus Migrant Mothers and Newborns in the North of Italy: A Call to Act with a Stronger Prevention Program

et al. 2015

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BackgroundVitamin D status during pregnancy is related to neonatal vitamin D status. Vitamin D deficiency has been associated with an increased risk of rickets in children and osteomalacia in adults. Aim of this study was to investigate 25OHD levels in maternal serum and in neonatal blood spots in native and migrant populations living in Novara (North Italy, 45°N latitude).Methods and FindingsWe carried out a cross sectional study from April 1st 2012 to March 30th 2013, in a tertiary Care Center. Maternal blood samples after delivery and newborns' blood spots were analyzed for 25OHD levels in 533 pairs. Maternal country of origin, skin phototype, vitamin D dietary intake and supplementation during pregnancy were recorded. Multivariate regression analysis, showed a link between neonatal and maternal 25OHD levels (R-square:0.664). Severely deficient 25OHD values (<25 nmol/L) were found in 38% of Italian and in 76.2% of migrant’s newborns (p <0.0001), and in 18% of Italian and 48,4% of migrant mothers (p <0.0001) while 25OHD deficiency (≥25 and <50 nmol/L) was shown in 40.1% of Italian and 21.7% of migrant’s newborns (p <0.0001), and in 43.6% of Italian and 41.3% of migrant mothers (p <0.0001). Italian newborns and mothers had higher 25OHD levels (34.4±19.2 and 44.9±21.2nmol/L) than migrants (17.7±13.7 and 29.7±16.5nmol/L; p<0.0001). A linear decrease of 25OHD levels was found with increasing skin pigmentation (phototype I 42.1 ±18.2 vs phototype VI 17.9±10.1 nmol/l; p<0.0001). Vitamin D supplementation resulted in higher 25OHD values both in mothers and in their newborns (p<0.0001).ConclusionsVitamin D insufficiency in pregnancy and in newborns is frequent especially among migrants. A prevention program in Piedmont should urgently be considered and people identified as being at risk should be closely monitored. Vitamin D supplementation should be taken into account when considering a preventative health care policy.

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Evaluation of Vitamin D Supplementation Doses during Pregnancy in a Population at High Risk for Deficiency

Cited by 26 publications

References 24 publications

Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality

Association Between Vitamin D Supplementation During Pregnancy and Offspring Growth, Morbidity, and Mortality

Vitamin D replacement in children, adolescents and pregnant women in the Middle East and North Africa

High Prevalence of Vitamin D Deficiency in Native versus Migrant Mothers and Newborns in the North of Italy: A Call to Act with a Stronger Prevention Program

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