Vitamin K supplementation during pregnancy for improving outcomes: a systematic review and meta-analysis

Abstract

To study supplementation effect of vitamin K (VK) alone or combined with other nutrients administered to pregnant women, we searched Cochrane Pregnancy and Childbirth Group’s Trials Register (till 22 January 2016, updated on 28 February 2018) including other resources. Two review authors independently assessed randomised or quasi-randomised controlled trials for inclusion, data extraction, accuracy, and risk of bias. We included older trials from high-income countries (six; 21,493 women-newborns), judged mostly as high or unclear bias risk. We could not assess high-risk e.g. epileptic women, but healthy women (different gestational ages) received varying VK dosages and duration. We meta-analysed neonatal bleeding (RR 1.16, 95% CI 0.59 to 2.29; P = 0.67) and maternal plasma VK1 (MD 2.46, 95% CI 0.98 to 3.93; P = 0.001). We found many outcomes were un-assessed e.g. perinatal death, maternal bleeding, healthcare utilization. Mostly newborns were included where VK found significantly effective for e.g. serum VK (mother-newborn), maternal breast milk VK. Few trials reported neonatal adverse side effects. The GRADE evidence quality was very low i.e. neonatal bleeding, neonatal jaundice, maternal plasma VK1. The intervention was favourable for maternal sera VK1 but remained uncertain for neonatal bleeding and other outcomes. The existing literature gaps warrant future investigations on un-assessed or inadequately reported outcomes.

Vitamin K Deficiency Bleeding in Infancy

“…However, a systematic review of the literature on antiepileptic drug use in pregnancy revealed that there was insufficient evidence to support vitamin K supplementation in the last weeks of pregnancy to reduce the risk of VKDB [55]. Further studies are required to establish a prophylactic strategy to prevent early-onset VKDB [56].…”

Effects of Vitamin Forms and Levels on Vitamin Bioavailability and Growth Performance in Piglets

“…This observation could be newborn piglets ingested enough vitamin K from their milk and creep feed, while their bodies stored rich menadione. Shahrook et al employed a meta-analysis to investigate the outcomes of vitamin K supplementation on pregnancy [43]. The author found that the antenatal vitamin K increased neonatal plasma vitamin K and breast milk vitamin K [43].…”

“…Shahrook et al employed a meta-analysis to investigate the outcomes of vitamin K supplementation on pregnancy [43]. The author found that the antenatal vitamin K increased neonatal plasma vitamin K and breast milk vitamin K [43]. The concentration of plasma vitamin K 3 increases when the dietary level of vitamins increases, which suggests that an improved vitamin K status may enhance alternative metabolic pathways through mechanisms beyond vitamin K's classic role as an enzyme cofactor.…”

Adherence to Long-Term Follow-Up of Patients with Life-Threatening, Inhaled Synthetic Cannabinoids-Associated Coagulopathy in Chicago

“…This, in turn, could lead to spontaneous abortion and embryopathy during the first trimester and CNS abnormalities, fatal hemorrhage and stillbirth at any stage during pregnancy (13)(14)(15)(16). In addition, safety of prolonged, off-label administration of daily pharmacologic doses (~100 mg) of oral VK 1 in pregnant women and their fetuses has not been established (17)(18)(19). For instance, fetal health may be susceptible to redox-modulating effects of menadione, an endogenous metabolite of oral VK 1 , that elaborates tissuedamaging reactive oxygen species (20,21).…”