Little Vitamin D while pregnant in Asia – survey Nov 2023

Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study

Heliyon https://doi.org/10.10167j.heliyon.2023.e21186
Ryan Wai Kheong Lee, Alicia Li Bin Chng, Kok Hian Tan , IPRAMHO International Study Group

Background: Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals.

Methods: We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries.

Results: Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy.

Conclusion: While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of re­spondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.
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Vitamin D Life recommends: 50,000 IU D3 weekly before, during, and after pregnancy

Preferably starting 50,000 IU daily for the first week.
Otherwise it takes 5 month for the vitamin D levels to plateau

Any amount of Vitamin D is far better than no Vitamin D
No Vitamin D screening nor test is needed

Note: Vitamin D2 should NOT be taken, and if taken, D2 must be daily

10+ Vitamin D Life Pregnancy pages with WEEKLY or BIWEEKLY in the title

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Survey Questions:

Practices on screening, treatment and perceptions
Question (Response) Number of responses (%)

Does your hospital screen for vitamin D deficiency in pregnancy?

Yes 0/15 (0.0 %)
No 12/15 (80.0 %)
Sometimes 3/15 (20.0 %)

Does your hospital screen for vitamin D deficiency in specific group of patients based on risk profile?

Yes 3/15 (20.0 %)
No 10/15 (66.7 %)
Sometimes 2/15 (13.3 %)

What is your hospital policy on screening for vitamin D deficiency in pregnancy?

Assessment of patient risk profile 3/15 (20.0 %)
Measurement of serum vitamin D levels based on risk profile 1/15 (6.7 %)
Research purpose, affordability 2/15 (14.3 %)
Leave it for physicians to decide 4/15 (26.7 %)
No screening for vitamin D 10/15 (66.7 %)

How does your hospital follow up on vitamin D levels in pregnancy women with vitamin D deficiency?

No need to repeat routinely 4/15 (26.7 %)
Repeat only if symptomatic 3/15 (20.0 %)
Repeat every trimester 2/15 (13.3 %)
Not sure 6/15 (40.0 %)

What do you think is the cut-off value to determine vitamin D deficiency (nmol/L) in pregnant women?

10 nmol/L 1/15 (6.7 %)
20 nmol/L 2/15 (13.3 %)
30 nmol/L 3/15 (20.0 %)
40 nmol/L 1/15 (6.7 %)
50 nmol/L 4/15 (26.7 %)
Not sure 4/15 (26.7 %)

Do you think that there is a need for a guideline and/or consensus on vitamin D screening and supplementation in pregnancy?

Yes 14/15 (93.3 %)
Not sure 1/15 (6.7 %)

Is there a national policy and/or regional guideline which your hospital refers to for vitamin D screening and supplementation in pregnancy?

Yes 3/15 (20.0 %)
No 10/15 (66.7 %)
Not sure 2/15 (13.3 %)

Does your hospital have a written protocol on vitamin D screening and supplementation deficiency in pregnancy?

Yes 1/14 (14.3 %)
No 11/14 (78.6 %)
Not sure 1/14 (7.1 %)

What percentage of pregnant women does your hospital see have vitamin D deficiency?

>80 % 2/14 (14.3 %)
40-60 % 2/14 (14.3 %)
<40 % 1/14 (7.1 %)
Not sure 9/14 (64.3 %)

What dose of vitamin D does your hospital prescribe in pregnant women WITHOUT vitamin D deficiency?

400IU 5/14 (40.0 %)
800IU 0/15 (0.0 %)
1,000 IU 1/14 (7.1 %)
1,500 IU 1/14 (7.1 %)
2,000 IU 1/14 (7.1 %)
Not sure 6/14 (42.9 %)

What dose of vitamin D does your hospital prescribe in pregnant women WITH vitamin D deficiency ?

400IU 0/15 (0.0 %)
800IU 0/15 (0.0 %)
1,000 IU 4/15 (25.0 %)
1,500 IU 0/15 (0.0 %)
2,000 IU 3/15 (20.0 %)
Not Sure 8/15 (53.3 %)

Vitamin D Life - Pregnancy category contains

 - see also

• Overview Pregnancy and vitamin D
• Number of articles in both categories of Pregnancy and:Dark Skin 28;   Depression 21;   Diabetes 44;   Obesity 15;  Hypertension 44;   Breathing 35;  Omega-3 40;  Vitamin D Receptor 24 Click here for details
• All items in category Infant/Child 823 items
• Pregnancy needs at least 40 ng of vitamin D, achieved by at least 4,000 IU – Hollis Aug 2017
• 38+ papers with Breastfed etc, in the title
• Call to action – more Vitamin D for pregnancies, loading doses are OK – Holick Aug 2019
• 53+ preeclampsia studies
• 94+ studies with PRETERM in the title
• Fertility problem (PCOS) reduced by vitamin D: many studies 15+
• 94+ Gestational Diabetes
• Caesarean birth much more likely if low Vitamin D - many studies 15+ studies
• Post-partum depression and low Vitamin D - many studies 15+ studies
• Stillbirth reduced by Vitamin D, Zinc, Omega-3 - several studies 5+ studies
• Search Vitamin D Life for "Assisted reproduction" 33 items as of Aug 2022
• Fertility and Sperm category listing has 134 items along with related searches
• (Stunting OR “low birth weight” OR LBW) 1180 items as of June 2020
• Less labor pain if higher level of vitamin D – August 2021
• Healthy pregnancies need lots of vitamin D
• Ensure a healthy pregnancy and baby - take Vitamin D before conception
  

Vitamin D Life – Healthy pregnancies need lots of vitamin D contains

RCT = Randomized Controlled Trial

Vitamin D Life – Breastfeeding and Vitamin D - many studies: 39+ as of Dec 2023