Opinions and Practice of US-Based Obstetrician-Gynecologists regarding Vitamin D Screening and Supplementation of Pregnant Women
Journal of Pregnancy, Volume 2016 (2016), Article ID 1454707, 7 pages. http://dx.doi.org/10.1155/2016/1454707
Sara A. Mohamed,1 Ayman Al-Hendy,1 Jay Schulkin,2 and Michael L. Power2
1Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
2The American College of Obstetricians and Gynecologists, Washington, DC 20024, USA
225 US (primarily white) OB/GYN surveyed
45% returned the survey
(I suspect that survey is higher than reality - many non-returners probably did not think much of Vitamin D)
The survey seems to not even mention many important VitaminD-Pregnancy topics, such as:
- Loading dose - needed to raise levels in less than 3 months
- Cofactors - to balance the body when greatly increasing vitamin D levels
- Increased need for pregnant women who:
Are obese
Have dark skin
Have given birth recently (have not re-stocked vitamin D lost in previous birth)
Have frequent miscarriage
Have a disease which consumes vitamin D (such as MS)
Get minimal sunlight
Already have an autistic or allergic child
Have been depressed during/after previous pregnancies - Different form of vitamin D needed if poor gut, poor liver, poor kidney,etc.
See also Vitamin D Life
- Improved births with 2,000 IU vitamin D during pregnancy in India - RCT Feb 2015
- Needed more than 1600 IU of vitamin D during pregnancy – RCT May 2013
- Near the end of pregnancy 50,000 IU vitamin D weekly was great – RCT April 2013
- 78 percent of pregnant immigrants in Sweden had less than 10 ng low vitamin D – Nov 2013
- Pregnant women vitamin D insuficiency Black 97 Hispanic 81 White 67 percent – July 2010
- Pregnancy – adding 35,000 IU Vitamin D weekly was nice, but not enough – RCT April 2016
that is, 5,000 IU daily average was not enough - Doctors not consistent on prescribing Vitamin D (Pakistan in this case) July 2018
- 5,000 IU Vitamin D was not enough to reduce preeclampsia but did help future infant – RCT April 2014
- Is 50 ng of vitamin D too high, just right, or not enough
Healthy pregnancies need lots of vitamin D has the following summary
Problem | Reduces | Evidence |
| 0. Chance of not conceiving | 3.4 times | Observe |
| 1. Miscarriage | 2.5 times | Observe |
| 2. Pre-eclampsia | 3.6 times | RCT |
| 3. Gestational Diabetes | 3 times | RCT |
| 4. Good 2nd trimester sleep quality | 3.5 times | Observe |
| 5. Premature birth | 2 times | RCT |
| 6. C-section - unplanned | 1.6 times | Observe |
| Stillbirth - OMEGA-3 | 4 times | RCT - Omega-3 |
| 7. Depression AFTER pregnancy | 1.4 times | RCT |
| 8. Small for Gestational Age | 1.6 times | meta-analysis |
| 9. Infant height, weight, head size within normal limits | RCT | |
| 10. Childhood Wheezing | 1.3 times | RCT |
| 11. Additional child is Autistic | 4 times | Intervention |
| 12.Young adult Multiple Sclerosis | 1.9 times | Observe |
| 13. Preeclampsia in young adult | 3.5 times | RCT |
| 14. Good motor skills @ age 3 | 1.4 times | Observe |
| 15. Childhood Mite allergy | 5 times | RCT |
| 16. Childhood Respiratory Tract visits | 2.5 times | RCT |
RCT = Randomized Controlled Trial
68% vitamin D insufficiency was a problem in their patient population
66% most of their pregnant patients would benefit from vitamin D
53% would recommend vitamin D to some patients
17% would recommend vitamin D to ALL patients
26% routinely screen their pregnant patients for vitamin D status.
In my patient population Vitamin D insufficiency
| IS NOT a problem (n = 29) | IS a problem (n = 66) | |
| Vitamin D supplementation during pregnancy is safe | 69.0% agree | 93.9% agree |
| All pregnant women should be screened for vitamin D status | 6.9% agree | 30.3% agree |
| Vitamin D supplementation during pregnancy usually is not necessary | 31.0% disagree | 66.7% disagree |
| I am generally not concerned about vitamin D deficiency in my pregnant patients | 20.7% disagree | 65.2% disagree |
| Pregnant women taking prenatal vitamins are at low risk for vitamin D deficiency | 48.3% disagree | 75.4% disagree |
| Most of my pregnant patients will get enough vitamin D through sun exposure and diet | 51.7% disagree | 75.8% disagree |
Clipped from PDF
- “The respondents seemed generally knowledgeable regarding conditions that increase the risk of vitamin D insufficiency, such as malabsorption syndrome, gastric bypass surgery, alcohol abuse, African American race, and obesity. “
- “The responding physicians were generally not supportive of screening all pregnant women for vitamin D status; even among physicians that expressed a concern regarding their patient population, less than half would screen most pregnant patients”
- “Almost all respondents recommend that pregnant patients be prescribed or counseled to take prenatal vitamins (92.1% always and 3.0% often). “
- “There was a lack of consensus of opinion among respondents regarding whether pregnant women taking prenatal vitamins are at low risk of vitamin D deficiency, with equal proportions agreeing and disagreeing and the modal response being neutral.”
- “ Most respondents were either neutral (23.8%) or disagreed (41.6%) with the following statement: Most of my pregnant patients will get enough vitamin D through sun exposure and diet”
- . . “recommend additional vitamin D supplementation to their pregnant patients
16.8 always
11.9% often
23.8% sometimes”
Supplementation dose if no sign of vitamin D insufficiency:
1,000 IU/day (41.6%),
400 IU/day (22.8%)
600 IU/day (20.8%)
1,200 IU/day (5.0%)
2,000 IU/day (3.0%)
4,000 IU/day (2.0%)
% of responses for Vitamin D level to be achieved
20 ng 46.5%
30 ng 40.6%
50 ng 5.9%
However, Greens absolutely DO NOT have Vitamin D