Posted Sept 20, 2010
The American Journal of Obstetrics and Gynecology published an article in the May 2010 edition that is noteworthy of discussion. Although vitamin D has been around since time immemorial, recent studies have suggested that the American intake is insufficient. Although the Recommended Dietary Allowances (RDA) originally suggested a daily intake of 200 International Units (IU) until age 50 and 400 IU thereafter, these recommendations might change in the near future.
Vitamin D is fat soluble and is important in the metabolism of calcium. For pregnant women calcium is extremely important because it supports the developing fetal skeleton. Sun exposure, skin pigmentation, diet and obesity can affect the amount of vitamin D that one receives. In the United States, vitamin D deficiency is estimated to occur in 5-50% of pregnant women. Why is this important? Because vitamin D deficiency has been associated with an increased risk of pre-eclampsia, bone loss, poor weight gain, gestational diabetes and small babies. African American women also have a higher incidence of vitamin D deficiency because of their increased pigment. Breast-fed babies from vitamin D deficient mothers may occasionally exhibit life-threatening conditions such as seizures and enlarged hearts (aka dilated cardiomyopathy). In the third trimester, the demand for calcium increases for the fetus because of the mineralization of its skeleton.
In November of 2008, the American Academy of Pediatrics recommends that exclusively breast-fed infants receive vitamin supplements that include 400 IU of vitamin D daily from birth until adolescence. Although pregnant women can receive vitamin D through fortified cereals and prenatal vitamins, the 400 IU standard dose might not be enough. At present, prenatal care does not include monitoring vitamin D levels which is unfortunate because a deficiency detected could be easily treated.
Further studies are needed to determine exactly how much vitamin D is really necessary for pregnant women to consume and there are also medical studies that suggest women who desire children begin taking vitamin D a few months before becoming pregnant in order to have sufficient levels in the first trimester. Perhaps it’s time for pregnant women to bring up the discussion of vitamin D supplementation and monitoring during their prenatal visits.
A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Linda Burke-Galloway, MD, MS, FACOG is a board-certified ob-gyn physician who is a champion of patient safety and is on a mission to keep pregnant women from falling through the cracks of our imperfect healthcare system. For over twenty years she has provided clinical services to high-risk pregnant women in medically underserved communities. She served our country through the National Health Service Corp, is a medical malpractice consultant for the U.S. Human Health Services and the federal government has also sought her expertise in reducing obstetrical malpractice cases in high-risk communities. Dr. Burke-Galloway has worked for the State of Florida Department of Health for over thirteen years in direct patient care. She is the author of The Smart Mothers Guide to a Better Pregnancy and is the Pregnancy Expert for LifeScript.com. She is a graduate of City College of the City University of New York, Columbia University School of Social Work and Boston University School of Medicine. She lives with her husband in Central Florida and is the proud mother of two sons. Dr. Galloway is the author of The Smart Mother’s Guide to a Better Pregnancy (Red Flags Pub/ 2008). You’ll find Dr. Galloway online at www.smartmothersguide.com
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