Vitamin D: is it really deficient? Is calcium supplement necessary?
Jim Thornton
Nottingham
Two issues
Women with Vitamin D deficiency due to lack of sunlight
To prevent rickets
Routine Vitamin D and/or calcium
supplementation
Prevalence of low vitamin D in pregnant women
Palacios 2014
Rickets
Easily prevented.
20 minutes sun/week
Or 400 IU Vit D daily
Higher level supplementation
Vitamin D v placebo
Vitamin D plus calcium v placebo
High dose calcium v placebo
Vitamin D deficiency & pre- eclampsia
Observational studies
Tabesh et al 2013
Vitamin D v placebo
Randomised trials Effect on pre-eclampsia
Vitamin D defıcıency &
preterm birth
Observational studies
Vitamin D v placebo
On preterm birth (<37 weeks)
On low birthweight
Vitamin D + calcium v placebo
On pre-eclampsia
Vitamin D + calcium v placebo
On pre-term birth (<37 weeks)
Randomised trials of calcium
supplementation
High dose calcium
More than 1g/day
Trials in women
On “adequate” calcium diet
On low calcium diet
High dose calcium on
hypertension +- proteinuria
High dose calcium on pre-term
birth
Calcium trials risk of bias
Hypertension Pre-term birth
NICE UK Guidelines for pregnant women
Vitamin D.
10 micrograms (400 IU) daily
Calcium
Unless on a vegan diet (no dairy)
Not recommended routinely unless documented deficiency
WHO guidelines
WHO Vitamin D guideline
Not recommended to prevent pre-
eclampsia (strong recommendation).
Not recommended for improving maternal and infant health outcomes, (conditional recommendation).
In documented deficiency, give 5 μg (200 IU)per day
Alone or as part of a multiple micronutrient supplement, to improve maternal serum
vitamin D concentrations.
WHO calcium guideline
Recommendation
“In populations where calcium intake is low, calcium supplementation as part of
the antenatal care is recommended for the prevention of preeclampsia in pregnant
women, particularly among those at higher risk of developing hypertension (strong
recommendation)”
WHO calcium guideline
Summary for Turkey
Calcium
For most women easy to include in diet (milk etc.)
If on low calcium diet. 1.5 to 2 g per day in divided doses.
Vitamin D
5 micrograms (200IU) per day
