Vitamin D during pregnancy – single 200,000 IU similar to daily 5,000 IU – April 2020

Daily versus stat vitamin D supplementation during pregnancy; A prospective cohort study

PLoS One. 2020 Apr 16;15(4):e0231590. doi: 10.1371/journal.pone.0231590. eCollection 2020.
Nida Bokharee 1, Yusra Habib Khan 2, Tayyiba Wasim 3, Tauqeer Hussain Mallhi 2, Nasser Hadal Alotaibi 2, Muhammad Shahid Iqbal 4, Kanwal Rehman 5, Abdulaziz Ibrahim Alzarea 2, Aisha Khokhar 1

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Background: Despite favorable climatic conditions, vitamin D deficiency (VDD) is widespread in Pakistan. Current study was aimed to evaluate the prevalence of VDD in Pakistani pregnant women and effectiveness of various regimen of Vitamin D supplementation.

Methodology: This hospital-based prospective cohort study included pregnant women at 12th to 24th weeks of gestation attending Gynae clinic from October 2018 to April 2019. Patients were classified into control and treatment groups (Groups: G1, G2 and G3) according to the dose of vitamin D supplementation. Patients received various regimens of vitamin D including 2000 IU/day (G1), 5000 IU/day (G2) and stat 200000 IU (G3). The levels of vitamin D were measured before and after supplementation. The effectiveness of dosages were compared between and within the groups. Moreover, factors associated with vitamin D sufficiency and insufficiency were ascertained using appropriate statistical methods.

Results: Among 281 pregnant women (mean age: 28.22 ± 4.61 years), VDD was prevalent in 47.3% cases. Vitamin D supplementation caused significant rise in the levels 25(OH)D in treatment groups, while there was no significant difference in control group. The highest mean increment in vitamin D (23.14 ± 11.18 ng/ml) was observed with dose 5000 IU/day followed by doses 200000 IU stat (21.06 ± 13.73 ng/ml) and 2000 IU/day (10.24 ± 5.65 ng/ml). Vitamin D toxicity was observed in one patient who received 200000 IU stat of vitamin D. The frequency of VDD following the supplementation was 5.7%. Education status, duration of sun exposure and use of sunblock was substantially associated with vitamin D sufficiency in the current study.

Conclusion: Our findings underscore the high proportion of VDD among pregnant women in Pakistan. Maternal vitamin D supplementation substantially improved the levels of 25(OH)D. Of three used regimens, the dose of 5000 IU/day is considered safe and equally effective as of 200000 IU stat. Since pregnancy is a time of tremendous growth and physiological changes for mother and her developing fetus with lifelong implications for the child, gestational vitamin D supplementation should be considered to ensure the optimal vitamin D accrual in pregnant women. This study generates the hypothesis that vitamin D supplementation at a dose of 5000 IU/day during pregnancy is superior to the other regimens. However, well-controlled randomized trials are needed to confirm these findings.

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PDF shows that one woman had >100 ng of vitamin D at 2 months, but had no medical problems

• “Only one patient attained serum 25(OH)D > 100 ng/ml. However, serum biochemical indices were within the normal range and USG showed no stones in the kidneys. Levene’s test and normality checks were carried out and assumptions met.”
• If they had also measured the vitamin D levels at say 1 month. they most likely would have found >10% with >100 ng of Vitamin D - which is not a problem

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