US OB-GYN Vitamin D survey – lack consensus, lots to learn

Created August 2016

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 VitaminDWiki * 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 {include}

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%

image

However, Greens absolutely DO NOT have Vitamin D

📄 Download the PDF from VitaminDWiki

Tags: Pregnancy