Australia no longer testing every pregnant woman for vitamin D - Nov 2018

Updated clinical practice guidelines on pregnancy care

Caroline SE Homer, Jeremy Oats, Philippa Middleton, Jenny Ramson and Samantha Diplock
Med J Aust 2018; 209 (9): 409-412. doi: 10.5694/mja18.00286

• recommend routine testing for hepatitis C at the first antenatal visit;
• recommend against routine testing for vitamin D status in the absence of a specific indication;
• recommend discussing weight change, diet and physical activity with all pregnant women; and
• recommend offering pregnant women the opportunity to be weighed at every antenatal visit and encouraging women to self-monitor weight gain.

• " Routine testing of all pregnant women for vitamin D status and subsequent vitamin D supplementation is not supported by evidence and should cease as the benefits and harms of vitamin D supplementation remain unclear."

Vitamin D testing
Do not routinely recommend testing for vitamin D status to pregnant women in the absence of a specific indication (evidence-based recommendation).
If testing is performed, only recommend vitamin D supplementation for women with levels lower than 50 nmol/L (practice point).
Over the past decade there has been significant interest in vitamin D deficiency in the community and pregnancy is no exception. The 2011–12 Australian Health Survey showed 23% of Australian adults had low vitamin D levels, particularly for people living in the south-eastern states of Australia and in major cities and more often in winter.

However, there is limited evidence supporting testing of all women for vitamin D status in pregnancy and lack of clarity regarding the benefits and harms of supplementation in pregnancy. Despite this lack of clear evidence of benefit, there is anecdotal evidence that routine testing of pregnant women for vitamin D status and recommendation of vitamin D supplementation when levels are found to be low is common. It was the experience of members in the EWG that this practice has cost implications, as testing for vitamin D status is expensive and supplementation involves a further cost for women. The revised recommendation in the guidelines provides an opportunity to be more directive and specifically advises clinicians not to routinely recommend testing for vitamin D status to pregnant women in the absence of a specific indication.

 Download the PDF with Vitamin D reasoning from VitaminDWiki