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

VitaminDWiki Summary

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

Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesEvidence
0. Chance of not conceiving3.4 times Observe
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT
3. Gestational Diabetes 3 times RCT
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT
6. C-section - unplanned 1.6 timesObserve
     Stillbirth - OMEGA-3 4 timesRCT - Omega-3
7. Depression AFTER pregnancy 1.4 times RCT
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
RCT
10. Childhood Wheezing 1.3 times RCT
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT
16. Childhood Respiratory Tract visits 2.5 times RCT

RCT = Randomized Controlled Trial

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 patients20.7% 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 diet51.7% 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

Attached files

ID Name Comment Uploaded Size Downloads
7161 OBGYN T3.jpg admin 10 Oct, 2016 15:49 92.91 Kb 123
7016 OB-GYN T2.jpg admin 25 Aug, 2016 20:07 35.83 Kb 401
7015 Obstetrician-Gynecologists.pdf PDF 2016 admin 25 Aug, 2016 20:06 1.21 Mb 181
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