Dr Hana Fakhoury Hajeer

Vitamin D deficiency among pregnant women in the Middle East

Objectives

• Overview of published studies on vitamin D deficiency in pregnant women from the middle east and its impact on maternal and neonatal health

• Studies from Turkey, Iran, Saudi Arabia, Jordan and Lebanon

Conclusion

• Vitamin D deficiency was common among pregnant Saudi women

• Sunlight exposure needs to be increased for these women by encouraging them to involve in more outdoor activity during the daytime.

• Vitamin D fortification of dairy products should be increased

• Dietary supplements of vitamin D should be considered for pregnant women

• Effective education programs targeting pregnant Saudi women are needed.

Conclusion

• Despite the sunny environment, vitamin D deficiency is highly prevalent among Turkish mothers and neonates because of life style and nutritional status of mothers

• More efficient vitamin D prophylaxis programs should be implemented for pregnant women and infants

3,731 newborns

Heel stick blood samples

for 25(OH) D within 96 hours of birth

Conclusion

• The prevalence of severely low vitamin D levels in newborn infants in Jordan, is substantial, even in newborns born during the spring and summer months.

• Vitamin D supplementation for pregnant women and babies is needed

PEDIATRICS Volume 130, Number 4, October 2012

• infants supplemented daily with 400 IU of vitamin D within 15 days after birth

Conclusion

• Despite daily supplementation with 400 IU of vitamin D, the rate of vitamin D deficiency was high in 4-month-old exclusively breastfed infants living in Izmir, Turkey, especially on winter days.

• Further studies are needed to clarify optimal amount of vitamin D supplementation to the infants, especially in winter days.

Conclusion

• Low level of cord-blood vitamin D was found to be associated with an increased risk of EONS.

• If this association is causal, measures to increase vitamin D status during pregnancy could reduce the burden of early-onset sepsis in neonates.

Remarks

• Vitamin D deficiency has a statistically significant relationship with pre-eclampsia.

• Serum vitamin D levels are low in Iranian women because of their particular lifestyle

• They may need more than 400 IU day vitamin D supplement during pregnancy.

• Compared dietary vitamin D and calcium intake among subfertile women versus pregnant women

• Observational case-control study of 181 (83 previously diagnosed subfertile cases and 98 pregnant controls) women of reproductive age.

RESULTS:• Prevalence of vitamin D deficiency was significantly higher in subfertile group than

controls (59.0% versus 40.4%; p < 0.01). • Calcium supplements intake was significantly higher in controls than subfertile

group (64.6% versus 10.0%; p value < 0.001). • Total dietary vitamin D intake (> 400 IU/day) was significantly higher in the controls

than subfertile group.

CONCLUSION:• Vitamin D deficiency is prevalent among subfertile women. Optimization of serum

calcium and vitamin D levels is encouraged.

• Analysed the relation between serum vitamin D level and various serum metabolic markers among Saudi women (n = 515) in their first trimester of pregnancy (11.2 ± 3.4 weeks)

• Vitamin D status was sufficient in only 3.5 % of the study participants

Conclusion

• Women in first trimester of pregnancy had high prevalence of vitamin D deficiency

• Serum vitamin D correlated positively with serum levels of triglycerides, cholesterol and corrected calcium.

• This abnormal association may represent adaptation to high metabolic demands of pregnancy

Serum 25(OH)D concentrations were measured at 11-14

weeks’ gestation in 229 pregnancies

• The median serum 25(OH)D concentration was 10.8 ng/mL

• 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL.

Conclusion

• High prevalence of severe vitamin D deficiency in first-trimester among pregnant women can be related with dress code and season.

• Low 25(OH)D levels may not be associated with increased risk of adverse pregnancy outcomes.

Control group received calcium plus multivitamin (containing vitamin D3 400 U) dailyIntervention group received same plus vitamin D3 (50,000 U) each week for 8 weeks. At delivery, maternal and cord blood 25(OH)D levels, maternal weight gain, neonatal length, neonatal weight and neonatal head circumference were compared between two groups

• Treatment of vitamin D deficiency or insufficiency improves fetal growth indices (length, weight and head circumference)

• high-dose regimen (HDR; single oral bolus 30,000 IU vitamin D3, n = 34) • standard-dose regimen (SDR; 400 IU/day vitamin D3 within two weeks of life, n = 48)

Conclusion

• For infants born to vitamin D-deficient mothers, oral supplementation of 30,000 IU vitamin D3 during the first month of life, followed by a routine recommended dose of 400 IU/day, should be considered.

• The four-month lag for attaining vitamin D sufficiency in 90% of infants in the SDR group may have clinical implications and should be further investigated.

• Sixty women with GDM and their newborns

• 1000 mg Ca/d plus 50 000 IU of vitamin D3 one at study baseline and another at day 21 of the intervention

Conclusion

• Ca plus vitamin D supplementation for 6 weeks among pregnant women with GDM led to decreased caesarean section rate and maternal hospitalization

• Also decreased macrosomia, hyperbilirubinaemia and hospitalization in newborns compared with placebo

• No significant effect on pre-eclampsia, newborns’ birth size, and apgar scores.

Hypothesis :vitamin D dose of 3000 IU/day is required to reach a desirable maternal 25-hydroxyvitamin D level, and topositively impact infant bone mineral content.

Effect of vitamin D supplementation on 25(OH)D level in pregnant women

Conclusion

• In children, adolescents and pregnant women from the MENA, an intermediate vitamin D dose of 1000–2000 IU daily may be necessary to allow for the majority of the population to reach the desirable 25(OH)D level of 20 ng/ml

• Data on skeletal and extra-skeletal outcomes and on the long term safety of high vitamin D doses in our region are scarce.

• Further high quality RCTs are required to confirm/refute the beneficial impact of vitamin D supplementation on various outcomes.

Summary• Vitamin D deficiency is widely prevalent in pregnant middle

eastern women and their newborns• Life style (dress, lack of outdoor activity) is a major

contributor• D deficiency is associated with pre-eclampsia, and adverse

nenonatal outcome such as sepsis• Supplementation of newborns with 400 IU D may not be

enough• Mother supplementation with 600 IU may not be enough

for middle eastern women• Correcting deficiency in pregnant women can improve

birth outcome (fetal indices)• RCT from the middle east are needed