Vitamin D Supplementation

Pregnancy, Lactation and Infant Nutrition

 Presentation Objectives
To reintroduce function, importance and
sources of vitamin D
To discuss controversy of vitamin D
supplementation, including daily
recommendations and upper limits
To identify people at risk for vitamin D
deficiency and to determine why they are at
risk
To present peer-reviewed and current
research articles discussing vitamin D
http://www.cog-med.com/cogblog/2016/3/16/digdeep supplementation during pregnancy,
lactation
What is Vitamin D?

Fat soluble vitamin/Hormone

Produced in the skin by sunlight
exposure
Converted to active form in kidney
Only available in small amounts
from food
Best from sun and supplements
 Food Sources
of Vitamin D

Food Serving Vitamin D (IU) Vitamin D (g)

Pink salmon, canned 3 ounces 465 11.6
Mackerel, canned 3 ounces 211 5.3
Sardines, canned 3 ounces 164 4.1
Quaker Nutrition for Women Instant Oatmeal 1 packet 154 3.9
Milk, low-fat, fortified with vitamin D 8 ounces 98 2.5
Orange juice, fortified with vitamin D 8 ounces 100 2.5
Cereal, fortified 1 serving (usually 1 cup) 40-50 1.0-1.3
Egg yolk 1 large 37 0.9
http://www.thehealthyhomeeconomist.com/vitamin-d-deficiency-signs-people-miss/
Why Do We Need Vitamin D?

http://www.vitamindday.net
 Vitamin D Deficiency Risk Groups
People with darker skin
People who spend a lot of time indoors
People who cover their skin most of the
time
People who wear sunscreen most of the
time
People who live far north
Older adults
Infants who are breastfed
Pregnant women

http://www.thehealthyhomeeconomist.com/vitamin-d-deficiency-signs-people-miss/
Breastfeeding and Vitamin D Deficiency

Human milk typically contains 25 IU

vitamin D/liter or less
2008 American Pediatric Association
report recommended 400 IU/d
supplementation for breastfed infants
Formula fed infants consuming at least
1000 mL formula receive adequate
vitamin D
One in five breastfed infants receive the
adequate dose of 400 IU
http://www.medscape.com/viewarticle/851758
 Pregnant women were supplemented with 400, 2000 or 4000 IU vitamin D3 per day from 12-16 weeks
gestation until delivery

Measured maternal/neonatal circulating 25 hydroxyvitamin D at delivery

Circulating active 25(OH)D was significantly higher one month before and at delivery in the 4000 IU group

Obtaining a circulating level of 80 nmol/L was met by 50% of 400 IU group, 71% of 2000 IU group and 83% of
4000 IU group

No significant difference between groups in safety measures and no adverse affects related to vitamin D
supplementation

Conclusion: Adequate vitamin D levels cannot be obtained with current IOM recommendations and should be
revised to 4000 IU/d for pregnant women
 Aimed to determine if Vitamin D supplementation of pregnant women alone or with other
vitamins/minerals would improve neonatal and maternal outcomes

Examined 15 trials that included 2833 pregnant women

Conclusions:

Vitamin D supplementation resulted in higher levels of circulating vitamin D

Vitamin D supplementation resulted in lower incidence of preeclampsia
Vitamin D supplementation resulted in lower incidence of gestational diabetes
Vitamin D supplementation resulted in lower frequency of low birth weight
Vitamin D supplementation resulted in lower frequency of pre term birth
No clear differences in cesarean births, neonatal deaths, or stillbirths
 216 mother infant pairs

Exclusively breastfeeding mothers received 6400 IU, 2400 IU, or 400 IU vitamin D3/day for 6
months

6400 IU/day safely and significantly increased maternal vitamin D

Infants whose only source of vitamin D was maternal did not differ from status of 400 IU
supplemented infants

Conclusion: High dose maternal vitamin D supplementation may offer an alternative to infant
supplementation
Applying this Research to Our Work at WIC
Continue to recommend all breast fed babies supplement with 400 IU vitamin D
Educate on vitamin D rich foods and that it is hard to get enough from foods
Educate on the lack of vitamin D available from sun exposure in Seattle
Educate on the importance of vitamin D not to just prevent rickets but to promote
growth and development of the infant

Know what to say if a client asks about maternal supplementation of vitamin D

Current research is investigating but IOM recommendations have not been changed
Recommend further discussion between the client and the doctor
References
1. Hollis B, Johnson D, Hulsey Et al. Vitamin D Supplementation During Pregnancy: A
Double-Blind, Randomized Clinical Trial of Safety and Effectiveness. JMBR. October
2011;26(10): 2343-2357.
2. De-Regil L, Palacios C, Lombardo LK Et al. Vitamin D Supplementation for Women
During Pregnancy. Cochrane Database of Systematic Review. 2016.
3. Hollis B, Wagner C, Howard C Et al. Maternal Versus Infant Supplementation During
Lactation: A Randomized Controlled Trial. Pediatrics 2015;136;625.