USE OF VITAMIN D IN PREGNANCY

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(Date of issue: March 2019, Version: 2)

This is a UKTIS monograph for use by health care professionals. For case-specific advice please contact UKTIS on 0344 892 0909. To report an exposure please download and complete a pregnancy reporting form. Please encourage all women to complete an online reporting form.

Summary

Vitamin D encompasses a large family of fat-soluble steroid preprohormones. Humans require vitamin D2 (ergocalciferol), present in some foods such as fungi, and vitamin D3 (colecalciferol), which is synthesised in the skin and present in oily fish/cod liver oil. In the UK vitamin D deficiency is defined as calcifediol (25(OH)D) <25nmol/l. 

Vitamin D deficiency in pregnancy may be associated with an increased risk of small for gestational age infants, preterm delivery, infantile rickets and maternal pre-eclampsia. 

Routine supplementation: Vitamin D supplements of 400IU (10µg)/day vitamin D (or equivalent) are currently recommended for all pregnant and breastfeeding women. There is no evidence from epidemiological studies that use of the above dose of vitamin D, or any of its analogues, is associated with an increased risk of congenital malformation, however data are limited. There are insufficient data to determine whether there are any associations between maternal vitamin D supplementation during pregnancy and the risk of miscarriage. Vitamin D supplementation is not associated with an increased risk of preterm delivery, small for gestational age, low birth weight, intrauterine or neonatal death.

Treatment of deficiency: There are insufficient data to provide recommendations regarding high dose vitamin D for established vitamin D deficiency in pregnancy. RCOG Scientific Impact Paper recommends the treatment of vitamin D-deficient pregnant women with either colecalciferol 20,000IU/week or ergocalciferol 10,000IU twice a week for 4–6 weeks. No adverse outcomes were identified in a small case series of pregnant women with hypoparathyroidism treated with vitamin D2 doses up to 6.25mg (250,000IU) per day. Whilst reassuring, due to the small study population size, these data are considered too limited to exclude the possibility of risk.

Treatment with very high doses of vitamin D may induce hypercalcaemic vitamin D toxicity, although this is usually associated with serum calcifediol levels in excess of 350nmol/l. Regular monitoring of plasma calcium concentration is advised for all pregnant patients receiving high doses of vitamin D.

Use of vitamin D or vitamin D analogues (present in dietary supplementation products) taken at the recommended dose do not require additional fetal monitoring. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments. Where exposure to larger doses has occurred, discussion with UKTIS is recommended.

This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to be sure you are using the most up-to-date version.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to health care professionals at www.toxbase.org.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from TOXBASE.org or UKTIS.org to ensure you are using the most up-to-date version.