ACOG Says More Data Needed on Vitamin D During Pregnancy

June 22, 2011 — More data are needed before physicians start routinely screening pregnant women for vitamin D deficiency, according to a statement from the American College of Obstetricians and Gynecologists (ACOG), published in the July issue of Obstetrics & Gynecology.

The group's Committee on Obstetric Practice reviews "emerging clinical and scientific advances." The committee opinion acknowledges evidence suggesting that vitamin D deficiency is common during pregnancy, especially among "high-risk groups," including vegetarians, women with limited exposure to the sun, and minorities with darker skin. Committee chair George A. Macones, MD, MSCE, obstetrics and gynecology chairman, Department of Obstetrics and Gynecology, Washington University, St. Louis, Missouri, issued the current statement noting that there is a push to screen all pregnant women for vitamin D deficiency.

However, he said in a press release, the committee found that there is no consensus on the optimal level of vitamin D during pregnancy. Therefore, the statement notes, there is not enough evidence to support screening.

"For pregnant women thought to be at increased risk of vitamin D deficiency, maternal serum 25-OH-D levels can be considered and should be interpreted in the context of the individual clinical circumstance. When vitamin D deficiency is identified during pregnancy, most experts agree that 1,000–2,000 international units per day of vitamin D is safe," the committee writes. "Higher dose regimens used for the treatment of vitamin D deficiency have not been studied in pregnant women."

Most people get vitamin D from fortified milk or juice, fish oils, and supplements. Exposure to sunlight also produces vitamin D, which promotes calcium absorption and normal bone growth. According to the ACOG statement, vitamin D deficiency in pregnant women has been linked to "disordered skeletal homeostasis, congenital rickets, and fractures in the newborn."

The committee concluded that there is not enough research to back the use of higher doses for treatment of vitamin D deficiency during pregnancy.

"Recommendations concerning routine Vitamin D supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials."

The increased use of vitamin D and calcium supplements led the Institute of Medicine to issue a report last year noting that the "public has heard conflicting messages about other benefits of these nutrients — especially vitamin D." The institute suggests that most adults, including pregnant and breastfeeding women, need 600 IU vitamin D per day, with a safe upper limit of 4000 IU, compared with ACOG's upper limit for pregnant women of 1000 to 2000 IU.

Obstet Gynecol. 2011;118:197-198. Abstract

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