Vitamin D and pregnancy - An old problem revisited - Aug 2010

Best Practice & Research Clinical Endocrinology & Metabolism

Volume 24, Issue 4, August 2010, Pages 527-539

Clinical Problems in Diabetic Pregnancy

doi:10.1016/j.beem.2010.05.010 ; Copyright © 2010 Published by Elsevier Ltd.

Helen Barrett BSc, MBBSa, Dr. and Aidan McElduff MBBS, PhD, FRACPb, c, Corresponding Author Contact Information, E-mail The Corresponding Author, Associate Professor

a Obstetric Medicine Fellow, Royal Brisbane and Womens’ Hospital, Brisbane, Australia

b Clinical Associate Professor, Discipline of Medicine, University of Sydney, Sydney, Australia

c Endocrinologist, the Northern Sydney Endocrine Centre, Sydney, Australia

Vitamin D has historically been considered to play a role solely in bone and calcium metabolism. Human disease associations and basic physiological studies suggest that vitamin D deficiency is plausibly implicated in adverse health outcomes including mortality, malignancy, cardiovascular disease, immune functioning and glucose metabolism.

There is considerable evidence that low maternal levels of 25 hydroxyvitamin D are associated with adverse outcomes for both mother and fetus in pregnancy as well as the neonate and child. Vitamin D deficiency during pregnancy has been linked with a number of maternal problems including infertility, preeclampsia, gestational diabetes and an increased rate of caesarean section .

Likewise, for the child, there is an association with small size, impaired growth and skeletal problems in infancy, neonatal hypocalcaemia and seizures, and an increased risk of HIV transmission . Other childhood disease associations include type 1 diabetes and effects on immune tolerance .

The optimal concentration of 25 hydroxyvitamin D is unknown and compounded by difficulties in defining the normal range. Whilst there is suggestive physiological evidence to support a causal role for many of the associations, whether vitamin D deficiency is a marker of poor health or the underlying aetiological problem is unclear. Randomised controlled trials of vitamin D supplementation with an appropriate assessment of a variety of health outcomes are required.

Article Outline

Introduction

Vitamin D: physiology

– Actions of vitamin D: classical

– Actions of vitamin D: non-classical

– – Associations with mortality

– - Associations with cancer

– - Associations with diabetes

– Other non-classical effects of vitamin D

– – Skeletal muscle and skin

Physiology of vitamin d during pregnancy and lactation

– Lactation

Impact of vitamin D deficiency on maternal and infant health

– Effect of vitamin D on the fetus and neonate

– – Infant size

– – Infant bone

– – Neonatal morbidity

– Associations with maternal problems in pregnancy

– – Gestational diabetes

– – Preeclampsia

– – Infertility treatment

Measurement of vitamin D

What is the normal range for vitamin D?

How much vitamin D supplement is required to achieve the desired normal range?

Summary/conclusions

PDF is attached at bottom of this page