WHO recommends zero vitamin D during pregnancy, rest of the world disagrees – 2018, 2020

Created December 2018

Compare IOM and WHO
Organization most adults Elderly Pregnant
IOM RDA 600 IU 800 IU 600 IU
WHO RNI 200 IU 600 IU 0 IU

Chart adapted from Vitamin D Recommendations around the world - IU and ng

image

WHO: Vitamin D supplementation during pregnancy

WHO: Vitamin D supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes

WHO allows 200 IU to be given only if the pregnant women has a proven Vitamin D deifciency

Example of problems with their references - ignored 1) Dose size 2) When it was given during pregnancy 3) How often the dose was given (daily, weekly, monthly, or a single time) 4) If Calcium was also given * Overview Pregnancy and vitamin D * Preterm birth interventions – 4 studies found possible vitamin D benefit – Cochrane – Nov 2018 W.H.O.. seems to have missed this * A paltry 400 IU Vitamin D recommended during pregnancy - NICE UK Dec 2018 * Before W.H.O. of zero IU I thought UK of 400 IU was tiny * Vitamin D is at least 100 X better than Folic Acid which WHO recommends * 4,000 IU of Vitamin D is OK - 19 organizations agree - 2018 - Rest of world = 4,000 IU,WHO = 0 IU * Healthy pregnancies need lots of vitamin D had the following summary as of Dec 2018 | | | | | --- | --- | --- | | ::Problem:: | Reduces | Evidence | | 0. Chance of not conceiving | **3.4 times| Observe | | 1. Miscarriage | 2.5 times| Observe | | 2. Pre-eclampsia | 3.6 times| Randomized Controlled Trial | | 3. Gestational Diabetes | 3 times| Randomized Controlled Trial | | 4. Good 2nd trimester sleep quality | 3.5 times| Observe | | 5. Premature birth | 2 times| Randomized Controlled Trial | | 6. C-section - unplanned | 1.6 times * | Observe | |        Stillbirth - OMEGA-3 | **4 times| RCT - Omega-3 | | 7. Depression AFTER pregnancy | 1.4 times | Randomized Controlled Trial | | 8. Small for Gestational Age | 1.6 times * | meta-analysis | | 9. Infant height, weight, head size
        within normal limits | | Randomized Controlled Trial | | 10. Childhood Wheezing | **1.3 times| Randomized Controlled Trial | | 11. Additional child is Autistic | 4 times| Intervention | | 12.Young adult Multiple Sclerosis | 1.9 times| Observe | | 13. Preeclampsia in young adult | 3.5 times| Randomized Controlled Trial | | 14. Good motor skills @ age 3 | 1.4 times| Observe | | 15. Childhood Mite allergy | 5 times| Randomized Controlled Trial | | 16. Childhood Respiratory Tract visits | 2.5 times * | Randomized Controlled Trial | --- The articles in Pregnancy AND Intervention are here: {category} --- The articles in Pregnancy AND Meta-analysis are here: {category} --- 1. WHO recommendation of 200 IU during pregnancy was reduced to 0 IU (by 2018) image

📄 Download the PDF from VitaminDWiki

Remarks

  • This recommendation supersedes the previous WHO recommendation found in the 2012 Guideline: vitamin D supplementation in pregnant women (1).

  • Pregnant women should be advised that sunlight is the most important source of vitamin D. The amount of time needed in the sun is not known and depends on many variables, such as the amount of skin exposed, the time of day, latitude and season, skin pigmentation (darker skin pigments synthesize less vitamin D than lighter pigments) and sunscreen use (1).

  • Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet, and to refer to WHO guidance on healthy eating (2).

  • For pregnant women with documented vitamin D deficiency , vitamin D supplements may be given at the current recommended nutrient intake (RNI) of 200 IU (5 µg) per day.

  • According to the Cochrane review, there are 23 ongoing or unpublished studies on vitamin D supplementation in pregnancy (3). Evidence from these trials should help to clarify the current uncertainties regarding vitamin D effects, particularly the effect on preterm birth, and any other associated benefits or harms of vitamin D when combined with other vitamins and minerals, particularly calcium.

  • This is an extract from the relevant guideline (4). Additional guidance information can be found in these documents.

References

Vitamin D supplementation during pregnancy Dec 17, 2018

Evidence – go to above website to get more hyperlinks

Systematic reviews used to develop the guidelines

Vitamin D supplementation for women during pregnancy

De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JP.

Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD008873.

Summary of this review

Podcast (Cochrane)

Related systematic reviews

Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials

Pérez-López FR, Pasupuleti V, Mezones-Holguin E, Benites-Zapata VA, Thota P, Deshpande A, Hernandez AV.

Fertility and Sterility. 2015; 103(5):1278-88.e4. 📄 Download the PDF from VitaminDWiki

Comment by VitaminDWiki: This old study ignored
Dose size
When it was given during pregnancy
How often the dose was given (daily, weekly, monthly, or a single time)
If Calcium was also given

Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis

Thorne-Lyman A, Fawzi WW.Paediatric and Perinatal Epidemiology. 2012; 26(s1):75–90.

Clinical trials

Current and ongoing clinical trials relating to vitamin D supplementation during pregnancy

WHO 2020 update - similar

📄 Download the PDF from VitaminDWiki

My impression is that WHO considered only trials which used low doses of vitamin D and too late in pregnancy

    THEN

proceeded to ignore the dose size and took the weighted average of result of the trials

    where the weighting is were based on number of participants (not the dose size).

📄 Download the Cochrane PDF that they refer to from VitaminDWiki

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Tags: Pregnancy