Vitamin D Supplementation In Pregnancy Guideline

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Vitamin D Supplementation in PregnancyDocument InformationDocument Type:GuidelineValid From:28/04/2016Date of Review:28/04/2019Appraisal Score:DomainScore (%)192286388492Ratification Date& Body:28/04/2016,Women’s Clinical Governance CommitteeDocumentAuthor(s):Obstetric Physician592DevelopmentGroup Member(s):Obstetric Physician TeamClinical Lead:Obstetric PhysicianAssociated OUHDocuments:N/ADocumentReplaces:Vitamin D Supplementation in Pregnancy, V1.1, 04/05/2017Equality ImpactAssessment:04/01/2016Overall89%Vitamin D Supplementation in Pregnancy Guideline 1. Approved by APCO September 2017. ReviewSeptember 2019– Page 1 of 14Author: Lucy Mackillop, Obstetric Physician, OUH Maternity Department

ContentsDocument Information . 1Key Recommendations . 3Background . 3Aims . 3Scope . 4Definitions . 4Executive Summary . 5Key aims of Vitamin D supplementation . 5Full Guideline . 6The importance of screening for Vitamin D sufficiency . 6The ‘at risk’ population (NEW) . 6When to test Vitamin D levels (NEW) . 6Additional laboratory investigations.7Key aims of Vitamin D supplementation . 7Supplementing Vitamin D based on levels of sufficiency .7Definition of Vitamin D Sufficiency (NEW) .8Safety of Vitamin D . 8Safety of Vitamin D in pregnancy .8Safety of Vitamin D in the general population (risk of toxicity) .8Monitoring . 9Dosing – intensity and timing .9Special circumstances for Vitamin D supplementation .9Vitamin D replacement algorithm in pregnant and breastfeeding women (NEW). 10Post-natal follow up . 10Appendix 1 – The need for more intensive Vitamin D supplementation in pregnancy . 12Appendix 2 – Monitoring and Compliance . 13References . 13Vitamin D Supplementation in Pregnancy Guideline 1. Approved by APCO September 2017. ReviewSeptember 2019– Page 2 of 14Author: Lucy Mackillop, Obstetric Physician, OUH Maternity Department

Key Recommendations Vitamin D supplementation should be discussed with all pregnant andbreastfeeding womenAll pregnant/breastfeeding women should receive at least 400 units/daycholecalciferol from OTC preparations or “Healthy Start” if eligible.Women should be assessed for their risk of vitamin D deficiency at theirbooking appointment.‘At risk’ groups for vitamin D deficiency or insufficiency should be started on1000 units cholecalciferol daily (Figure 1)Women at moderate or high risk of vitamin D deficiency should be testedwith their booking blood tests.All pregnant women with Vitamin D deficiency should have their Vitamin Dreplaced according to the level of insufficiency to ensure it is adequatelyreplaced by the third trimester.All babies should have 400 units per day unless fully formula fed.BackgroundThere has been increasing awareness of the benefits of vitamin D supplementationduring pregnancy and studies demonstrating current levels of deficiency in the UKpopulation. The National Diet and Nutrition Survey have demonstrated that a quarter ofthe inhabitants in UK have low vitamin D levels. In 2012, the UK Health Departmentidentified at risk groups for vitamin D deficiency, this included pregnant andbreastfeeding women, especially teenagers and young women (Vitamin D – adviceon supplements for at risk groups – letter from UK Chief Medical OfficersDepartment of stics/Lettersandcirculars/Dearcolleagueletters/DH 132509).In June 2014, the RCOG Scientific Impact Paper No. 43 discusses the benefits ofVitamin D in pregnancy. The NICE public health guidance 56 (Nov 2014) aims toidentify and prevent vitamin D deficiency in at risk populations, which includepregnant and breastfeeding women.Aims To inform clinicians and other practitioners caring for pregnant women aboutthe need for Vitamin D in pregnancy and breastfeedingTo recognise the ‘at risk’ population in need of Vitamin D supplementationTo guide the optimal management for Vitamin D supplementation inpregnant and breastfeeding womenTo enable all pregnant and breastfeeding women to have optimalsupplementation of Vitamin D by the third trimesterVitamin D Supplementation in Pregnancy Guideline 1. Approved by APCO September 2017. ReviewSeptember 2019– Page 3 of 14Author: Lucy Mackillop, Obstetric Physician, OUH Maternity Department

Scope To incorporate these latest recommendations from NICE and RCOG toimprove the care of pregnant and breastfeeding women within the OxfordUniversity Hospitals NHS Foundation Trust, by raising the awareness ofHealth Care Professionals within the Maternity Services.DefinitionsTermDefinitionCKDChronic kidney diseaseTBTuberculosisMMRAMaternal Medicine Risk AssessmentOTCOver the counterPETPre-eclampsiaVitamin D Supplementation in Pregnancy Guideline 1. Approved by APCO September 2017. ReviewSeptember 2019– Page 4 of 14Author: Lucy Mackillop, Obstetric Physician, OUH Maternity Department

Executive SummaryAround 20% of adults in the United Kingdom have low Vitamin D levels because of the lack of ambientsunlight and other extenuating risk factors. Rickets has now re-emerged, within the UK. ‘At risk’populations are likely to have low Vitamin D levels, so their infants are also likely to be born with lowvitamin D stores that are further depleted by the lack of vitamin D in maternal breastmilk. Thesechildren are at high risk of childhood rickets.Key aims of Vitamin D supplementationT

vitamin D stores that are further depleted by the lack of vitamin D in maternal breastmilk. These children are at high risk of childhood rickets. Key aims of Vitamin D supplementation To ensure: 1. Maternal Vitamin D levels are replete to avoid neonatal rickets. 2. Vitamin D deficiency is reversed in a timely manner. 3.

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