Vitamin D in Pregnancy and Beyond: Important for pregnant women, breastfeeding, and children

I have 5 posts on this blog encouraging foods over the use of vitamin/mineral supplements. In fact, for last year's RD Blogfest post, I concluded with the following statement:

"Get your vitamins, minerals, and phytochemicals in their natural form from food, not pills, unless you can't (eg: health reason or food restrictions). If you think you might need to supplement your diet, ask a Registered Dietitian to help you."

However, Vitamin D proves the exception to this rule. There is overwhelming evidence in support of taking vitamin D supplements due to the fact that that food sources are sparse and absorption from sun is limited in the winter. Therefore, I am responding to this years RD blogfest question (with one slight modification):

"If you could only give one message (this winter), what would that be?"

Take Vitamin D supplements during pregnancy and give them to your children!

In September 2007, the National Institutes of Health held a conference entitled "Vitamin D and Health in the 21st Century" to address several key research questions. Recommendations have become more clear because of this conference, other research articles, and an updated American Academy of Pediatrics policy published last year.

Here is what we currently know about vitamin D and perinatal/pediatric health:

• If you live above the LA/Atlanta latitude you cannot absorb/convert enough Vitamin D from the sun between November and February. The same holds true if you always wear sunscreen of SPF 30+ in the summer.

• Your doctor can test your blood for 25(OH)D and make sure it is between the optimal level of 30-80 ng/ml.

• Low Vitamin D levels in women have been associated with breast cancer, other cancers, recurrent vaginal infections, fibromyalgia and other bone pain, heart disease, diabetes and insulin disorders, multiple sclerosis, and rheumatoid arthritis.

• Of specific interest to pregnant women, Vitamin D deficiency in childhood can cause a permanent deformed pelvis ("rachitic" pelvis due to rickets) making vaginal delivery later on in life difficult or impossible. Vitamin D deficiency in pregnancy may also be a factor in preeclampsia, a dangerous condition of high blood pressure in pregnancy that can lead to preterm labor and illness and death of mother and/or infant if left untreated. Low vitamin D levels in pregnant women may cause the fetus to be deficient leading to bone abnormalities, such as extra wide fontanelles in the skull.

• In infants and children, low Vitamin D levels can lead to Rickets, which is defined as growth retardation and bone abnormalities marked by: bone pain, muscle weakness, dental problems, easily broken bones, projections along the ribcage, bowed legs, knock-knees, cranial/spinal/pelvic deformations, poor growth, low calcium levels, uncontrolled muscle spasms, soft skull, deformed chest (wider at the bottom, narrow at the top), wide wrists. Some of the more obvious physical signs may be square heads, large foreheads, sunken or close-set eyes, bowed legs or the opposite, knock knees. Any child with any of these symptoms should have their Vitamin D levels tested to see if that may be the cause.

• The reason why supplements are preferred in the winter is because vitamin D is not normally found in high levels in food (fatty fish, eggs, mushrooms) and our ability to absorb it from the sun is limited during the winter months.

• During the summer months ask your dermatologist about exposing your arms and legs for 10-15 minutes 2-3 times/week and applying sunscreen afterward.

• During the winter months, supplement with vitamin D3 to keep your blood levels of 25(OH)D between 30-80 ng/ml. Please discuss this with your personal physician. Recent research studies indicate that infants and children would need 400-800 IU/day, while adults would need 1,000-2,000 IU/day and pregnant and nursing women may need up to 4,000IU/day. You should supplement during the winter even if you or your doctor does not want to do a blood test.

• Breastfed babies can either get vitamin D from their mothers (if their mothers supplement with 4,000 IU/day) or the infant can receive 400-800 IU/day from vitamin D drops. See my favorite brand below, it is the least allergenic. If your baby is drinking formula, infant formula is fortified with about 11 IU per ounce. Your baby might need additional supplementation depending on how much he eats.