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LETTER TO THE EDITOR |
Obstetrics and Gynaecology
Queen's Park Hospital
Blackburn
United Kingdom
Paediatrics
Royal Manchester Children's Hospital
Manchester
United Kingdom
E-mail: reemaraman{at}doctors.org.uk
Dear Sir:
We read with interest the article by van der Meer et al (1) on Vitamin D deficiency in pregnant non-Western women in the Netherlands. We would like to share the British experience and will mainly discuss 2 aspects of the issue. First, we will address evidence of vitamin D deficiency in pregnant Asian women in the United Kingdom and the benefit of routine antenatal supplementation. Second, we will discuss the confusion that has arisen from conflicting recommendations from the Department of Health and National Institute of Clinical Excellence on antenatal vitamin D supplementation.
There has long been evidence of vitamin D deficiency in pregnant Asian women and their newborns in the United Kingdom (2, 3), as assessed by maternal and neonatal serum 25-hydroxycholecalciferol concentrations. Several studies have shown the benefit of vitamin D supplementation in pregnant women in the United Kingdom, including a double-blind randomized controlled trial that showed increases in maternal serum 25-hydroxycholecalciferol concentrations after vitamin D supplementation (4–6). Maternal nutritional status also benefited as assessed by maternal weight gain and concentrations of retinol-binding protein and thyroid binding prealbumin (4). Cord blood 25-hydroxycholecalciferol concentrations also improved (6, 7). After birth, there was a significantly lower incidence of asymptomatic and symptomatic hypocalcaemia in the supplemented group and evidence of significant improvements in weight and length of the infant up to 1 y of age (4).
Considering the abovementioned evidence, it seems logical that pregnant British Asian women should routinely be supplemented with vitamin D. Indeed, the Department of Health (DOH) recommendations, based on Committee on Medical Aspects of Food Policy (COMA), are that all pregnant and breastfeeding women should receive 10 µg (400 IU) vitamin D/d (8). However, the National Institute of Clinical Excellence (NICE) (9) recommends, based on a Cochrane review (10), that there is insufficient evidence to evaluate the effectiveness of vitamin D in pregnancy, and, in the absence of evidence of benefit, vitamin D supplementation should not be offered routinely to pregnant women. The same Cochrane review, however, recommends that vitamin D supplementation in the later part of pregnancy should be considered in vulnerable groups, such as Asian women living in Northern Europe, and possibly in those living in geographic areas with long winters (eg, the United Kingdom and the Netherlands). The contradictory statements from the DOH and NICE have led to confusion in antenatal clinics in hospitals and in general practice. In a recent survey of general practices in the Thames Valley area and Lambeth (where 67.9% of practices had Asian or African Caribbean populations constituting >8% of the total population), none were supplementing pregnant women with vitamin D (11).
On the basis of the abovementioned evidence, we believe that, at a minimum, the DOH recommendations should be followed, and all pregnant and breastfeeding women should receive 10 µg (400 IU) vitamin D/d. We also echo the concerns raised by others concerning the recommendations of NICE (12, 13) and call for clarity.
ACKNOWLEDGMENTS
The authors had no conflict of interest to declare.
REFERENCES
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