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Benefits of vitamin D supplement during pregnancy

Research shows that vitamin D supplementation during pregnancy can reduce the risk of small-gestational age or low-birth-weight babies. Even so, the results of this study have not been adopted as guidelines, both nationally and internationally, for routine supplementation of vitamin D in pregnant women.

Vitamin D has long been known as a fat soluble vitamin that functions for muscle and bone growth but vitamin D is known to play an important role during pregnancy especially for fetal growth. Neonates are very dependent on maternal vitamin D status. However, vitamin D deficiency is still common and is still a global health problem. About 60% of pregnant women and 15-65% of neonates experience vitamin D deficiency. Vitamin D deficiency during pregnancy can increase maternal and fetal morbidity and mortality. Vitamin D deficiency in pregnant women can lead to gestational diabetes, preeclampsia, and bacterial vaginosis. Vitamin D deficiency during pregnancy can result in intrauterine growth restriction, such as a small gestational age or low birth weight, which ultimately increases the risk of neonatal morbidity and mortality. Several studies have suggested a link between vitamin D deficiency in pregnant women with reduced skeletal, cardiovascular, respiratory and neurocognitive function of infants. Giving vitamin D supplementation is expected to prevent the occurrence of low body weight in infants, thereby reducing the risk of infant morbidity and mortality.

Vitamin D metabolism in the fetus

Vitamin D is a fat soluble vitamin that can be obtained from exposure to sunlight and several food sources, such as fish oil, mushrooms, egg yolks, and liver. Vitamin D has two active forms of vitamin D, namely calciferol D2 and D3. Vitamin D2 is synthesized by plants and vitamin D3 is produced subcutaneously in humans through exposure to ultraviolet B (UVB) radiation. Vitamins D2 and D3 enter the body and are hydroxylated in the liver to form 25-hydroxy vitamin D or calcidiol. Then calcidiol will be converted to calcitriol in the kidney. Calcitriol has an important role in maintaining cell integrity, bone mineral metabolism, and calcium and phosphorus homeostasis.

Vitamin D works in several organs, such as the skin, small intestine, bone, parathyroid gland, immune system, pancreas, and in infants also works in the large intestine. Vitamin D can also help maintain normal levels of glucose in the blood, through vitamin D receptor activization in pancreatic beta cells and also regulation of insulin secretion.




Calcidiol, an active metabolite of vitamin D given from the maternal circulation to the fetal circulation via the placenta to meet fetal vitamin D needs. The need for vitamin D in pregnancy is very important because the fetus is fully dependent on vitamin D levels in the mother's body.

Rationalizing the Use of Vitamin D in Pregnancy

Meta analysis conducted by Theodoratou, et al. and Wei, et al. stated that there was a significant association between low vitamin D status during pregnancy and the incidence of low birth weight. There are also several observational studies which suggest that there is a significant relationship between lack of vitamin D and the incidence of preterm birth.

Vitamin D functions in fetal growth through calcium metabolism, bone growth, and maintaining placental function. Adequate vitamin D levels during pregnancy can also help the development of skeletal muscles and adipose tissue that are needed for fetal growth and development when they are born. Vitamin D maintains the levels of calcium and phosphorus in the blood, minerals that function in the process of mineral ion homeostasis, myoblast activity, and bone formation during the initial growth period. In one study it was found that low maternal calcidiol interferes with fetal bone growth detected by ultrasound.

Clinical Evidence Related to the Benefits of Vitamin D Supplement in Pregnancy

Many studies have suggested that the prevalence of low vitamin D levels during pregnancy is still high and this is considered to interfere with fetal health. However, to date there are no national or international organizations that recommend the use of routine vitamin D supplementation during pregnancy unless the woman is at risk of nutritional disorders. The effectiveness and safety of vitamin D supplementation during pregnancy is often questionable.

Meta analysis was carried out by Perez-Lopez, et al. consisting of 13 Randomized Controlled Trials (RCTs) assessing the effect of giving vitamin D supplementation during pregnancy to see maternal and infant outcomes. A lower risk of low birth weight but not statistically significant. This meta-analysis still has some limitations, such as heterogeneous studies in the form of dosage, type, and duration of vitamin D supplementation. In this meta-analysis also did not discuss the side effects of vitamin D supplements.

Another meta-analysis was carried out by Roth, et al. consisting of 43 RCTs to assess the effect of giving vitamin D supplementation during pregnancy for both the maternal and fetal. There were 5 RCTs that assessed the incidence of low birth weight infants in this meta-analysis. The group that received vitamin D supplementation significantly had a 40% lower risk of low birth weight compared to controls. Also found a significant difference in the vitamin D supplement group had children with an asthma risk of 20% lower than the control group at 3 years of age. 30 RCTs in this meta-analysis found a significant mean difference in infant birth weight of 58.33 grams in the vitamin D supplement group. In this meta-analysis no further study of side effects regarding vitamin D supplements was examined.

 

Conclusion

Vitamin D supplementation during pregnancy is thought to have good enough benefits to reduce the risk of low birth weight events. Vitamin D functions in fetal growth through calcium and phosphorus metabolism, bone growth, and maintaining placental function. Several studies have shown that the effectiveness of vitamin D supplementation is quite good during pregnancy, but its side effects have not been studied further. Therefore, vitamin D can be one supplementation for pregnant women at risk of nutritional disorders. It is expected that in the future there will be further research regarding the side effects, dosage and duration of giving vitamin D supplementation during pregnancy.





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Is a health and wellness enthusiast. In him free time, she loves to travel and taste different types of teas.

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