Vitamin D replacement in pregnant women in developing countries

Abstract

Many pregnant women residing in developing countries have inadequate vitamin D levels despite the fact that some of these countries are at a lower latitude. Darker pigmentation with inadequate sun exposure, a home-bound lifestyle especially during the third trimester, and limited dietary source of vitamin D due to lack of availability of fortified foods, all contribute towards maternal hypovitaminosis D. Inadequate vitamin D levels further contribute to the precarious nutritional state accompanied by a markedly inadequate intake of dietary calcium typically observed in many low resource settings. Early marriage along with early pregnancy are some of the other challenges specific to developing parts and attention is needed for vitamin D and bone health issues during pregnancy. Some regions, especially South Asia, have noted a high prevalence of vitamin D insufficiency among pregnant women aggravated during the winter. Despite the high prevalence vitamin D insufficiency and the importance of vitamin D during pregnancy, it continues to remain an underappreciated problem in many developing countries. Infrequent and inadequate use of antenatal care by many rural women provides a limited window for assessing risk and planning intervention with measures in the area of education or medication. Daily vitamin D supplementation may meet challenges related to compliance in low resource settings. Pharmacological doses per week or per trimester have been observed to improve 25(OH)D levels at delivery and amidst inconsistent data some trials have shown a beneficial impact on the anthropometry of new-borns. There have been no reports of any adverse risk to mother or child with such an approach. There will continue to be a debate on what constitutes adequate levels and whether vitamin D supplementation indeed influences any maternal or fetal outcome. While one reaches to find conclusive answers, given the growing burden of this condition, periodic supplementation should be offered to pregnant females at risk.