Deficiency In Pregnancy Research Articles

Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review.

Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.

The persistence of maternal vitamin D deficiency and insufficiency during pregnancy and lactation irrespective of season and supplementation.

Pregnancy and lactation comprise a critical window spanning all seasons during which maternal vitamin D status potentially may influence the long-term health of the newborn. Women typically receive calcium/vitamin D supplementation through antenatal vitamins, but there has been limited serial evaluation of maternal vitamin D status across this critical window. In this prospective observational cohort study, 467 women in Toronto, Canada, underwent measurement of serum 25-hydroxy vitamin D (25-OH-D) at mean 29·7 ± 2·9 weeks' gestation, 3 months postpartum and 12 months postpartum, enabling serial assessment across 3 seasons. At each assessment, vitamin D status was classified as deficiency (25-OH-D<50 nmol/l), insufficiency (25-OH-D≥50 nmol/l and <75 nmol/l) or sufficiency (25-OH-D≥75 nmol/l). The prevalence rates of vitamin D deficiency and insufficiency were 31·5% and 35·1% in pregnancy, 33·4% and 35·3% at 3 months, and 35·6% and 33·8% at 12 months postpartum, respectively. These high rates remained stable over time (P = 0·49) despite declining usage of antenatal calcium/vitamin D supplementation from pregnancy to 3 months to 12 months postpartum (P < 0·001). Indeed, on mixed model analyses, vitamin D deficiency and insufficiency in pregnancy were independently associated with decrements in average 25-OH-D over time of 49·6 nmol/l and 26·4 nmol/l, respectively (both P < 0·001). In contrast, season of baseline assessment and use of calcium/vitamin D supplements were independently associated with changes in 25-OH-D in the range of 3-5 nmol/l (both P < 0·008). The persistence of vitamin D deficiency/insufficiency during pregnancy and lactation, irrespective of season and supplementation, supports the emerging concept that current vitamin D supplementation in antenatal care is likely inadequate.

Vitamin D Status in Pregnancy and Determinants in a Southern European Cohort Study.

Population-based data on vitamin D status in pregnancy in southern European countries are scarce. We assessed the prevalence and determinants of vitamin D insufficiency and deficiency in pregnancy in Spain. Plasma 25-hydroxyvitamin D3 (25(OH)D3) concentration was measured at the first trimester of gestation in 2,036 pregnant women from several geographical areas of Spain (latitude 39-42°N). Uni- and multivariable regression models were conducted to identify predictors of circulating 25(OH)D3 concentration and vitamin D insufficiency (20-30 ng/mL) and deficiency (<20 ng/mL). Thirty-one per cent and 18% of women were vitamin D insufficient and deficient, respectively. Season at blood collection, latitude, age, social class, tobacco smoking, physical activity and use of vitamin D supplements were identified as independent determinants of 25(OH)D3 concentration. Lower risk of vitamin D insufficiency and deficiency was associated with summer season at blood collection (RR for insufficiency = 0.34, confidence intervals (CI) 0.25, 0.48; and RR for deficiency = 0.07, 95% CI 0.04, 0.12), southern latitude (RR for insufficiency = 0.71, 95% CI 0.50, 1.02; RR for deficiency = 0.60, 95% CI 0.38, 0.94); use of vitamin D supplements (RR for insufficiency = 0.50, 95% CI 0.35, 0.71; RR for deficiency = 0.24, 95% CI 0.14, 0.41); and strong physical activity (RR for insufficiency = 0.80, 95% CI 0.58, 1.09; and RR for deficiency = 0.67, 95% CI 0.46, 1.03). Higher risk of vitamin D deficiency was related to lower social class (RR = 1.94, 95% CI 1.19, 3.16) and smoking (RR = 1.76, 95% CI 1.23, 2.54). Vitamin D insufficiency and deficiency are highly prevalent in pregnancy. Recommendations and policies to detect and prevent hypovitaminosis D during pregnancy should be developed taking into account the associated factors.

Are there anamnestic risk factors for iron deficiency in pregnancy? Results from a feasibility study.

The conditions of iron deficiency are highly incident in pregnancy with elevated risks for preterm birth and low birth weight. In our recent study, we found 6% of participants having anemia, whereas between 39% and 47% showed iron deficiency without anemia. In many countries in prenatal care solely hemoglobin (Hb) measurement is applied. For the gynecologists till date there is no indication to determine other markers (e.g., serum-ferritin). As iron deficiency results from an imbalance between intake and loss of iron, our aim was to find out if the risk of iron deficiency conditions can be estimated by a diet history protocol as well as questionnaires to find about iron loss. We found that the risk of having iron deficiency in upper gestational week (>=21) increased by a factor of five. Thus, additional diagnostics should be done in this group by now. Using the questionnaire as a screening instrument, we further estimated the probability of disease in terms of a positive likelihood ratio (LR+). The positive LR for the group below 21th week of gestation is 1.9 thus, increasing the post-test probability to 52% from 36% as before. Further research based on higher sample sizes will show if the ratios can be increased further.

Nutritional iodine status of pregnant women in Zaria, North-Western Nigeria

Background: Iodine deficiency is a major public health problem worldwide, especially in pregnant women and young children. It is the most common cause of preventable mental retardation all over the world. Few among the devastating outcomes of iodine deficiency in pregnancy are increased perinatal mortality, abortions, stillbirths, neonatal hypothyroidism, goiter, and congenital anomalies. Objective: To assess the nutritional iodine status of pregnant women in Zaria. Methods: Four hundred subjects were recruited for this study consisting of three hundred apparently healthy pregnant women and one hundred apparently healthy nonpregnant age-matched controls. Random urine samples were collected and analyzed for iodine by modified Sandell-Kolthoff reaction. Data were analyzed using Epi-Info 3.5.3 to obtain the mean ages and median urinary iodine concentration (UIC) for pregnant women, controls and then for each trimester of pregnancy. P ≤ 0.05 was considered statistically significant. Results: Mean ages ± standard deviation for pregnant women and controls were 25.41 ± 5.98 and 26.70 ± 5.83 years, respectively (P > 0.05). Median UIC for pregnant women and controls were 193 μg/L and 205 μg/L, respectively. Trimester-specific UICs were 250 μg/L, 154 μg/L, and 150 μg/L for the first, second, and third trimesters, respectively. The percentage of women with iodine deficiency increased with advancing gestational age. Conclusion: Pregnant women in Zaria were iodine sufficient. There was a progressive decline in median UIC from the first through the third trimester.

The effect of iodine supplementation in pregnancy on early childhood neurodevelopment and clinical outcomes: results of an aborted randomised placebo-controlled trial.

BackgroundConcern that mild iodine deficiency in pregnancy may adversely affect neurodevelopment of offspring has led to recommendations for iodine supplementation in the absence of evidence from randomised controlled trials. The primary objective of the study was to investigate the effect of iodine supplementation during pregnancy on childhood neurodevelopment. Secondary outcomes included pregnancy outcomes, maternal thyroid function and general health.MethodsWomen with a singleton pregnancy of fewer than 20 weeks were randomly assigned to iodine (150 μg/d) or placebo from trial entry to birth. Childhood neurodevelopment was assessed at 18 months by using Bayley Scales of Infant and Toddler Development (Bayley-III). Iodine status and thyroid function were assessed at baseline and at 36 weeks’ gestation. Pregnancy outcomes were collected from medical records.ResultsThe trial was stopped after 59 women were randomly assigned following withdrawal of support by the funding body. There were no differences in childhood neurodevelopmental scores between the iodine treated and placebo groups. The mean cognitive, language and motor scores on the Bayley-III (iodine versus placebo, respectively) were 99.4 ± 12.2 versus 101.7 ± 8.2 (mean difference (MD) −2.3, 95 % confidence interval (CI) −7.8, 3.2; P = 0.42), 97.2 ± 12.2 versus 97.9 ± 11.5 (MD −0.7, 95 % CI −7.0, 5.6; P = 0.83) and 93.9 ± 10.8 versus 92.4 ± 9.7 (MD 1.4, 95 % CI −4.0, 6.9; P = 0.61), respectively. No differences were identified between groups in any secondary outcomes.ConclusionsIodine supplementation in pregnancy did not result in better childhood neurodevelopment in this small trial. Adequately powered randomised controlled trials are needed to provide conclusive evidence regarding the effect of iodine supplementation in pregnancy.Trials registrationThe trial was registered with the Australian New Zealand Clinical Trials Registry at http://www.anzctr.org.au. The registration number of this trial is ACTRN12610000411044. The trial was registered on 21 May 2010.

Screening for iron deficiency and iron deficiency anaemia in pregnancy: a structured review and gap analysis against UK national screening criteria.

BackgroundIron deficiency anaemia is a common problem in pregnancy despite national recommendations and guidelines for treatment. The aim of this study was to appraise the evidence against the UK National Screening Committee (UKNSC) criteria as to whether a national screening programme could reduce the prevalence of iron deficiency anaemia and/or iron deficiency in pregnancy and improve maternal and fetal outcomes.MethodsSearch strategies were developed for the Cochrane library, Medline and Embase to identify evidence relevant to UK National Screening Committee (UKNSC) appraisal criteria which cover the natural history of iron deficiency and iron deficiency anaemia, the tests for screening, clinical management and evidence of cost effectiveness.ResultsMany studies evaluated haematological outcomes of anaemia, but few analysed clinical consequences. Haemoglobin and ferritin appeared the most suitable screening tests, although future options may follow recent advances in understanding iron homeostasis. The clinical consequences of iron deficiency without anaemia are unknown. Oral and intravenous iron are effective in improving haemoglobin and iron parameters. There have been no trials or economic evaluations of a national screening programme for iron deficiency anaemia in pregnancy.ConclusionsIron deficiency in pregnancy remains an important problem although effective tests and treatment exist. A national screening programme could be of value for early detection and intervention. However, high quality studies are required to confirm whether this would reduce maternal and infant morbidity and be cost effective.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0679-9) contains supplementary material, which is available to authorized users.

Insomnia and sleep deficiency in pregnancy.

Insomnia and sleep deficiency in pregnancy are very common with most women reporting sleep disturbances during pregnancy. Insomnia and sleep deficiency are also more prevalent as pregnancy progresses, possibly related to pregnancy-related physical symptoms or discomfort. There is increasing evidence indicating that these sleep problems may be associated with adverse maternal and fetal outcomes such as depressive symptoms, increased pain during labor, more Caesarean sections, preterm birth, and low birth weight. Treatment of insomnia remains challenging as some of the more commonly used sleep inducing medications such as benzodiazepines and hypnotic benzodiazepine receptor agonists may be associated with adverse neonatal outcomes. Nonpharmacological treatments such as cognitive behavioral therapy are available but the data in pregnancy is often lacking.

Maternal Vitamin D Deficiency and Fetal Growth

ABSTRACT There is increasing incidence of vitamin D deficiency in pregnancy in developed countries. Dark skinned women who have migrated and live in higher latitudes are at greatest risk. Vitamin D supplementation is now recommended in several countries, yet its impact on fetal growth remains unclear. Observational studies suggest a possible correlation between maternal serum vitaminD and birth weight. However, differences in birth weight can be confounded by soft-tissue growth and placental function. The effect on vitamin D on bone mineral indices using dual energy X-ray absorptiometry is difficult to ascertain in the neonatal period and therefore remains unclear. Prenatal ultrasound is a safe and practical modality for assessing skeletal growth, yet very few studies have investigated fetal growth in the context of vitamin D status: one study has demonstrated no correlation with femur length, whereas two studies have shown positive correlations with femur length and femur volume respectively. The effect of vitamin D supplementation on birth weight has been investigated in seven interventional studies. However, there is considerable methodological heterogeneity and high risk of bias among some of them. Meta-analysis of well conducted randomized controlled trials (RCTs) has not demonstrated a significant effect on birth weight. The effect of vitamin D supplementation on ultrasound markers of fetal growth has not been reported to date. In summary, there is weak evidence that maternal vitamin D status may have a positive association with measures of fetal skeletal growth. However, if such an association exists, it is not clear whether it is causal or spurious. Randomized controlled trials of vitamin D supplementation are needed, where fetal ultrasound and neonatal bone mineral indices will be reported as primary outcome measures. How to cite this article Ioannou C. Maternal Vitamin D Deficiency and Fetal Growth. Donald School J Ultrasound Obstet Gynecol 2015;9(3):223-229.

Vitamin D Deficiency in BALB/c Mouse Pregnancy Increases Placental Transfer of Glucocorticoids.

The prevalence of vitamin D deficiency in pregnancy is increasing and implicated in adverse consequences for the health of offspring in later life. The aim of this study was to determine whether vitamin D deficiency increases fetal exposure to glucocorticoids, which are known to alter fetal development and result in adverse adult health outcomes. Female BALB/c mice were placed on either a vitamin D control (2195 IU/kg) or deficient (0 IU/kg) diet for 5 weeks before and during pregnancy. Maternal serum, placentas and fetal brains were collected at embryonic day 14.5 or 17.5 for morphological and gene expression analysis. Vitamin D deficiency during pregnancy increased maternal corticosterone concentrations and reduced placental weight. Maternal vitamin D deficiency decreased placental expression of 11β-hydroxysteroid dehydrogenase type II, which inactivates glucocorticoids thereby protecting the fetus from inappropriate glucocorticoid exposure. There was a corresponding increase in placental and fetal expression of the highly glucocorticoid-sensitive factor glucocorticoid-induced leucine zipper. Furthermore, placental expression of the angiogenic factor vascular endothelial growth factor-A was reduced in vitamin D-deficient pregnancies, with a corresponding decline in fetal capillary volume within the placenta. Overall, we show that prenatal vitamin D deficiency leads to an increase in maternal corticosterone, alterations in genes indicative of increased fetal glucocorticoid exposure and impairment in placental vascular development. Thus, the long-term adverse health consequences of vitamin D deficiency during early development may not just be due to alteration in direct vitamin D-related pathways but also altered fetal glucocorticoid exposure.

The new emergence of iodine deficiency in the UK: consequences for child neurodevelopment.

Adequate iodine intake is important during pregnancy as it is a component of the thyroid hormones that are crucial for fetal brain and neurological development. While randomized controlled trials in severe iodine deficiency have shown that iodine deficiency in pregnancy causes impaired offspring cognition, less is known of the effects in regions of mild/mild-to-moderate deficiency. The United Kingdom is now classified as mildly iodine deficient by the World Health Organization, based on a 2011 national study of 14-15-year-old schoolgirls. As pregnancy is the most critical time for brain development, we evaluated iodine status in pregnant women in Surrey (n = 100) and Oxford (n = 230). The median urinary iodine concentration was 85.3 μg/L in Surrey women, considerably lower than the WHO/United Nations Children's Fund/International Council for the Control of Iodine Deficiency Disorders cut-off of 150 μg/L. Oxford women had similarly low status. We investigated whether that level of iodine deficiency was associated with adverse child cognitive effects using stored samples and data from the Avon Longitudinal Study of Parents and Children cohort. In adjusted analyses, we found a significant association between low maternal iodine status in early pregnancy (urinary iodine-to-creatinine ratio <150 μg/g) such that children had an approximately 60% greater risk of being in the bottom quartile of scores for verbal intelligence quotient, reading accuracy and comprehension. UK women who might become pregnant should ensure they have adequate iodine status to avoid compromising their children's brain development.

Determinants of Postpartum Vitamin D Status in the Caucasian Mother-Offspring Pairs at a Latitude of 52°N: A Cross-Sectional Study

Background: High prevalence of vitamin D deficiency in pregnancy is recorded. Aim: To establish determinants of postpartum 25-hydroxyvitamin D (25(OH)D) levels on mothers and offspring. Methods: 25(OH)D level was measured in cord blood and maternal blood collected ≤3 weeks postpartum. Maternal socioeconomic status, vitamin D intake, sun exposure during pregnancy and maternal and neonatal fat mass (FM; dual X-ray absorptiometry) were assessed within 3 weeks postpartum. Results: A total of 174 mother-offspring pairs were enrolled. Maternal 25(OH)D <20 ng/ml was seen in 32 (51%) of summer and 82 (74%) of winter deliveries. Women with 25(OH)D <20 ng/ml had a 2-fold lower percentage of vitamin D intake of ≥800 IU/day than women with 25(OH)D ≥20 ng/ml (p = 0.02). FM (%) was comparable between groups (p > 0.05). Multiple regression analysis revealed the delivery season, prenatal vitamin D intake ≥800 IU/day and duration of supplementation to be the determinants of maternal 25(OH)D level (R² = 0.26, p < 0.001). Maternal 25(OH)D level, season of birth and duration of maternal supplementation explained 83% of the variance in cord blood 25(OH)D level (R² = 0.83, p < 0.001). Conclusions: The key determinants of higher maternal vitamin D status were the summer-autumn season of delivery and prenatal use of ≥800 IU/day of vitamin D. The cord blood 25(OH)D level was mainly determined by maternal 25(OH)D level and season of birth.

Daily oral iron supplementation during pregnancy.

Iron and folic acid supplementation has been the preferred intervention to improve iron stores and prevent anaemia among pregnant women, and it is thought to improve other maternal and birth outcomes. To assess the effects of daily oral iron supplements for pregnant women, either alone or in conjunction with folic acid, or with other vitamins and minerals as a public health intervention in antenatal care. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (10 January 2015). We also searched the WHO International Clinical Trials Registry Platform (ICTRP) (26 February 2015) and contacted relevant organisations for the identification of ongoing and unpublished studies (26 February 2015) . Randomised or quasi-randomised trials evaluating the effects of oral preventive supplementation with daily iron, iron + folic acid or iron + other vitamins and minerals during pregnancy. We assessed the methodological quality of trials using standard Cochrane criteria. Two review authors independently assessed trial eligibility, extracted data and conducted checks for accuracy. We used the GRADE approach to assess the quality of the evidence for primary outcomes.We anticipated high heterogeneity among trials and we pooled trial results using a random-effects model and were cautious in our interpretation of the pooled results: the random-effects model gives the average treatment effect. We included 61 trials. Forty-four trials, involving 43,274 women, contributed data and compared the effects of daily oral supplements containing iron versus no iron or placebo.Preventive iron supplementation reduced maternal anaemia at term by 70% (risk ratio (RR) 0.30; 95% confidence interval (CI) 0.19 to 0.46, 14 trials, 2199 women, low quality evidence), iron-deficiency anaemia at term (RR 0.33; 95% CI 0.16 to 0.69, six trials, 1088 women), and iron deficiency at term by 57% (RR 0.43; 95% CI 0.27 to 0.66, seven trials, 1256 women, low quality evidence). There were no clear differences between groups for severe anaemia in the second or third trimester, or maternal infection during pregnancy (RR 0.22; 95% CI 0.01 to 3.20, nine trials, 2125 women, very low quality evidence; and, RR 1.21; 95% CI 0.33 to 4.46; one trial, 727 women, low quality evidence, respectively), or maternal mortality (RR 0.33; 95% CI 0.01 to 8.19, two trials, 12,560 women, very low quality evidence), or reporting of side effects (RR 1.29; 95% CI 0.83 to 2.02, 11 trials, 2423 women, very low quality evidence). Women receiving iron were on average more likely to have higher haemoglobin (Hb) concentrations at term and in the postpartum period, but were at increased risk of Hb concentrations greater than 130 g/L during pregnancy, and at term.Compared with controls, women taking iron supplements less frequently had low birthweight newborns (8.4% versus 10.3%, average RR 0.84; 95% CI 0.69 to 1.03, 11 trials, 17,613 women, low quality evidence), and preterm babies (RR 0.93; 95% CI 0.84 to 1.03, 13 trials, 19,286 women, moderate quality evidence). They appeared to also deliver slightly heavier babies (mean difference (MD) 23.75; 95% CI -3.02 to 50.51, 15 trials, 18,590 women, moderate quality evidence). None of these results were statistically significant. There were no clear differences between groups for neonatal death (RR 0.91; 95% CI 0.71 to 1.18, four trials, 16,603 infants, low quality evidence), or congenital anomalies (RR 0.88, 95% CI 0.58 to 1.33, four trials, 14,636 infants, low quality evidence).Twenty-three studies were conducted in countries that in 2011 had some malaria risk in parts of the country. In some of these countries/territories, malaria is present only in certain areas or up to a particular altitude. Only two of these studies reported malaria outcomes. There is no evidence that iron supplementation increases placental malaria. For some outcomes heterogeneity was higher than 50%. Supplementation reduces the risk of maternal anaemia and iron deficiency in pregnancy but the positive effect on other maternal and infant outcomes is less clear. Implementation of iron supplementation recommendations may produce heterogeneous results depending on the populations' background risk for low birthweight and anaemia, as well as the level of adherence to the intervention.

Intravenous Iron Sucrose Therapy in Iron Deficiency Anemia in Antenatal and Postnatal Patients

Iron deficiency anemia is the most common nutritional deficiency in pregnancy and more common in developing countries which is aggravated due to increased demand and blood loss during delivery. Though there are different methods for treating iron deficiency anemia. Iron sucrose is being used because of its minimal side effects. This study was undertaken to evaluate the response and effect of intravenous iron sucrose given to patient in antenatal and postnatal period with moderate iron deficiency anemia. A hospital based prospective study was conducted 1st Jan 2013-30th Dec 2014 in the department of obstetrics and gynecology Kathmandu Medical College, Teaching Hospital Kathmandu, Nepal. Antenatal and postnatal patients with hemoglobin between 5-9 gm% with diagnosed iron deficiency anemia were included in the study. The aim was to bring her hemoglobin level to 11gm%. All together 37 patients were enrolled out of which two patient were dropped due to allergic reaction and 35 patients were included in study. Iron sucrose therapy is effective in achieving target hemoglobin of 11gm/dl in 80% of patients. It showed that intravenous iron sucrose significantly (P < 0.001) increase hemoglobin level within two weeks of therapy without any major adverse effects. Iron sucrose therapy is safe, effective and well tolerated for the treatment of iron deficiency anemia. Parental iron therapy was effective in increasing hemoglobin, serum ferritin and other hematological parameters in antenatal and postnatal patients with anemia. The treatment will help to reduce the risk of maternal complication during pregnancy and postpartum and its adverse effect to fetus.

High Prevalence of Vitamin D Deficiency in Native versus Migrant Mothers and Newborns in the North of Italy: A Call to Act with a Stronger Prevention Program.

BackgroundVitamin D status during pregnancy is related to neonatal vitamin D status. Vitamin D deficiency has been associated with an increased risk of rickets in children and osteomalacia in adults. Aim of this study was to investigate 25OHD levels in maternal serum and in neonatal blood spots in native and migrant populations living in Novara (North Italy, 45°N latitude).Methods and FindingsWe carried out a cross sectional study from April 1st 2012 to March 30th 2013, in a tertiary Care Center. Maternal blood samples after delivery and newborns' blood spots were analyzed for 25OHD levels in 533 pairs. Maternal country of origin, skin phototype, vitamin D dietary intake and supplementation during pregnancy were recorded. Multivariate regression analysis, showed a link between neonatal and maternal 25OHD levels (R-square:0.664). Severely deficient 25OHD values (<25 nmol/L) were found in 38% of Italian and in 76.2% of migrant’s newborns (p <0.0001), and in 18% of Italian and 48,4% of migrant mothers (p <0.0001) while 25OHD deficiency (≥25 and <50 nmol/L) was shown in 40.1% of Italian and 21.7% of migrant’s newborns (p <0.0001), and in 43.6% of Italian and 41.3% of migrant mothers (p <0.0001). Italian newborns and mothers had higher 25OHD levels (34.4±19.2 and 44.9±21.2nmol/L) than migrants (17.7±13.7 and 29.7±16.5nmol/L; p<0.0001). A linear decrease of 25OHD levels was found with increasing skin pigmentation (phototype I 42.1 ±18.2 vs phototype VI 17.9±10.1 nmol/l; p<0.0001). Vitamin D supplementation resulted in higher 25OHD values both in mothers and in their newborns (p<0.0001).ConclusionsVitamin D insufficiency in pregnancy and in newborns is frequent especially among migrants. A prevention program in Piedmont should urgently be considered and people identified as being at risk should be closely monitored. Vitamin D supplementation should be taken into account when considering a preventative health care policy.

OC-057 Anaemia and iron deficiency in adults; how to manage it for nurses. a new guide from the royal college of nursing

Introduction Iron deficiency anaemia (IDA) is the most common cause of anaemia in primary care and causes >57,000 emergency admissions to hospital/yr at a cost to the NHS of £55.48 m. Effective identification and management is often overlooked. Dealing with IDA prevents complications and blood transfusion use with a cost saving of £8.43 m per year. These guidelines have been developed by expert nurses from relevant specialties. They are aimed at all nurses, health care assistants, midwives and health visitors from all specialties and backgrounds. Method The document gives guidance on; identifying IDA and escalating management understanding how IDA occurs, give dietary advice and using oral iron supplements, the use of intravenous iron with practical tips for its delivery.good patient information links. It gives specialist guidance to nurses working in renal disease, gastroenterology, obstetrics and gynaecology and patient blood management. Results The main guidance contains; Definition of IDA, iron metabolism and pathophysiology, storage or iron, causes of functional and actual iron deficiency, measuring iron status, common symptoms of anaemia, history taking and examination, dietary iron, oral iron supplements, practical advice for administrating intravenous iron, use of blood transfusion and preoperative optimisation of patients. The GI appendix discusses IDA in coeliac disease and inflammatory bowel disease, and gives case study examples to show the impact of effective nursing intervention on patiient outcomes. Conclusion These newly published Royal College of Nursing Guidelines provide an invaluable resource about all areas of iron deficiency management for nurses from all backgrounds and specialties. The specialist appendices provide extra information for nurses working within renal disease, obstetrics and gyanecology, patient blood management and gastroenterology. Disclosure of interest None Declared.

Vitamin D deficiency in early pregnancy.

ObjectiveVitamin D deficiency is a common problem in reproductive-aged women in the United States. The effect of vitamin D deficiency in pregnancy is unknown, but has been associated with adverse pregnancy outcomes. The objective of this study was to analyze the relationship between vitamin D deficiency in the first trimester and subsequent clinical outcomes.Study DesignThis is a retrospective cohort study. Plasma was collected in the first trimester from 310 nulliparous women with singleton gestations without significant medical problems. Competitive enzymatic vitamin D assays were performed on banked plasma specimens and pregnancy outcomes were collected after delivery. Logistic regression was performed on patients stratified by plasma vitamin D concentration and the following combined clinical outcomes: preeclampsia, preterm delivery, intrauterine growth restriction, gestational diabetes, and spontaneous abortion.ResultsVitamin D concentrations were obtained from 235 patients (mean age 24.3 years, range 18-40 years). Seventy percent of our study population was vitamin D insufficient with a serum concentration less than 30 ng/mL (mean serum concentration 27.6 ng/mL, range 13-71.6 ng/mL). Logistic regression was performed adjusting for age, race, body mass index, tobacco use, and time of year. Adverse pregnancy outcomes included preeclampsia, growth restriction, preterm delivery, gestational diabetes, and spontaneous abortion. There was no association between vitamin D deficiency and composite adverse pregnancy outcomes with an adjusted odds ratio of 1.01 (p value 0.738, 95% confidence intervals 0.961-1.057).ConclusionVitamin D deficiency did not associate with adverse pregnancy outcomes in this study population. However, the high percentage of affected individuals highlights the prevalence of vitamin D deficiency in young, reproductive-aged women.

Non-anaemic iron deficiency in pregnancy: the views of health service users and health care professionals.

The prevalence of anaemia in pregnancy in Europe is 25% and that resulting from iron deficiency is estimated at 40%. The maternal and fetal morbidity of non-anaemic iron deficiency (NAID) in pregnancy is likely to be significant. To determine the views and opinions of health service users and clinicians concerning NAID in pregnancy in order to inform future research. Two semi-structured focus groups were carried out to determine health service users' views on anaemia and NAID in pregnancy. A questionnaire was administered to obstetricians, haematologists, midwives and anaesthetists to elucidate their views on NAID in pregnancy. The study indicated that health service users and clinicians were interested in implementing testing for NAID in pregnancy with serum ferritin, if proven to be effective at reducing the effects of anaemia and improving maternal and neonatal outcomes. Clinicians had reservations in the use of intravenous iron supplementation for NAID in pregnancy. NAID is now accepted as a target condition for research by health service users and clinicians. The focus of future research should be on screening for NAID and its treatment.

Carnitine Deficiency and Pregnancy.

We present two cases of carnitine deficiency in pregnancy. In our first case, systematic screening revealed L-carnitine deficiency in the first born of an asymptomatic mother. In the course of her second pregnancy, maternal carnitine levels showed a deficiency as well. In a second case, a mother known with carnitine deficiency under supplementation was followed throughout her pregnancy. Both pregnancies had an uneventful outcome. Because carnitine deficiency can have serious complications, supplementation with carnitine is advised. This supplementation should be continued throughout pregnancy according to plasma concentrations.

Pregnany-dependent blood flow velocity changes in lower extermities veis in venous insufficiency

Venous insufficiency in pregnancy is associated witch an increased risk of complications. The aim of the study was to analyse the venous system changes of the lower limbs during pregnancy and puerperium with or without venous insufficiency The research was carried out on pregnant women divided into two groups according to the presence or lack of venous insufficiency The venous system was examined four times: between 11-14th, 18-22nd, 28-32nd gestational week and at the 6th week of puerperium. The doppler examination included the measurement of the blood flow velocity in selected deep veins of the lower limbs: common femoral vein, the superficial femoral vein and the popliteal vein. Consecutively the changes in the blood flow velocity during pregnancy and puerperium were compared between groups and finally to the results obtained in the 1st trimester The analysis of the blood flow showed that the blood flow velocity was statistically lower in the group with venous insufficiency Velocity changes in time showed, in majority of cases, a substantial reduction in the blood flow velocity in the third trimester in both groups. This blood flow velocity increases during the puerperium and does not differ from those observed in the first trimester Thus, the tendency of changes in the blood flow velocity were similar in character in both groups. The pregnancy related changes in venous system of lower extremities showed the reduction of blood flow velocity with advancing gestational age and were more evident in pregnancy complicated by venous insufficiency