References

Antonakou A. Vitamin D supplementation for women during pregnancy. Women Birth. 2017; S1871-5192:(17)30540-1 https://doi.org/https://doi.org/10.1016/j.wombi.2017.11.001

Arrish J, Yeatman H, Williamson M. Midwives' role in providing nutrition advice during pregnancy: meeting the challenges? A qualitative study. Nurs Res Pract. 2017; 2017 https://doi.org/https://doi.org/10.1155/2017/7698510

Aubuchon-Endsley NL, Kennedy TS, Gilchrist M, Thomas DG, Grant S. Relationships among socioeconomic status, dietary intake, and stress in breastfeeding women. J Acad Nutr Diet. 2015; 115:(6)939-46 https://doi.org/https://doi.org/10.1016/j.jand.2014.12.017

Barbour RS, Macleod M, Mires G, Anderson AS. Uptake of folic acid supplements before and during pregnancy: focus group analysis of women's views and experiences. J Hum Nutr Diet. 2012; 25:(2)140-7 https://doi.org/https://doi.org/10.1111/j.1365-277X.2011.01216.x

Barker M, D'Angelo S, Ntani G The relationship between maternal self-efficacy, compliance and outcome in a trial of vitamin D supplementation in pregnancy. Osteoporos Int. 2017; 28:(1)77-84 https://doi.org/https://doi.org/10.1007/s00198-016-3721-5

Barnes K, Ball L, Desbrow B, Alsharairi N, Ahmed F. Consumption and reasons for use of dietary supplements in an Australian university population. Nutrition. 2016; 32:(5)524-30 https://doi.org/https://doi.org/10.1016/j.nut.2015.10.022

Barrett H, McElduff A. Vitamin D and pregnancy: an old problem revisited. Best Pract Res Clin Endocrinol Metab. 2010; 24:(4)527-39 https://doi.org/https://doi.org/10.1016/j.beem.2010.05.010

Bouillon R, Van Schoor NM, Gielen E Optimal vitamin D status: a critical analysis on the basis of evidence-based medicine. J Clin Endocrinol Metab. 2013; 98:(8)E1283-304 https://doi.org/https://doi.org/10.1210/jc.2013-1195

Bowyer L, Catling-Paull C, Diamond T, Homer C, Davis G, Craig ME. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Horumon To Rinsho. 2009; 70:(3)372-7 https://doi.org/https://doi.org/10.1111/j.1365-2265.2008.03316.x

British Dietetic Association. Food Fact Sheet: Vitamin D. 2013. https://www.bda.uk.com/foodfacts/VitaminD.pdf (accessed 19 April 2018)

Camargo CA, Rifas-Shiman SL, Litonjua AA Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. Am J Clin Nutr. 2007; 85:(3)788-95 https://doi.org/https://doi.org/10.1093/ajcn/85.3.788

Cawley S, Mullaney L, McKeating A, Farren M, McCartney D, Turner MJ. Knowledge about folic acid supplementation in women presenting for antenatal care. Eur J Clin Nutr. 2016; 70:(11)1285-90 https://doi.org/https://doi.org/10.1038/ejcn.2016.104

Chen TC, Chimeh F, Lu Z Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys. 2007; 460:(2)213-17 https://doi.org/https://doi.org/10.1016/j.abb.2006.12.017

de Jersey SJ, Nicholson JM, Callaway LK, Daniels LA. An observational study of nutrition and physical activity behaviours, knowledge, and advice in pregnancy. BMC Pregnancy Childbirth. 2013; 13:(1) https://doi.org/https://doi.org/10.1186/1471-2393-13-115

Department of Health, Social Services and Public Safety, NHS Wales, Scottish Government, NHS England. Healthy Start. 2018. https://www.healthystart.nhs.uk/for-health-professionals/your-role/ (accessed 14 April 2018)

De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev. 2016; (1) https://doi.org/https://doi.org/10.1002/14651858.CD008873.pub3

Vitamin supplementation in pregnancy. DTB. 2016; 54:81-84 https://doi.org/https://doi.org/10.1136/dtb.2016.7.0414

Emmerson AJB, Dockery KE, Mughal MZ, Roberts SA, Tower CL, Berry JL. Vitamin D status of white pregnant women and infants at birth and 4 months in North West England: A cohort study. Matern Child Nutr. 2018; 14:(1) https://doi.org/https://doi.org/10.1111/mcn.12453

Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients. 2010; 2:(5)482-95 https://doi.org/https://doi.org/10.3390/nu2050482

Ferrari RM, Siega-Riz AM, Evenson KR, Moos MK, Carrier KS. A qualitative study of women's perceptions of provider advice about diet and physical activity during pregnancy. Patient Educ Couns. 2013; 91:(3)372-7 https://doi.org/https://doi.org/10.1016/j.pec.2013.01.011

Finer S, Khan KS, Hitman GA, Griffiths C, Martineau A, Meads C. Inadequate vitamin D status in pregnancy: evidence for supplementation. Acta Obstet Gynecol Scand. 2012; 91:(2)159-63 https://doi.org/https://doi.org/10.1111/j.1600-0412.2011.01305.x

Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988; 124:(6)869-71 https://doi.org/https://doi.org/10.1001/archderm.1988.01670060015008

Fraser WD, Milan AM. Vitamin D assays: past and present debates, difficulties, and developments. Calcif Tissue Int. 2013; 92:(2)118-27 https://doi.org/https://doi.org/10.1007/s00223-012-9693-3

Harvey NC, Holroyd C, Ntani G Vitamin D supplementation in pregnancy: a systematic review. Health Technol Assess. 2014; 18:(45)1-190 https://doi.org/https://doi.org/10.3310/hta18450

Hensel KJ, Randis TM, Gelber SE, Ratner AJ. Pregnancy-specific association of vitamin D deficiency and bacterial vaginosis. Am J Obstet Gynecol. 2011; 204:(1)41.e1-41.e9 https://doi.org/https://doi.org/10.1016/j.ajog.2010.08.013

Heyden E, Wimalawansa S. Vitamin D: Effects on human reproduction, pregnancy, and fetal well-being. J Steroid Biochem Mol Biol. 2018; 180:41-50 https://doi.org/https://doi.org/10.1016/j.jsbmb.2017.12.011

Holick MF. Vitamin D deficiency. N Engl J Med. 2007; 357:(3)266-81 https://doi.org/https://doi.org/10.1056/NEJMra070553

Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008; 87:(4)1080S-86S https://doi.org/https://doi.org/10.1093/ajcn/87.4.1080S

Holick M, Garabedian M. Vitamin D: photobiology, metabolism, mechanisms of action, and clinical applications. In: Favus MJ (ed). Chicago, IL: American Society for Bone and Mineral Research;

Högler W. Complications of vitamin D deficiency from the foetus to the infant: one cause, one prevention, but who's responsibility?. Best Pract Res Clin Endocrinol Metab. 2015; 29:(3)385-98 https://doi.org/https://doi.org/10.1016/j.beem.2015.03.003

Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr. 2004; 79:(5)717-26

Early warnings, universal credit and food banks. 2017. https://www.trusselltrust.org/wp-content/uploads/sites/2/2017/04/Early-Warnings-Universal-Credit-and-Foodbanks.pdf (accessed 14 April 2018)

Karras SN, Anagnostis P, Bili E Maternal vitamin D status in pregnancy and offspring bone development: the unmet needs of vitamin D era. Osteoporos Int. 2014; 25:(3)795-805 https://doi.org/https://doi.org/10.1007/s00198-013-2468-5

Kovacs CS. Maternal vitamin D deficiency: fetal and neonatal implications. Semin Fetal Neonatal Med. 2013; 18:(3)129-35 https://doi.org/https://doi.org/10.1016/j.siny.2013.01.005

Lamb K, Sanders R. Nutrition in pregnancy and breastfeeding: A public health issue. Journal of Health Visiting. 2015; 3:(10)530-6 https://doi.org/https://doi.org/10.12968/johv.2015.3.10.530

Lee DJ, Haynes CL, Garrod D. Exploring the midwife's role in health promotion practice. Br J Midwifery. 2012; 20:(3)178-86 https://doi.org/https://doi.org/10.12968/bjom.2012.20.3.178

Lepsch J, Eshriqui I, Farias DR Association between early pregnancy vitamin D status and changes in serum lipid profiles throughout pregnancy. Metabolism. 2017; 70:85-97 https://doi.org/https://doi.org/10.1016/j.metabol.2017.02.004

Lerner PP, Sharony L, Miodownik C. Association between mental disorders, cognitive disturbances and vitamin D serum level: current state. Clin Nutr ESPEN. 2018; 23:89-102 https://doi.org/https://doi.org/10.1016/j.clnesp.2017.11.011

Lips P. Vitamin D status and nutrition in Europe and Asia. J Steroid Biochem Mol Biol. 2007; 103:(3-5)620-5 https://doi.org/https://doi.org/10.1016/j.jsbmb.2006.12.076

Lu Z, Chen TC, Zhang A An evaluation of the vitamin D3 content in fish: is the vitamin D content adequate to satisfy the dietary requirement for vitamin D?. J Steroid Biochem Mol Biol. 2007; 103:(3-5)642-4 https://doi.org/https://doi.org/10.1016/j.jsbmb.2006.12.010

Maher JH, Lowe JB. Navigating health priorities and motivators during pregnancy and new motherhood. Nutr Diet. 2015; 72:(4)333-9 https://doi.org/https://doi.org/10.1111/1747-0080.12155

Malek L, Umberger WJ, Makrides M, Collins CT, Zhou SJ. Understanding motivations for dietary supplementation during pregnancy: A focus group study. Midwifery. 2018; 57:59-68 https://doi.org/https://doi.org/10.1016/j.midw.2017.11.004

Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009; 94:(3)940-5 https://doi.org/https://doi.org/10.1210/jc.2008-1217

Mithal A, Wahl DA, Bonjour JP Global vitamin D status and determinants of hypovitaminosis D. Osteoporos Int. 2009; 20:(11)1807-20 https://doi.org/https://doi.org/10.1007/s00198-009-0954-6

National Institute for Health and Care Excellence. Maternal and child health nutrition [PH11]. 2008. https://www.nice.org.uk/guidance/Ph11 (accessed 26 June 2018)

National Institute for Health and Care Excellence. Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors [CG110]. 2010. https://www.nice.org.uk/guidance/cg110 (accessed 26 June 2018)

NICE support for commissioning postnatal care.London: NICE; 2013

National Institute for Health and Care Excellence. Sunlight exposure: risks and benefits [NG34]. 2016. https://www.nice.org.uk/guidance/ng34 (accessed 26 June 2018)

National Institute for Health and Care Excellence. Antenatal care [CG62]. 2017a. https://www.nice.org.uk/guidance/cg62 (accessed 26 June 2018)

National Institute for Health and Care Excellence. Vitamin D: increasing supplement use in at-risk groups [PH56]. 2017b. https://www.nice.org.uk/guidance/ph56 (accessed 26 June 2018)

Interventions and advice about diet for women who may become pregnant, or who are pregnant or breastfeeding.London: NICE; 2017c

Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem?. J Steroid Biochem Mol Biol. 2014; 144:138-45 https://doi.org/https://doi.org/10.1016/j.jsbmb.2013.11.003

Parker G, Brotchie H, Graham R. Vitamin D and depression. J Affect Disord. 2017; 208:56-61 https://doi.org/https://doi.org/10.1016/j.jad.2016.08.082

Pludowski P, Holick MF, Pilz S Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality—A review of recent evidence. Autoimmun Rev. 2013; 12:(10)976-989 https://doi.org/https://doi.org/10.1016/j.autrev.2013.02.004

Pouchieu C, Lévy R, Faure C Socioeconomic, lifestyle and dietary factors associated with dietary supplement use during pregnancy. PLoS One. 2013; 8:(8) https://doi.org/https://doi.org/10.1371/journal.pone.0070733

Rhodes LE, Webb AR, Fraser HI Recommended summer sunlight exposure levels can produce sufficient (> or =20 ng ml(-1)) but not the proposed optimal (> or =32 ng ml(-1)) 25(OH)D levels at UK latitudes. J Invest Dermatol. 2010; 130:(5)1411-18 https://doi.org/https://doi.org/10.1038/jid.2009.417

Rodda CP, Benson JE, Vincent AJ, Whitehead CL, Polykov A, Vollenhoven B. Maternal vitamin D supplementation during pregnancy prevents vitamin D deficiency in the newborn: an open-label randomized controlled trial. Horumon To Rinsho. 2015; 83:(3)363-8 https://doi.org/https://doi.org/10.1111/cen.12762

Royal College of Obstetricians and Gynaecologists. RCOG Statement on vitamin D supplementation for pregnant women. 2012. http://www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-vitamin-d-supplementation-pregnant-women (accessed 26 June 2018)

Vitamin D in pregnancy, Scientific impact paper No. 43. 2014a;

Royal College of Obstetricians and Gynaecologists. Healthy eating and vitamin supplements in pregnancy. 2014b. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-healthy-eating-and-vitamin-supplements-in-pregnancy.pdf (accessed 14 April 2018)

Robinson CJ, Wagner CL, Hollis BW, Baatz JE, Johnson DD. Maternal vitamin D and fetal growth in early-onset severe preeclampsia. Am J Obstet Gynecol. 2011; 204:(6)556.e1-556.e4 https://doi.org/https://doi.org/10.1016/j.ajog.2011.03.022

Sanders R, Lamb K. Promoting vitamin D uptake in pregnancy and the puerperium. Br J Midwifery. 2015; 23:(7)5-9 https://doi.org/https://doi.org/10.12968/bjom.2015.23.Sup7.5

Saraf R, Morton SMB, Camargo CA, Grant CC. Global summary of maternal and newborn vitamin D status - a systematic review. Matern Child Nutr. 2016; 12:(4)647-68 https://doi.org/https://doi.org/10.1111/mcn.12210

Vitamin D and Health.London: SACN; 2016

Shin JS, Choi MY, Longtine MS, Nelson DM. Vitamin D effects on pregnancy and the placenta. Placenta. 2010; 31:(12)1027-34 https://doi.org/https://doi.org/10.1016/j.placenta.2010.08.015

Steer P. AGAINST: Proven benefits of vitamin D supplementation remain elusive Vitamin D supplementation should be routine in pregnancy. BJOG. 2015; 122:(7) https://doi.org/https://doi.org/10.1111/1471-0528.13305

Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ. 2014; 348:(g2035)1-19

Thiele D, Ralph J, El-Masri M, Anderson C Vitamin D3 supplementation during pregnancy and lactation improves vitamin d status of the mother infant dyad. J Obstet Gynecol Neonatal Nurs. 2017; 46:(1)135-47 https://doi.org/https://doi.org/10.1016/j.jogn.2016.02.016

Thorne-Lyman A, Fawzi WW. Vitamin D during pregnancy and maternal, neonatal and infant health outcomes: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2012; 26:75-90 https://doi.org/https://doi.org/10.1111/j.1365-3016.2012.01283.x

van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab. 2011; 25:(4)671-80 https://doi.org/https://doi.org/10.1016/j.beem.2011.06.007

Wacker M, Holick MF. Sunlight and Vitamin D: A global perspective for health. Dermatoendocrinol. 2013; 5:(1)51-108 https://doi.org/https://doi.org/10.4161/derm.24494

Wennberg AL, Lundqvist A, Hogberg U, Sandstrom H, Hamberg K. Women's experiences of dietary advice and dietary changes during pregnancy. Midwifery. 2013; 29:(9)1027-34 https://doi.org/https://doi.org/10.1016/j.midw.2012.09.005

Windrim CM, Crosby DA, Mitchell K, Brophy C, Mahony R, Higgins M. Vitamin D supplementation in pregnancy—a survey of compliance with recommendations. Ir J Med Sci. 2017; https://doi.org/https://doi.org/10.1007/s11845-017-1707-8

WHO recommendations on antenatal care for a positive pregnancy experience.Geneva: WHO; 2016

Wyness L. Nutritional issues of vulnerable groups around pregnancy. Br J Midwifery. 2014; 22:(2)94-104 https://doi.org/https://doi.org/10.12968/bjom.2014.22.2.94

Xuan Y, Zhao HY, Liu JM. Vitamin D and type 2 diabetes mellitus (D2). J Diabetes. 2013; 5:(3)261-7 https://doi.org/https://doi.org/10.1111/1753-0407.12024

Yu CKH, Sykes L, Sethi M, Teoh TG, Robinson S. Vitamin D deficiency and supplementation during pregnancy. Horumon To Rinsho. 2009; 70:(5)685-90 https://doi.org/https://doi.org/10.1111/j.1365-2265.2008.03403.x

Overcoming the barriers of vitamin D in pregnancy: A midwifery public health perspective

02 August 2018
12 min read
Volume 26 · Issue 8

Abstract

Vitamin D deficiency remains a significant public health issue for childbearing women in the UK. As the effect of vitamin D appears to be unclear, and supplementation outcomes for maternal and fetal health debatable, there has been widespread confusion, with midwives unclear about recommendations and women unsure about supplementation. A partnership approach allows women to understand the public health context and view vitamin uptake as beneficial for neonatal health, with women and midwives working together to break down barriers and optimise supplementation and endogenous vitamin D intakes. Many women find a balanced diet in the childbearing continuum period difficult to achieve, and midwives can only address vitamin D deficiency on an individual, case-by-case basis. Communication, and an acknowledgement that women come from a variety of cultural and social backgrounds, can be key to public health success, via a thorough exploration of women's barriers to vitamin D uptake.

Guidance from the National Institute for Health and Care Excellence (NICE) (2008, 2017a; 2017b) and Royal College of Obstetricians and Gynaecologists (RCOG) (2014a) recommends vitamin D supplementation to all pregnant women in the UK. Internationally, however, there is much dispute as to whether this is of benefit to mother and fetus/neonate, and indeed the World Health Organization (WHO) does not recommend routine antenatal supplementation (WHO, 2016). There is a dearth of evidence to underpin antenatal supplementation, and although it is known to increase maternal vitamin D levels, there is no consensus as to what effect this has on maternal or fetal wellbeing (De-Regil et al, 2016). However, it is acknowledged that supplementation is unlikely to cause harm (RCOG 2014a), so while awaiting more robust evidence, midwives can continue to recommend supplementation in line with national guidance (NICE, 2017b).

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