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