Vitamin and mineral supplementation in pregnancy

Question 1

Why is vitamin D important?

What are the negative outcomes for severe childhood deficiency of vitamin D?

Answer 1

• Role in gut absorption of calcium and mineralisation of bones.

Negative outcomes of severe vitamin D deficiency:

• Hypocalcaemic seizures
• Rickets

Question 2

What dose of vitamin D is recommended during pregnancy?

What dose of vitamin D is recommended when an infant is exclusively breastfed and for how long?

Answer 2

Dose of vitamin D during pregnancy: 400 IU PO daily.

Dose of vitamin D during exclusive breastfeeding: 400 IU PO daily for at least first 6 months of life.

Formula fed infants do not need supplementation.

Question 3

What are the main sources of vitamin D?

Answer 3

• Diet
• UVB exposure

Question 4

Vitamin D does not consistently show improved maternal or neonatal outcomes.

Outline evidence of findings relating to antenatal vitamin D supplementation as per RANZCOG:

Answer 4

• Increases maternal and cord blood levels.
• No improvement in :
  
  • Maternal obstetric outcomes.
  • Infant vitamin D levels at 3, 6 and 12 months
  • Fetal bone density at 2 weeks.
• Reduces childhood wheeze by 20% at 3 years of age but not other respiratory outcomes.

Question 5

What is the recommended dose and duration of folic acid?

What is the recommended high dose of folic acid and when would this be indicated?

Answer 5

• Folic acid 0.8 mg po daily from 1 month preconception to 12 weeks gestation.
• High dose folic acid 5 mg po daily
• Indications:
  
  • Previous neural tube defects or FamHx
  • Malabsorptive disorders
  • Obesity
  • T2DM
  • Taking folate antagonist medications: anticonvulsants

Question 6

What is the recommended dose and duration of iodine supplementation in pregnancy?

Answer 6

Iodine 150 mcg po daily throughout pregnancy and during lactation.

Question 7

When is vitamin B12 supplementation indicated in pregnancy?

What is the recommended daily intake (RDI) during pregnancy and breastfeeding?

Answer 7

• Vitamin B12 indicated when woman is vegan or vegetarian.
• RDI during pregnancy: 2.6 mcg/day
• RD during lactation: 2.8 mcg/day

Question 8

When is maternal vitamin K supplementation indicated in pregnancy?

Answer 8

Vitamin K supplementation indicated in late pregnancy in women diagnosed with obstetric cholestasis due to associated vitamin K malabsorption.

Question 9

What is the recommended daily intake of calcium during pregnancy?

When should a calcium supplement be taken in pregnancy?

Answer 9

Recommended daily intake of calcium 1000 mg PO daily. Can be prescribed as same.

Indicated when has dairy-free diet / low calcium intake.

Question 10

Why is omega-3 fatty acid important for pregnancy?

What is a good source of omega-3 fatty acid?

Answer 10

Omega-3 FAs are important for fetal brain and retina development.

Seafood is the richest source. Because seafood should be avoided in pregnancy women should consider taking a fish oil supplement.