Vitamin D testing & supplementation in Pregnancy- Australian guidelines

WHAT IS VITAMIN D?
Vitamin D is a hormone that controls calcium levels in the blood and is needed for strong bones, muscles and overall health. 

HEALTH EFFECTS OF LOW VITAMIN D
Vitamin D deficiency can mostly be asymptomatic but can have significant health implications without treatment. These can include bone and muscle pain, and softening of the bones. In pregnancy, vitamin D also helps to develop your baby’s bones. If you have a vitamin D deficiency it can affect the amount of calcium your baby has in their bones. In severe deficiency this can cause a bone deformity called rickets. Rickets is a preventable bone disease that can cause bones to bend and become an abnormal shape.

SOURCE OF VITAMIN D
Most of our vitamin D(almost 90%) is made in our skin by the sun’s ultraviolet rays.
In addition our bodies get a small amount from the food we eat (5-10%). It is present in oily fish such as mackerel and sardines and eggs and in Australia it is also added in small amounts to margarine and some brands of milk. Although liver and cod liver oil contain vitamin D, they are not recommended in pregnancy as they also contain too much vitamin A for pregnant women. 

VITAMIN D AND SAFE SUN EXPOSURE
Vitamin D levels change naturally with the seasons. How much UV exposure a person needs depends on the time of year, UV levels, their skin type and their existing vitamin D levels.
Overexposure to UV is never recommended, even for people who have vitamin D deficiency.It is important to get enough sunlight to produce vitamin D without increasing your risk of skin cancer.
In summer, many fair skinned people make enough vitamin D from having their hands, arms and face (or equivalent area of skin) in the sun for a few minutes each day during normal, day to day outdoor activities.
If you are fair skinned it is best to avoid the sun between 11am and 3pm in summer unless you are wearing sun protection.
In winter, in Victoria, you will need two to three hours of sunlight each week. People with darker skin need more sunlight and those with very black skin may need three to six times as much sunlight as fair skinned people. 

VITAMIN D TESTING & SUPPLEMENTATION IN PREGNANCY
Routine Vitamin D levels testing are no longer recommended at any stage in pregnancy. 
Latest Australian recommendations advise that all women, regardless of their skin colour, sun exposure and any other risk factors for vitamin D deficiency, to take at least 400units of vitamin D daily during pregnancy and continued for at least 6 weeks after baby is born. 
Please note that this dose is a recommendation for routine, asymptomatic pregnant females.
Vitamin D is given as Vitamin D3 supplement, which has a medical name of cholecalciferol.
If you are taking a pregnancy supplement, the dosage of Vitamin D differs amongst brands and should be checked in order to determine if additional Vitamin D supplementation is required.

Please note that these guidelines are made to avoid routine vitamin D testing and high dose vitamin D supplements where not clinically indicated.
For certain clinical indications and specific symptoms, your doctor will determine your eligibility for Vitamin D testing and may supplement you with much higher dose of Vitamin D.

Vitamin D supplements in Newborns
In Australia, it is now recommended that all babies are supplemented with Vitamin D until they are 6 months of age. In the case of babies receiving formula, Vitamin D supplementation should be continued until the baby has a daily intake of more than 1000mL of standard formula.
Recommendations is to give 400 IU to newborn baby. 
One of the common Vitamin D drops recommended for newborn is the ‘OsteVit-D® Vitamin D3 Kids Drops’, the dose is 2 drops given ONCE a day, starting on day 5 to 7 of life. This continues until 6 months of age unless directed otherwise by your doctor. One drop of the OsteVit-D® contains 200 IU (International Units) of Vitamin D.

Again note that these guidelines are made to avoid routine vitamin D testing and high dose vitamin D supplements where not clinically indicated.
For certain clinical indications , your doctor will determine your baby’s eligibility for Vitamin D testing and may supplement your baby with much higher dose of Vitamin D.

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