Ealing Hospital
NHS Trust
Antenatal vitamin D supplementation in a multicultural population in a West London hospital
Galea P, Lo H, Kalkur S , T A N T O H L I C K
Department of Obstetrics & Gynaecology, Ealing Hospital NHS Trust, London, United Kingdom
INTRODUCTION
RESULTS
CONCLUSIONS
Vitamin D deficiency in pregnancy has been associated with a variety of
One hundred and sixty two women consented to be interviewed and
Despite the NICE guidance, implementation of vitamin D supplement is
pregnancy complications including an increased risk of pre-eclampsia and
were recruited for analysis. A significant 75% of those interviewed were
poor even in mothers at greatest risk of vitamin D deficiency. To improve
gestational diabetes [1]. It also plays a role in fetal development,
of ‘high risk’ ethnicities and a further 23% were obese. Overall, only 52 of
our standards, we have recommended various measures including
imprinting and immunological function, with a raised susceptibility to
mothers (32%) took vitamin D supplements, with a third starting pre-
successful implementation of staff education sessions, identification of
chronic disease in later life [2]. Furthermore, fetuses of vitamin D
conceptually or in the first trimester. Within the ‘high risk’ ethnicities, the
women at risk and pro-actively offer them vitamin D supplements in our
deficient mothers are at risks of neonatal hypoglycaemia, seizures, heart
overall compliance in vitamin D supplementation was less than a third
early pregnancy unit.
failure and rickets [3]. In 2008, the National Institute for Health and
with Caribbean and Middle Eastern women more likely to be left out
Clinical Excellence (NICE) recommended vitamin D supplementation for
(South Asia 53%, Africa 52%, Caribbean 75% and Middle East 70%)(Figure
all pregnant women with special emphasis to those at risk of Vitamin D
1). Similarly, only 37% of women with a BMI >30 kg/m2 were given
deficiency including women from South Asia, Africa, Caribbean and
vitamin D supplements (Figure 2).
Vitamin D
Middle East and obese women [4]. Both groups are in high prevalence in
No vitamin D
our population. We audited the compliance of this guidance in pregnant
women booked in our hospital to improve our care.
Chinese
0
No vitamin D
23
Vitamin D
13
1
2
Other Black
No Vitamin D
3
Africans
8
Vitamin D
6
Caribbean
3
1
Other Asians
METHODS
19
Figure 2. Vitamin D intake in pregnant women with a BMI≥30kg/m2. The
10
Pakistan
7
3
A prospective audit of 162 mothers delivered during a 2-month period
Indians
Any other mixed
(5th
February 2011 –
5th
April 2011) at Ealing Hospital Trust. Women were
verbally consented and interviewed by a team member using a
standardized questionnaire as regards to prescribing, usage and
0
White and Black
0
1
1
Any other white
23
5
White Irish
0
1
White British
compliance of vitamin D supplementation in pregnancy. Their
data labels are the actual number of patients (n=36).
42
17
8
1
0
5
10
15
20
25
30
35
40
45
demographics were collected from their medical records. The audit was
registered with our hospital’s Clinical Governance audit department.
National Research Ethics Service (NRES UK) exempted the project from
ethics approval as it was considered an Audit.
Figure 1. Vitamin D intake according to ethnicity. The data labels denote
the actual number of in that group (n=162)
Correspondence: paula.galea@doctors.net.uk
References: 1. Lewis, S., et al., Vitamin D deficiency and pregnancy: from preconception to birth. Mol Nutr Food Res. 54(8): p. 1092-102. 2. Kovacs, C.S., Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Am J Clin Nutr, 2008. 88(2): p. 520S-528S. 3. Mulligan, M.L., et
al., Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. 202(5): p. 429 e1-9. 4. Antenatal Care: Routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence: Guidance, ed. R. press. 2008, London: National Collaborating Centre for Women' and Children's
Health (UK).