Pregnant women do not need to be routinely screened for vitamin D deficiency, according to a new policy from the American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, published online June 20 in Obstetrics & Gynecology.
There is no consensus on the optimal vitamin D level for pregnant women, Dr. George A. Macones, chair of the committee, said in a statement. Instead, the college recommends vitamin D testing only in pregnant women who are at increased risk for vitamin D deficiency.
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Existing evidence does not support screening all pregnant women for vitamin D deficiency, according to a new ACOG committee report.
High-risk groups include women who are vegetarians, those who have limited sun exposure because they live in northern locations or wear protective clothing, and women who are ethnic minorities, especially those with darker skin, according to ACOG committee opinion No. 495 (Obstet. Gynecol. 2011;118:) For these at-risk women, 1,000-2,000 IU of vitamin D supplementation daily is safe, but the safety of higher levels of supplementation has not been well studied, the committee wrote.
Women who are not at increased risk for vitamin D deficiency will get adequate vitamin D during pregnancy if they take a prenatal vitamin, the committee noted. The Institute of Medicine determined in 2010 that 600 IU of vitamin D daily was adequate for pregnant and lactating women, and most prenatal vitamins contain at least 400 IU per pill.
"I think first patients need to understand that most prenatal vitamins have vitamin D in them. If a patient is concerned beyond this, drinking fortified milk or fruit juices will help," Dr. Macones said in an interview.
Current evidence is insufficient to recommend screening all pregnant women for vitamin D deficiency, the committee wrote. "Recommendations concerning routine vitamin D. supplementation during pregnancy beyond that contained in a prenatal vitamin should await the completion of ongoing randomized clinical trials," they noted.
Dr. Macones emphasized that additional research is needed to improve understanding of the role of vitamin D during pregnancy. "I think this is really the key: We need to understand whether or not screening and supplementing with vitamin D in pregnancy improves the health of mother or baby. As of yet, we don’t know the answer to this, and that is why routine screening cannot be recommended," he said.
"I think there is lots of information and misinformation about vitamin D in the lay press, and patients are certainly asking about this," added Dr. Macones, the Mitchell and Elaine Yanow Professor and chair of obstetrics and gynecology at Washington University in St. Louis. "The goal of the opinion was really to tell ob.gyns. that you shouldn’t universally screen pregnant women for vitamin D deficiency."
Dr. Macones said he had no relevant financial disclosures.