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Vitamin D in pregnancy- continued….
What happens when Vitamin D is not maintained?
Without adequate vitamin D there is hypocalcaemia, which leads to hyperparathyroidism, which then both raises alkaline phosphatase and causes hypophosphataemia, eventually creating osteomalacia and rickets.
The mother may be asymptomatic or there may be osteomalacia, limb/bone pain, myopathy/myalgia, and obstetric problems during labour.
Low levels are also associated with gestational diabetes, pre-eclampsia, small-for-gestational-age babies, bacterial vaginitis, and a higher rate of caesarean sections.
Newborn babies of mothers who are vitamin D deficient are themselves vitamin D deficient. Unless the mother is also hypocalcaemic, the baby shows no obvious skeletal abnormality at birth. However, as there is very little vitamin D in breast milk, the baby’s vitamin D deficiency worsens unless cholecalciferol is given.
Problems can include:
• Hypocalcaemic seizures
• Limb deformity
• Developmental delay and myopathy
• Bone pain
• Delayed tooth eruption and enamel hypoplasia
• Raised intracranial pressure
There are also associations with immune-mediated diseases (asthma and wheeze, eczema, allergic rhinitis, multiple sclerosis, type 1 diabetes, pneumonia, RSV infections) and with poorer childhood growth and bone mass.
• Check vitamin D levels in the first trimester in all pregnant women.
• Check the baby’s vitamin D within first 4 weeks of birth if the mother is deficient.
Source: Associate Professor Craig Munns, Healthed Annual Women’s Health Update, Sydney 2012