Making sure pregnant and breastfeeding women receive vitamin D
With Britain and much of Europe in the midst of a cold snap, many of us have been doing our best to stay warm and fight off viral infections.
However, research shows that during the winter months it's also worth being aware of the dangers resulting from a lack of sunlight.
Figures from the National Diet and Nutrition Survey show that up to a quarter of people have low levels of vitamin D in their blood, and around one in six people in the UK have insufficient vitamin D in their systems by the end of winter.
Certain groups of people are at particular risk of vitamin D deficiency. These include people over the age of 65, infants and young children under 5, and those with low or no exposure to the sun.
Also at greater risk are pregnant women and those who breastfeed. NICE has recognised this and produced public health guidance on maternal and child nutrition which recommends that pregnant woman and those who breastfeed should take vitamin D supplements to ensure they are getting all the nutrients they need.
Among the problems resulting from vitamin D deficiency is the risk of developing bone problems such as rickets - a preventable condition that has become increasingly common among children in the UK.
Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE, says: “Vitamin D is essential for the growth and development of the baby's bones, by regulating the absorption of calcium and phosphate.
“The developing infant relies on the mother's vitamin D stores during pregnancy and breastfeeding.
“If the mother's own vitamin D stores are inadequate, lack of vitamin D may adversely affect fetal bone mineralisation.”
Addressing vitamin D deficiency
Concerned that more can be done to address vitamin D deficiency, the UK's Chief Medical Officers wrote to healthcare professionals earlier this month to raise awareness of the issue.
The officers recommend that all pregnant and breastfeeding women should take a daily supplement containing 10 micrograms (μg) of vitamin D.
This is to ensure that the mother's requirements for vitamin D are met, and to build adequate fetal stores for early infancy.
The recommendation is supported by NICE's public health guidance on maternal and child nutrition.
NICE says that during the booking appointment at the beginning of pregnancy, every woman should be offered information and advice from midwives on the benefits of taking a vitamin D supplement of 10 μg a day during pregnancy and while breastfeeding.
Women should also be told by healthcare professionals that the supplements will increase the vitamin D stores of both mother and baby, and reduce the risk of the baby developing rickets.
The guidance urges healthcare professionals to take particular care to check that those at greatest risk of vitamin D deficiency are advised to take vitamin D supplements during pregnancy and while breastfeeding.
These include women who are obese, have limited skin exposure to sunlight or who are of South Asian, African, Caribbean or Middle Eastern descent.
Figures from the 2005 Infant Feeding Survey suggest more can be done to spread the advice, as most women are currently not taking vitamin D supplements during pregnancy.
Professor Kelly says: “Health professionals, including midwives and health visitors may be unaware of the importance of vitamin D supplements for pregnant women or they may be concerned about its safety.
“But there is no evidence that vitamin D supplements at the doses recommended, in addition to what is normally consumed in the diet, are harmful.”
Healthy Start is here to help
To increase the take up of vitamin D supplements, the Chief Medical Officers recommend greater promotion of the availability of free vitamin D supplements.
Women and children who qualify for the government's Healthy Start scheme are entitled to get free vitamin supplements, including vitamin D.
NICE says that healthcare professionals should ensure that the scheme is promoted among those who are eligible.
GPs and health visitors should offer Healthy Start vitamin supplements, which include vitamin D, to all children aged from 6 months to 4 years in families receiving Healthy Start benefit.
Commissioners should consider distributing the supplements to all women who receive a Healthy Start benefit for children aged between 1 and 4, and particularly to those who may become pregnant.
Women are eligible for the scheme if they are at least 10 weeks pregnant or if they have a child under 4, and if they or their family receive either:
- income support, or
- income-based jobseeker's allowance, or
- income-related employment and support allowance, or
- child tax credit (but not working tax credit unless the family is receiving working tax credit run-on only) and has an annual family income of £16,190 or less.
Women who are under 18 and pregnant also qualify, even if they don't receive any of the benefits or tax credits above.
In their letter, the Chief Medical Officers urge for more to be done to promote the scheme as uptake is currently low.
Professor Kelly adds: “NICE's guidance recommends that the maternal vitamin supplements should be made available for all women with a child between 1 and 4 years, not just those eligible for Healthy Start benefits so that the risk of rickets could be reduced.
“Healthy Start vitamin supplements are considerably cheaper than commercially available alternatives.
“Increasing the availability of these supplements from community pharmacies - and women's awareness of their affordability - would support recommendations on vitamin D.”
All of NICE's guidance on nutrition during pregnancy can be found in the NICE pathway on diet, which also includes recommendations physical activity and weight management.
21 February 2012