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Background
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Vitamin D is important for calcium metabolism, bone growth and mineralisation. Around 90% of our vitamin D requirement comes from the action of UV light on skin.
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The average diet contains only about 10% of our requirements - insufficient to prevent deficiency. People with darker skin produce less vitamin D for a given sunlight exposure.
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In Melbourne, sun exposure is insufficient for people with dark skin. Women who choose to cover up, like Muslim women, are at high risk of vitamin D insufficiency, whatever the climate, because of low skin exposure to sunlight.
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Vitamin D has been measured in 120 covered or dark-skinned women at the Women's and 84% had very low levels1.
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Vitamin D deficiency
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Women with vitamin D deficiency are at risk of:
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- with accelerated risk of osteoporosis
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Babies of women with vitamin D deficiency during pregnancy are at risk of:
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There is also increasing evidence that the active form of vitamin D is a potent steroid hormone regulating important developmental processes.
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Screening and treatment
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Pregnant women at high risk of Vitamin D insufficiency are to be offered Vitamin D screening at booking. Refer to the  Antenatal Care Schedule-Routine Low Risk CPG
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For all veiled women:
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- any darker skinned women, including Indian and Sri Lankan
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1. Order Vitamin D levels
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2. Commence maintenance dose of 1000 units OsteVit-D® (Vitamin D - cholecalciferol) daily
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| - This can be obtained without prescription at pharmacies
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3. Check the report of the Vitamin D assay by the next appointment
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| Increase to 2000 units/day
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| | Continue maintenance dose 1000 units/day
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- encourage women to continue taking Vitamin D after birth
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- offer / advise Pentavite 0.45ml/day to their infants for the duration of breastfeeding and seek paediatric assessment / advice once weaned
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References
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- Grover S R, Morley R. Vitamin D deficiency in veiled or dark-skinned pregnant women, Medical Journal of Australia 2001, pp175, 251-2
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- Mason R S, Diamond T H. Editorials, Vitamin D deficiency and multicultural Australia, Medical Journal of Australia 2001, pp 175, 236-7
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- Nozza J M, Rodda C P., Vitamin D deficiency in mothers of infants with rickets, Medical Journal of Australia 2001, pp 175, 253-5
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Royal Women's Hospital Clinical Practice Guidelines (CPGs) are intended to provide guidance to health care professionals, based on a thorough evaluation of research evidence, on the practical assessment and management of specific clinical issues or situations. The guidelines allow some flexibility on the part of the health care professional based on the needs of the specific patient for whom they are caring.
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