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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 9  |  Issue : 1  |  Page : 32

Vitamin D Supplementation in Tunisian Pregnant Women: Needs More Evidence?


Department of Neonatology, Charles Nicolle Hospital, Tunis El Manar University, Tunis, Tunisia

Date of Submission25-Mar-2017
Date of Acceptance11-Jun-2017
Date of Web Publication09-Mar-2018

Correspondence Address:
Ayadi D Imene
Boulevard 9 April 1938, Tunis 1006
Tunisia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpvm.IJPVM_158_17

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How to cite this article:
Imene AD, Emira BH, Zahra M. Vitamin D Supplementation in Tunisian Pregnant Women: Needs More Evidence?. Int J Prev Med 2018;9:32

How to cite this URL:
Imene AD, Emira BH, Zahra M. Vitamin D Supplementation in Tunisian Pregnant Women: Needs More Evidence?. Int J Prev Med [serial online] 2018 [cited 2019 Jan 23];9:32. Available from: http://www.ijpvmjournal.net/text.asp?2018/9/1/32/226950



Dear Editor,

Vitamin D deficiency in pregnancy remains widespread globally.[1] Adequate Vitamin D status is needed for optimal pregnancy outcome. Very high prevalence of Vitamin D deficiency was reported in Tunisian mothers (98%) and their newborns (97%) with severe deficiency in most cases.[2],[3] Vitamin D deficiency exposes to adverse outcomes such as osteomalacia, preeclampsia, gestational diabetes, cesarean delivery, genital infection, preterm birth, low birth weight, hypocalcemia, and neonatal rickets.[4] Previous Tunisian studies reported the association between inadequate Vitamin D status and the risk of fetal neural tube defects [5] and preeclampsia.[6] Although Tunisia is a sunny country, sun exposure was reported to be insufficient and dietary Vitamin D intake does not achieved the dietary reference intakes in most women.[2],[3] Thus, Vitamin D supplementation is needed.

There are persistent controversies about the need and the effectiveness of Vitamin D supplementation during pregnancy to improve pregnancy outcome.[7],[8] Recent updated Cochrane review states that supplementing pregnant women with Vitamin D increases serum 25-hydroxyvitamin D (25 (OHD)) at term and may reduce the risk of preeclampsia, low birth weight, and preterm birth.[9] However, the review concluded that there were insufficient data to advise Vitamin D supplementation during pregnancy and recommended further high-quality research to answer more evidence of the effectiveness of Vitamin D supplementation on maternal and offspring outcomes.

Recent reviews reported significant increase in circulating 25 (OHD) in pregnant women who received Vitamin D supplementation and suggested that Vitamin D supplementation can safely be utilized during pregnancy.[8],[9]

For Tunisian pregnant women, given the high prevalence and the severity of Vitamin D deficiency, it would be relevant to establish Vitamin D supplementation to achieve adequate Vitamin D status. Recent recommendations indicate that pregnant women should receive 600 IU/day of supplemental Vitamin D to ensure adequacy of maternal serum 25 (OHD) levels.[10] There is continuing controversy over the appropriate dose of Vitamin D supplementation during pregnancy. The recommendation does not consider the severity of deficiency. Hence, there are some concerns in generalizing recommendations. A recent study conducted in a population of pregnant women with severe Vitamin D deficiency reported that with doses as high as 4000 IU/day, normalization of Vitamin D status was achieved in only 15% of the studied population. In view of the recent literature data, we recommend research to determine the appropriate doses of Vitamin D supplementation in Tunisian pregnant women, and we wish to appeal policies maker for introducing Vitamin D supplementation in the Tunisian prenatal care program.

In conclusion, Vitamin D deficiency is prevalent in Tunisian pregnant women and was reported to be associated with adverse outcomes in mothers and their newborns. We hope for soon Tunisian recommendations of Vitamin D supplementation during pregnancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Saraf R, Morton SM, Camargo CA Jr. Grant Global summary of maternal and newborn Vitamin D status – A systematic review. Matern Child Nutr 2016;12:647-68.  Back to cited text no. 1
    
2.
Ayadi ID, Nouaili EB, Talbi E, Ghdemssi A, Rached C, Bahlous A, et al. Prevalence of Vitamin D deficiency in mothers and their newborns in a Tunisian population. Int J Gynaecol Obstet 2016;133:192-5.  Back to cited text no. 2
    
3.
Fenina H, Chelli D, Ben Fradj MK, Feki M, Sfar E, Kaabachi N. Vitamin D deficiency is widespread in tunisian pregnant women and inversely associated with the level of education. Clin Lab 2016;62:801-6.  Back to cited text no. 3
    
4.
Lapillonne A. Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes. Med Hypotheses 2010;74:71-5.  Back to cited text no. 4
    
5.
Nasri K, Ben Fradj MK, Feki M, Kaabechi N, Sahraoui M, Masmoudi A, et al. Maternal 25-Hydroxyvitamin D level and the occurrence of neural tube defects in Tunisia. Int J Gynaecol Obstet 2016;134:131-4.  Back to cited text no. 5
    
6.
Fares S, Sethom MM, Khouaja-Mokrani C, Jabnoun S, Feki M, Kaabachi N. VitaminA, E, and D deficiencies in tunisian very low birth weight neonates: Prevalence and risk factors. Pediatr Neonatol 2014;55:196-201.  Back to cited text no. 6
    
7.
De-Regil LM, Palacios C, Ansary A, Kulier R, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2012;15:CD008873.  Back to cited text no. 7
    
8.
Harvey NC, Holroyd C, Ntani G, Javaid K, Cooper P, Moon R, et al. Vitamin D supplementation in pregnancy: A systematic review. Health Technol Assess 2014;18:1-190.  Back to cited text no. 8
    
9.
De-Regil LM, Palacios C, Lombardo LK, Peña-Rosas JP. Vitamin D supplementation for women during pregnancy. Cochrane Database Syst Rev 2016;14:CD008873.  Back to cited text no. 9
    
10.
Pludowski P, Holick MF, Grant WB, Konstantynowicz J, Mascarenhas MR, Haq A, et al. Vitamin D supplementation guidelines. J Steroid Biochem Mol Biol 2017. pii: S0960-076030031-6.  Back to cited text no. 10
    




 

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