Background:
Women with diabetes in pregnancy (both pre-existing and gestational, GDM) are routinely tested in Far North Queensland for low serum vitamin D levels, following the results of a recent study which revealed around 20% of such women had either insufficient or deficient levels of vitamin D.1
Aims:
To assess the appropriateness of vitamin D supplementation in the treatment of low vitamin D levels in this population of pregnant women, and to relate vitamin D levels to pregnancy outcomes.
Methods:
A prospective chart audit was conducted between February 2014 and February 2015 of all women attending the diabetes clinic at Cairns Hospital. All women were given an initial pathology request form to assess serum vitamin D levels. Those women diagnosed with vitamin D insufficiency or deficiency were given a script for supplementation and a repeat pathology request form to monitor serum vitamin D levels.
Results:
Of the women diagnosed with vitamin D insufficiency or deficiency, 69% did not have a follow-up blood test. Of those women who had a follow-up blood test, mean serum vitamin D levels were found to have increased significantly. However, when the sample was stratified by ethnicity, it was found that the mean serum vitamin D levels of non-Indigenous women increased significantly, whereas the mean serum vitamin D levels of Indigenous women did not increase significantly. No relationship was found between pregnancy outcomes and vitamin D levels during pregnancy.
Conclusions:
The results of this study indicate that the current guidelines for monitoring and treatment of vitamin D deficiency in pregnancy are not suitable for the majority of pregnant women with inadequate vitamin D levels in Far North Queensland. Other methods of treatment need to be considered including culturally appropriate education regarding low vitamin D levels and the possibility of providing supplements to women most at risk.
Key message:
Further research is required to assess the most effective education and treatment solution.