Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Prevalence of suboptimal vitamin D status during pregnancy. Maternal vitamin D sufficiency and reduced placental gene expression in angiogenic biomarkers related to comorbidities of pregnancy Maternal Serum and Breast Milk Vitamin D Levels: Findings from the Universiti Sains Malaysia Pregnancy Cohort Study The Effect of Vitamin D and Calcium plus Vitamin D during Pregnancy on Pregnancy and Birth Outcomes: a Randomized Controlled Trial. Vitamin D requirement in pregnancy to prevent deficiency in neonates: a randomised trial. Routine Vitamin Supplementation To Prevent Cancer and Cardiovascular Disease: Recommendations and Rationale Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Seasonal variation of maternal serum vitamin D in Newfoundland and Labrador. Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity. Daily Cholecalciferol Supplementation during Pregnancy Alters Markers of Regulatory Immunity, Inflammation, and Clinical Outcomes in a Randomized Controlled Trial. Maternal vitamin D supplementation during pregnancy and lactation to promote infant growth in Dhaka, Bangladesh (MDIG trial): study protocol for a randomized controlled trial Lipid-Based Nutrient Supplements Providing Approximately the Recommended Daily Intake of Vitamin A Do Not Increase Breast Milk Retinol Concentrations among Ghanaian Women. Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial The effects of ascorbic acid, vitamin B6, vitamin B12, and folic acid supplementation on the breast milk and maternal nutritional status of low socioeconomic lactating women. Vitamin D: do we get enough? Vitamin and Mineral Supplements: What Clinicians Need to Know. Rationale and Design of Khuzestan Vitamin D Deficiency Screening Program in Pregnancy: A Stratified Randomized Vitamin D Supplementation Controlled Trial Regular vitamin C supplementation during pregnancy reduces hospitalization: outcomes of a Ugandan rural cohort study National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention Maternal Early-Pregnancy Vitamin D Status Is Associated With Maternal Depressive Symptoms in the Amsterdam Born Children and Their Development Cohort Low iron status as a factor of increased bone resorption and effects of an iron and vitamin D-fortified skimmed milk on bone remodelling in young Spanish women Mid-pregnancy vitamin D levels and postpartum depression.
• The recommended level for serum 25-hydroxyvitamin D ( 25(OH)D ) in infants , children , adolescents and during pregnancy and lactation is ≥ 50 nmol/L. This level may need to be 10 - 20 nmol/L higher at the end of summer to maintain levels ≥ 50 nmol/L over winter and spring . • Sunlight is the most important source of vitamin D. The US recommended dietary allowance for vitamin D is 600 IU daily in children aged over 12 months and during pregnancy and lactation , assuming minimal sun exposure . • Risk factors for low vitamin D are : lack of skin exposure to sunlight , dark skin , southerly latitude , conditions affecting vitamin D metabolism and storage ( including obesity ) and , for infants , being born to a mother with low vitamin D and exclusive breastfeeding combined with at least one other risk factor . • Targeted measurement of 25(OH)D levels is recommended for infants , children and adolescents with at least one risk factor for low vitamin D and for pregnant women with at least one risk factor for low vitamin D at the first antenatal visit . • Vitamin D deficiency can be treated with daily low-dose vitamin D supplements , although barriers to adherence have been identified . High-dose intermittent vitamin D can be used in children and adolescents . Treatment should be paired with health education and advice about sensible sun exposure . Infants at risk of low vitamin D should be supplemented with 400 IU vitamin D₃ daily for at least the first year of life . • There is increasing evidence of an association between low vitamin D and a range of non-bone health outcomes , however there is a lack of data from robust r and omised controlled trials of vitamin D supplementation Low maternal vitamin D status has been associated with reduced intrauterine long bone growth and shorter gestation , decreased birth weight , as well as reduced childhood bone-mineral accrual . Despite data from other countries indicating low maternal vitamin D status is common during pregnancy , there is a dearth of information about vitamin D status during pregnancy in the Irish female population . Therefore , we prospect ively assessed vitamin D nutritive status and the prevalence of suboptimal vitamin D status in a cohort of Irish pregnant women . The mean ( SD ) daily intake of vitamin D  by the group of pregnant women was 3.6 ( 1.9 ) microg/day . None of the women achieved the recommended daily vitamin D intake value for Irish pregnant women ( 10 microg/day ) . Taking all three trimesters collectively , 14.3 - 23.7 % and 34.3 - 52.6 % of Irish women had vitamin D deficiency ( serum 25 ( OH ) D < 25 nmol/l ) and insufficiency ( serum 25 ( OH ) D 25 - 50 nmol/l ) , respectively during pregnancy . Both the levels of serum 25 ( OH ) D and the prevalence of vitamin D deficiency/adequacy were dramatically influenced by season , with status being lowest during the extended winter period and best during the extended summer period . These findings show that inadequate vitamin D status is common in Irish pregnant women INTRODUCTION Maternal circulating 25-hydroxyvitamin D [ 25(OH)D ] has been shown to optimize production of 1,25-dihydroxyvitamin D [ 1,25(OH)2D ] during pregnancy at approximately 100nmoles/L , which has pronounced effects on fetal health outcomes . Additionally , associations are noted between low maternal 25(OH)D concentrations and vascular pregnancy complications , such as preeclampsia . To further eluci date the effects of vitamin D activity in pregnancy , we investigated the role of maternal 25(OH)D , the nutritional indicator of vitamin D status , in relation to placental maintenance and , specifically , expression of placental gene targets related to angiogenesis and vitamin D metabolism . METHODS A focused analysis of placental mRNA expression related to angiogenesis , pregnancy maintenance , and vitamin D metabolism was conducted in placentas from 43 subjects enrolled in a r and omized controlled trial supplementing 400IU or 4400IU of vitamin D3 per day during pregnancy . Placental mRNA was isolated from biopsies within one hour of delivery , followed by quantitative PCR . We classified pregnant women with circulating concentrations of < 100nmoles/L as deficient and those with ≥100nmoles/L as sufficient . The value of each gene 's change in the PCR cycle threshold ( ΔCT ) , which is a relative measure of target concentration , was compared with maternal 25(OH)D concentrations < 100nmoles/L and ≥100nmoles/L based on a two- sample Wilcoxon test . RESULTS Soluble FMS-like tyrosine kinase 1 ( sFlt-1 ) and vascular endothelial growth factor ( VEGF ) gene expression was significantly downregulated in the maternal subgroup with circulating 25(OH)D ≥100ng/mL compared to the subgroup < 100ng/mL. DISCUSSION Here , we report a significant association between maternal vitamin D status and the expression of sFlt-1 and VEGF at the mRNA level . Achieving maternal circulating 25(OH)D ≥100nmoles/L suggests the impact of maternal vitamin D3 supplementation on gene transcription in the placenta , thereby potentially decreasing antiangiogenic factors that may contribute to vascular pregnancy complications Background Vitamin D deficiency has become a global health issue in pregnant women . This study aim ed to assess the adequacy of maternal vitamin D status by measuring maternal serum and breast milk 25-hydroxyvitamin D [ 25(OH)D ] levels and to determine the association between maternal serum and milk 25(OH)D levels . Methods Data was obtained from the Universiti Sains Malaysia Pregnancy Cohort Study . This study was conducted from April 2010 to December 2012 in the state of Kelantan , Malaysia . Blood sample s from pregnant women aged 19 to 40 years were drawn in the second and third trimesters of pregnancy , while breast milk sample s at delivery , 2 , 6 and 12 months postpartum were collected to analyze for 25(OH)D levels . A total of 102 pregnant women were included in the analysis . Results Vitamin D deficiency [ 25(OH)D < 50 nmol/L ] was detected in 60 % and 37 % of women in the second and third trimesters of pregnancy , respectively . There were 6 % and 23 % of women who reached normal level of vitamin D status in the second trimester and the third trimester , respectively . Multivitamin intakes during pregnancy were significantly associated with higher serum 25(OH)D levels in the second trimester ( β = 9.16 , p = 0.005 ) and the third trimester ( β = 13.65 , p = 0.003 ) . 25(OH)D levels in breast milk during the first year of lactation ranged from 1.01 to 1.26 nmol/L. Higher maternal serum 25(OH)D level in the second trimester of pregnancy was associated with an elevated level of 25(OH)D in breast milk at delivery ( β = 0.002 , p = 0.026 ) . Conclusions This study shows that high proportions of Malay pregnant women are at risk of vitamin D deficiency . Maternal vitamin D status in the second trimester of pregnancy was found to influence vitamin D level in breast milk at delivery INTRODUCTION Evidence suggests a high prevalence of calcium and vitamin D deficiencies exists in both pregnant women and babies . Adequate intake of micronutrients has great importance especially during pregnancy and lactation period . Thus , the present study aim ed at assessing the effect of vitamin D and calcium-vitamin D on pregnancy and birth outcomes ( including duration of pregnancy , type of delivery and infant anthropometric indicators ) . METHODS A r and omized , controlled , clinical , triple-blind trial conducted on 126 pregnant women referring to Tabriz health centers in 2013 - 14 . Subjects were allocated into three groups using block r and omization . Interventional groups received vitamin D , calcium-vitamin D and placebo pills daily for 60 days . ANCOVA and Chi-square tests were used for data analysis . RESULTS By controlling BMI before and during pregnancy , there were no significant differences between the group in average neonatal weight , height and head circumference , duration of pregnancy , type of delivery and gestational age at the time of delivery . CONCLUSION The results show that calcium-vitamin D and vitamin D have no effect on duration of pregnancy , type of delivery and infant anthropometric indicators INTRODUCTION The exact amount of vitamin D required for pregnant women to adequately supply the foetus during pregnancy is still unclear . This r and omised trial attempted to determine the optimal dose of vitamin D necessary during pregnancy in order to attain a vitamin D level > 20 ng/mL in neonates . METHODS A total of 51 healthy , pregnant women in Yazd , Iran , were recruited in 2009 . Of these , 34 were r and omised to receive either 50,000 IU ( Group A ) or 100,000 IU ( Group B ) of vitamin D3 per month from the second trimester of pregnancy . The remaining 17 pregnant women , who formed the third group ( Group C ) and were found to have vitamin D deficiency , were initially treated with 200,000 IU of vitamin D3 , following which the dose was adjusted to 50,000 IU per month . 25-hydroxyvitamin D ( 25[OH]D ) in cord blood was measured by chemiluminescence immunoassay , and a serum 25(OH)D level < 20 ng/mL was defined as deficiency . RESULTS All the pregnant women had a vitamin D level < 30 ng/mL at the beginning of the second trimester . The neonates of 76 % of women from Group A had sufficient levels of 25(OH)D. All the neonates born to women in Groups B and C had 25(OH)D > 20 ng/mL. No side effects were observed in our participants during the period of vitamin D supplementation . CONCLUSION A vitamin D3dose > 50,000 IU/month is required during the second and third trimesters of pregnancy for vitamin D-deficient pregnant women in order for their neonates to achieve serum 25(OH)D levels > 20 ng/mL. Supplementation with < 50,000 IU/month is insufficient to ensure a vitamin D level > 20 ng/mL in all neonates born to vitamin D-deficient pregnant women Summary of the Recommendations The U.S. Preventive Services Task Force ( USPSTF ) concludes that the evidence is insufficient to recommend for or against the use of supplements of vitamins A , C , or E ; multivitamins with folic acid ; or antioxidant combinations for the prevention of cancer or cardiovascular disease . This is a grade I recommendation . ( See Appendix Table 1 for a description of the USPSTF classification of recommendations . ) The USPSTF found poor evidence to determine whether supplementation with these vitamins reduces the risk for cardiovascular disease or cancer . ( See Appendix Table 2 for a description of the USPSTF classification of levels of evidence . ) The available evidence from r and omized trials is either inadequate or conflicting , and the influence of confounding variables on observed outcomes in observational studies can not be determined . As a result , the USPSTF could not determine the balance of benefits and harms of routine use of supplements of vitamins A , C , or E ; multivitamins with folic acid ; or antioxidant combinations for the prevention of cancer or cardiovascular disease . The USPSTF recommends against the use of beta-carotene supplements , either alone or in combination , for the prevention of cancer or cardiovascular disease . This is a grade D recommendation . The USPSTF found good evidence that -carotene supplementation provides no benefit in the prevention of cancer or cardiovascular disease in middle-aged and older adults . In two trials restricted to heavy smokers , -carotene supplementation was associated with higher incidence of lung cancer and higher all-cause mortality . The USPSTF concludes that -carotene supplements are unlikely to provide important benefits and might cause harm in some groups . Clinical Considerations The USPSTF did not review evidence regarding vitamin supplementation for patients with known or potential nutritional deficiencies , including pregnant and lactating women , children , elderly persons , and people with chronic illnesses .  Dietary supplements may be appropriate for people whose diet does not provide the recommended dietary intake of specific vitamins . Individuals may wish to consult a health care provider to discuss whether dietary supplements are appropriate . With the exception of vitamins for which there is compelling evidence of net harm ( for example , beta-carotene supplementation in smokers ) , there is little reason to discourage people from taking vitamin supplements . Patients should be reminded that taking vitamins does not replace the need to eat a healthy diet . All patients should receive information about the benefits of a diet high in fruits and vegetables , as well as information on other foods and nutrients that should be emphasized or avoided in their diet ( see the 2002 USPSTF recommendations on counseling to promote a healthy diet [ 1 ] ) . Patients who choose to take vitamins  should be encouraged to adhere to the dosages recommended in the Dietary Reference Intakes of the Institute of Medicine . Some vitamins , such as A and D , may be harmful in higher doses ; therefore , doses greatly exceeding the Recommended Dietary Allowance or Adequate Intake should be taken with care while considering whether potential harms outweigh potential benefits . Vitamins and minerals sold in the United States are classified as dietary supplements , and there is a degree of quality control over content if they have a U.S. Pharmacopeia seal ( 2 ) . Nevertheless , imprecision in the content and concentration of ingredients could pose a theoretical risk not reflected in clinical trials using calibrated compounds . The adverse effects of beta-carotene on smokers have been observed primarily in those taking large supplemental doses . There is no evidence to suggest that beta-carotene is harmful to smokers at levels occurring naturally in foods . The USPSTF did not review evidence supporting folic acid supplementation among pregnant women to reduce neural tube defects . In 1996 , the USPSTF recommended folic acid for all women who are planning , or capable of , pregnancy ( see the 1996 USPSTF chapter on screening for neural tube defects [ 3 ] ) . Clinicians and patients should discuss the possible need for vitamin supplementation when taking certain medications ( for example , folic acid supplementation for patients taking methotrexate ) . Scientific Evidence The USPSTF review s ( 4 - 6 ) focused on the quality of the evidence regarding the effect of routine supplementation with certain vitamins on primary prevention of cancer and cardiovascular disease . These review s were undertaken because of the growing epidemiologic evidence that dietary factors may play a role in the etiology of these diseases ( 7 - 9 ) . The review s focused on prospect i ve trials of vitamin supplementation and observational studies of associations between the use of specific supplements and the risk for cancer or cardiovascular disease . The value of vitamins naturally occurring in food , the use of vitamin supplements for the prevention of other conditions ( for example , neural tube defects ) , and the use of vitamin supplements for the secondary prevention of complications in patients with existing disease were outside the scope of these review s. Vitamin A No prospect i ve trials have examined the effect of vitamin A supplements alone on the risk for cancer . Observational studies provide no evidence that such supplements prevent cancer in men . In women , observational studies have reported a statistically significant inverse association between use of vitamin A supplements and risk for colon and breast cancer ( 10 , 11 ) . Despite efforts to adjust for confounding variables , the observational , nonr and om design of these studies makes it difficult to assess the extent to which the reduced cancer risk is attributable to vitamin A or to other characteristics of women who take vitamin A supplements .  No evidence from prospect i ve trials is available regarding the benefits of vitamin A alone in preventing cardiovascular disease . One good- quality cohort study found no effect of vitamin A supplementation in reducing cardiovascular disease mortality ( 12 ) . Vitamin C No primary prevention trial of the effect of vitamin C supplementation alone on cancer or cardiovascular disease has been reported . Observational studies have generally shown no statistically significant associations between use of vitamin C supplements and risk for cancer of the breast , prostate , colon , or lung ( 12 - 14 ) . The observational cohort studies examining the effects of vitamin C on cardiovascular disease have produced inconsistent results ( 12 , 15 , 16 ) . Vitamin E Only a few trials have examined the effects of vitamin E on the primary prevention of cancer or cardiovascular disease . A r and omized , controlled trial ( RCT ) involving Finnish male smokers found that vitamin E supplementation is not protective against lung cancer but may have a beneficial impact on prostate cancer ( 14 ) . Because prostate cancer was not a primary end point of the trial and the trial had other limitations , further evidence is needed to confirm this finding . Observational studies have shown no statistically significant association between use of vitamin E supplements and risk for prostate , lung , or breast cancer ( 5 ) . One study suggested that vitamin E protects against colon cancer , but the influence of confounding variables can not be fully excluded ( 17 ) . Among primary prevention trials , two good- quality trials ( 14 , 18 ) and one fair- quality trial ( 19 ) found no statistically significant benefit of vitamin E supplementation in preventing cardiovascular disease ( 20 ) . Only one of seven trials of vitamin E supplementation for secondary prevention demonstrated a statistically significant reduction in cardiac events ( 4 ) . Some prospect i ve cohort studies have suggested a significant benefit , but the results are mixed and the influence of confounding variables can not be excluded ( 4 ) . -Carotene A consistent body of evidence from clinical trials suggests that beta-carotene supplementation does not decrease the risk for lung , prostate , colon , breast , or nonmelanoma skin cancer ( 14 , 21 - 25 ) . -Carotene supplements were associated with an increased risk for lung cancer among smokers , especially heavy smokers , in two RCTs ( 14 , 25 ) . Results from four RCTs demonstrated no reduced risk for cardiovascular events or death after beta-carotene supplementation ( 14 , 21 , 22 , 26 - 28 ) . Antioxidant Vitamin Combinations Studies of the effects of antioxidant vitamin combinations to prevent cancer have yielded mixed results . A recent RCT reported no statistically significant effect of daily supplementation with a combination of antioxidants : vitamin E , vitamin C , and beta-carotene ( 29 ) . Some studies have suggested an adverse effect of antioxidant combinations on cancer , but the results may have been confounded by the inclusion of beta-carotene ( 5 ) . Some observational studies of antioxidant vitamin combinations have suggested a benefit in preventing cardiovascular disease ( 13 , 30 , 31 ) , but other studies , including well- design ed RCTs , have shown no benefit ( 29 , 32 , 33 ) . One secondary prevention trial showed an increase in all-cause mortality among women taking antioxidant supplements  ( 34 ) . Multiple Vitamin Combinations The incremental benefit of taking supplemental doses of folic acid and B vitamins has been examined by comparing the outcomes of observational studies while controlling for the total intake of antioxidant vitamin supplements ( 35 ) . In these analyses , folic acid supplementation was associated with significantly decreased risk for colon cancer , but the protective effect requires confirmation in prospect i ve trials . There is conflicting evidence regarding the use of multivitamins and the risk for cardiovascular disease . Among cohort studies , one good- quality study reported a statistically significant reduction in coronary events ( 36 ) , two good- quality studies reported no statistically significant effect on mortality ( 16 , 37 ) , and one Scientific data pertaining to vitamin D supplementation during lactation are scarce . The daily recommended intake for vitamin D during lactation has been arbitrarily set at 400 IU/d ( 10 microg/d ) . This recommendation is irrelevant with respect to maintaining the nutritional vitamin D status of mothers and nursing infants , especially among darkly pigmented individuals . Our objective was to examine the effect of high-dose maternal vitamin D2 supplementation on the nutritional vitamin D status  of mothers and nursing infants . Fully lactating women ( n = 18 ) were enrolled at 1 mo after birth to 1 of 2 treatment arms , ie , 1600 IU vitamin D2 and 400 IU vitamin D3 ( prenatal vitamin ) or 3600 IU vitamin D2 and 400 IU vitamin D3 , for a 3-mo study period . High-dose ( 1600 or 3600 IU/d ) vitamin D2 supplementation for a period of 3 mo safely increased circulating 25-hydroxyvitamin D [ 25(OH)D ] concentrations for both groups . The antirachitic activity of milk from mothers receiving 2000 IU/d vitamin D increased by 34.2 IU/L , on average , whereas the activity in the 4000 IU/d group increased by 94.2 IU/L. Nursing infant circulating 25(OH)D2 concentrations reflected maternal intake and the amount contained in the milk . With limited sun exposure , an intake of 400 IU/d vitamin D would not sustain circulating 25(OH)D concentrations and thus would supply only limited amounts of vitamin D to nursing infants in breast milk . A maternal intake of 2000 IU/d vitamin D would elevate circulating 25(OH)D concentrations for both mothers and nursing infants , albeit with limited capacity , especially with respect to nursing infants . A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status BACKGROUND Research has suggested that vitamin D insufficiency and deficiency is common at northern latitudes , and that vitamin D insufficiency and deficiency may be common during pregnancy . We measured the serum 25-hydroxyvitamin D ( 25-[OH]D ) status of pregnant women across the province of Newfoundl and and Labrador in both summer and winter to investigate seasonal differences , age associations , and differences in geospatial distribution across the province . METHODS We uniformly and r and omly sample d blood from pregnant women in each of 79 census consoli date d subdivisions across Newfoundl and and Labrador from January to March 2007 and from July to September 2007 . RESULTS We obtained 304 sample s from the end of winter ( March ) and 289 sample s from the end of summer ( September ) . Mean serum 25-(OH)D concentration was 52.1 nmol/L in winter and 68.6 nmol/L in summer ( P < 0.001 ) ; 89 % were vitamin D insufficient in the winter and 64 % in the summer ( P < 0.001 ) ; 6.6 % were vitamin D deficient in winter and 1.7 % in summer ( P = 0.003 ) , and younger women tended to be more vitamin D insufficient in the winter than older women . The geospatial distribution of vitamin D insufficiency tends to follow a north-south distribution in the winter . CONCLUSIONS A significant proportion of pregnant women in Newfoundl and and Labrador are vitamin D insufficient . Vitamin D insufficiency may have important adverse health consequences for both the mother and the fetus . Further study is necessary to address health outcomes and effects of vitamin D supplementation and lifestyle changes in this population Osteoporotic fractures , falls and obesity are major health problems in developed nations . Evidence suggests that there are antenatal factors predisposing to these conditions . Data are emerging from Australia and elsewhere to suggest that maternal vitamin D status in pregnancy affects intrauterine skeletal mineralisation and skeletal growth together with muscle development and adiposity . Given that low levels of vitamin D have been documented in many urbanised population s , including those in countries with abundant sunlight , an important issue for public health is whether maternal vitamin D insufficiency during pregnancy has adverse effects on offspring health . The developing fetus may be exposed to low levels of vitamin D during critical phases of development as a result of maternal hypovitaminosis D. We hypothesise that this may have adverse effects on offspring musculoskeletal health and other aspects of body composition . Further research focused on the implication s of poor gestational vitamin D nutrition is warranted as these developmental effects are likely to have a sustained influence on health during childhood and in adult life . We suggest that there is a clear rationale for r and omised clinical trials to assess the potential benefits and harmful effects of vitamin D supplementation during pregnancy BACKGROUND Vitamin D deficiency is widespread in pregnancy and has been associated with adverse health conditions in mothers and infants .  Vitamin D supplementation in pregnancy may support the maintenance of pregnancy by its effects on innate and adaptive immunity . OBJECTIVE We assessed the effects of vitamin D supplementation during pregnancy on vitamin D status and markers of immune function associated with adverse pregnancy outcomes . METHODS We conducted a r and omized , controlled , double-blind intervention of 2 doses of cholecalciferol ( 400 and 2000 IU/d ) from < 20 wk to delivery in 57 pregnant women .  Vitamin D status , regulatory and inflammatory T cells , markers of innate immunity and systemic inflammation , and clinical outcomes including maternal blood pressure and birth weight were assessed at 26 and 36 wk of pregnancy . RESULTS Supplementation with 2000 IU/d vitamin D had a greater effect on the change in vitamin D status over pregnancy ( P < 0.0001 ) and the final value at 36 wk ( P < 0.0001 ) than 400 IU/d , increasing serum 25-hydroxyvitamin D from 81.1 nmol/L at baseline to 116 nmol/L at 36 wk and from 69.6 nmol/L at baseline to 85.6 nmol/L at 36 wk , respectively . The 2000-IU/d group had 36 % more interleukin-10 + regulatory CD4 + T cells at 36 wk than did the 400-IU/d group ( P < 0.007 ) . The daily intake of 2000 compared with 400 IU/d tended to dampen the pregnancy-related increase in diastolic blood pressure by 1.3-fold ( P = 0.06 ) and increase birth weight by 8.6 % ( P = 0.06 ) , but these differences were not statistically significant . CONCLUSIONS Supplementation with 2000 IU/d is more effective at increasing vitamin D status in pregnant women than 400 IU/d and is associated with increased regulatory T cell immunity that may prevent adverse outcomes caused by excess inflammation . This trial was registered at clinical trials.gov as NCT01417351 Background Vitamin D regulates bone mineral metabolism and skeletal development . Some observational studies have suggested that prenatal vitamin D deficiency increases the risk of adverse pregnancy and /or birth outcomes ; however , there is scant evidence from controlled trials , leading the World Health Organization to advise against routine vitamin D supplementation in pregnancy . Importantly , little is known about the effect of maternal vitamin D status on infant linear growth in communities in South Asia where stunting is highly prevalent and maternal-infant vitamin D status is commonly suboptimal . Methods / Design The Maternal Vitamin D for Infant Growth study is a r and omized , placebo-controlled , dose-ranging trial of  maternal vitamin D supplementation during pregnancy and lactation in Dhaka , Bangladesh . The primary aims are to estimate ( 1 ) the effect of maternal prenatal oral vitamin D3 supplementation ( 4200 IU/wk , 16,800 IU/wk , or 28,000 IU/wk , administered as weekly doses ) versus placebo on infant length at 1 year of age and ( 2 ) the effect of maternal postpartum oral vitamin D3 supplementation ( 28,000 IU/wk ) versus placebo on length at 1 year of age among infants born to women who received vitamin D 28,000 IU/wk during pregnancy . Generally healthy pregnant women ( n = 1300 ) in the second trimester ( 17–24 weeks of gestation ) are r and omized to one of five parallel arms : placebo 4200 IU/wk , 16,800 IU/wk , or 28,000 IU/wk in the prenatal period and placebo in the postpartum period or 28,000 IU/wk in the prenatal period and 28,000 IU/wk in the postpartum period . Household- and clinic-based follow-up of mother-infant pairs is conducted weekly by trained personnel until 26 weeks postpartum and every 3 months thereafter . The primary trial outcome measure is length for age z-score at 1 year of age . Anthropometric measurements , clinical information , and biological specimens collected at scheduled intervals will enable the assessment of a range of maternal , perinatal , and infant outcomes . Discussion The role of vitamin D in maternal and infant health remains unresolved . This trial is expected to contribute unique insights into the effects of improving maternal-infant vitamin D status in a low-income setting where stunting and adverse perinatal outcomes represent significant public health burdens . Trial registration Clinical Trials.gov identifier : NCT01924013 . Registered on 13 August BACKGROUND Vitamin A deficiency remains a global public health problem . Daily supplementation with a lipid-based nutrient supplement ( LNS ) has potential for increasing milk vitamin A concentrations . OBJECTIVE The objective of this study was to determine whether daily supplementation with approximately the recommended daily intake of vitamin A in an LNS or a multiple-micronutrient supplement ( MMN ) during pregnancy and the first 6 mo postpartum has an effect on breast milk retinol concentration at 6 mo postpartum . METHODS Women ≤20 wk pregnant ( n = 1320 ) were r and omly assigned to receive either the MMN providing 18 micronutrients , including 800 μg retinol equivalents of vitamin A , or the LNS with the same nutrients as the MMN group , plus 4 minerals and macronutrients , until 6 mo postpartum ; a control group received iron and folic acid during pregnancy and a placebo ( calcium tablet ) during the first 6 mo postpartum . Breast milk sample s collected at 6 mo postpartum were analyzed for retinol and fat concentrations by HPLC and creamatocrit , respectively , in a sub sample of 756 women . RESULTS The breast milk retinol concentration was ( mean ± SD ) 56.3 ± 2.1 nmol/g fat , with no significant differences between groups [ iron and folic acid ( n = 243 ) : 59.1 ± 2.8 ; MMN ( n = 260 ) : 55.4 ± 2.5 ; LNS ( n = 253 ) : 54.7 ± 2.5 nmol/g fat ; P = 0.45 ] , regardless of whether the woman had or had not received a high-dose vitamin A supplement ( 200,000 IU ) soon after childbirth . Around 17 % of participants had low milk retinol ( ≤28 nmol/g fat ) . We estimated that 41 % of infants were potentially receiving vitamin A at amounts above the Tolerable Upper Intake Level ( 600 μg retinol activity equivalents/d ) , with no group differences in percentages with low or high milk retinol concentration . CONCLUSION Daily consumption of approximately the recommended intake of vitamin A did not increase breast milk retinol concentrations in this sample of Ghanaian women . This trial was registered at clinical trials.gov as NCT00970866 Context Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation , no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care . Objective We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [ 25(OH)D ] levels and preventing pregnancy complications . Also , to identify a safe regimen , we compared several regimens in a subgroup of vitamin D-deficient pregnant women . Design Two cities of Masjed-Soleyman and Shushtar from Khuzestan province , Iran , were selected as the screening and nonscreening arms , respectively . Within the screening arm , a r and omized controlled trial was conducted on 800 pregnant women . Setting Health centers of Masjed-Soleyman and Shushtar cities . Patients or Participants Pregnant women aged 18 to 40 years . Intervention Women with moderate [ 25(OH)D , 10 to 20 ng/mL ] and severe [ 25(OH)D , < 10 ng/mL ] deficiency were r and omly divided into four subgroups and received vitamin D3 ( D3 ) until delivery . Main Outcome Measure Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications . Results After supplementation , only 2 % of the women in the nonscreening site met the sufficiency level ( > 20 ng/mL ) vs 53 % of the women in the screening site . Adverse pregnancy outcomes , including preeclampsia , gestational diabetes mellitus , and preterm delivery , were decreased by 60 % , 50 % , and 40 % , respectively , in the screening site . A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery . Conclusions A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women , improving 25(OH)D levels , and decreasing pregnancy adverse outcomes In this double-blind study , the effects of ascorbic acid , vitamin B6 , vitamin B12 , and folate supplementation on the maternal nutritional status and vitamin content of breast milk in 16 low socioeconomic lactating women were studied . Nine subjects were administered a commercial multivitamin-multimineral supplement and seven were given placebos . Milk sample s were collected four times per day at 4-h intervals from 5 to 7 and 43 to 45 days postpartum . Fasting blood sample s were taken from all mothers at the end of each milk collection period . Dietary records of all foods consumed were kept from 4 to 7 and 42 to 45 days postpartum . There were no significant differences in milk or plasma levels of ascorbic acid between the unsupplemented and supplemented groups . Both the EGPT index and milk concentration of vitamin B6 were significantly different ( p less than 0.01 ) between the unsupplemented and supplemented groups . The milk concentrations of vitamin B12 increased significantly ( p less than 0.05 ) in the supplemented group , as did the milk concentrations of folate ( p less than 0.01 ) . Because of consistently low levels of dietary vitamin B6 and folic acid in this group of low socioeconomic lactating women , either dietary changes or supplements could be necessary to maintain recommended levels of these vitamins in the womens ' breast milk Summary On September 29 , 2011 , acknowledged experts in the field of vitamin D , mainly European , were brought together in order to discuss the recent scientific advances in relation to vitamin D : the current requirements and associations with various health outcomes . In this article , the discussion s result ing from the meeting are summarized . Introduction Several groups at risk for developing vitamin D insufficiency have been identified . Accordingly , review s indicate that a significant percentage of the population worldwide have serum 25-hydroxyvitamin D levels below 50 nmol/l . In addition to the role of vitamin D in bone health , recent studies suggest that it may play a pivotal role in other systems , e.g. , the cardiovascular system , pancreas , muscle , immune system and brain . Most evidence , however , is obtained from observational studies and yet inconclusive . Methods To exchange and broaden knowledge on the requirements for vitamin D and its effect on various health outcomes , a workshop entitled “ Vitamin D Expert Meeting : Do we get enough ? ” , was organized . Results Despite low vitamin D levels worldwide , consensus on the definition of deficiency is not yet reached . In order to define cut-off points for vitamin D whilst taking into account extraskeletal health effects , r and omized controlled trials in these fields are warranted . The experts do emphasize that there is evidence to suggest an important role for vitamin D in the maintenance of optimal bone health at all ages and that vitamin D supplementation , in most studies co-administered with calcium , reduces fracture risk in the senior population . Conclusion To reach a serum 25-hydroxyvitamin D level of 50 nmol/l older adults aged ≥65 years are therefore recommended to meet a mean daily vitamin D intake of 20 μg ( 800 IU ) , which is best achieved with a supplement Dietary supplementation is approximately a $ 30 billion industry in the United States , with more than 90 000 products on the market . In recent national surveys , 52 % of US adults reported use of at least 1 supplement product , and 10%reporteduseofatleast4suchproducts.1 Vitamins and minerals are among the most popular supplements and are taken by 48 % and 39 % of adults , respectively , typically to maintain health and prevent disease . Despite this enthusiasm , most r and omized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency . Indeed , some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg , high doses of beta carotene , folic acid , vitamin E , or selenium — may have harmful effects , including increased mortality , cancer , and hemorrhagic stroke.2 In this Viewpoint , we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients , as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals . Importantly , clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and , in most cases , provides little if any benefit beyond that conferred by such a diet . Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements . Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects.2,3 A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form . Indeed , research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.3 Although routine micronutrient supplementation is not recommended for the general population , targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone , including people at certain life stages and those with specific risk factors ( discussed in the next 3 sections and in the Box ) Background Although there have been marked improvements in our underst and ing of vitamin D functions in different diseases , gaps on its role during pregnancy remain . Due to the lack of consensus on the most accurate marker of vitamin D deficiency during pregnancy and the optimal level of 25-hydroxyvitamin D , 25(OH)D , for its definition , vitamin D deficiency assessment during pregnancy is a complicated process . Besides , the optimal protocol for treatment of hypovitaminosis D and its effect on maternal and neonatal outcomes are still unclear . Objective The aim of our study was to estimate the prevalence of vitamin D deficiency in the first trimester of pregnancy and to compare vitamin D screening strategy with no screening . Also , we intended to compare the effectiveness of various treatment regimens on maternal and neonatal outcomes in Masjed-Soleyman and Shushtar cities of Khuzestan province , Iran . Methods This was a two-phase study . First , a population -based cross-sectional study was conducted ; recruiting 1600 and 900 first trimester pregnant women from health centers of Masjed-Soleyman and Shushtar , respectively , using stratified multistage cluster sampling with probability proportional to size ( PPS ) method . Second , to assess the effect of screening strategy on maternal and neonatal outcomes , Masjed-Soleyman participants were assigned to a screening program versus Shushtar participants who became the nonscreening arm . Within the framework of the screening regimen , an 8-arm blind r and omized clinical trial was undertaken to compare the effects of various treatment protocol s. A total of 800 pregnant women with vitamin D deficiency were selected using simple r and om sampling from the 1600 individuals of Masjed-Soleyman as interventional groups . Serum concentrations of 25(OH)D were classified as : ( 1 ) severe deficient ( < 10ng/ml ) , ( 2 ) moderate deficient ( 10 - 20ng/ml ) , and ( 3 ) normal status ( > 20ng/ml ) . Those with severe and moderate deficiency were r and omly divided into 4 subgroups and received vitamin D3 based on protocol and were followed until delivery . Data was analyzed according to the intention-to-treat principle . Results Recruitment commenced in July , 2014 , and as estimated , nearly 3.5 years is needed to complete the study . Results of this study will ( 1 ) provide reliable information regarding the prevalence of vitamin D deficiency during pregnancy using universal vitamin D screening approach and ( 2 ) determine the beneficial effects of universal screening and compare the various treatment protocol s in terms of pregnancy outcomes . Conclusions Since vitamin D deficiency is a prevalent disorder in pregnancy among Iranian population , this study will ensure creation of reliable evidence -based findings and will enable clinicians to better evaluate and treat vitamin D deficient pregnant women . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 2014102519660N1 ; http://www.i rct .ir/ search result .php?keyword=&id=19660&number=1&prt=7805&total=10&m=1 ( Archived by WebCite at http://www.webcitation.org/6p3lkqFdV Background Vitamin C or ascorbic acid is a hydro-soluble lactone ( synthesized from glucose ) essential to human body and available from diet . Despite its broad availability in fruits and vegetables , in many developing countries the incidence of clinical symptoms due to the vitamin deficiency is still very high . Also , pregnant women in the developing countries are frequently hospitalized for several preventable reasons such as anemia in pregnancy , mostly iron-deficient anemia ( IDA ) and the upper/lower respiratory tract infections ( RTI ) . The aim of the study was to investigate , in a Ug and an rural pregnant women cohort , the preventive effects of vitamin C supplementation on hospital admission . Methods 384 pregnant women met the inclusion criteria and were r and omly assigned to receive either 400 mg of vitamin C daily ( 187 ) or not ( 197 ) in addition to their st and ard antenatal vitamins until delivery . The primary outcome measure of this study was to assess the prevention of hospitalization during pregnancy in the group of women supplemented with vitamin C compared to the controls . Fisher‘s exact test was employed in this assessment . Results 42.2 % women in the vitamin C group and 27.9 % in the control group were not hospitalized during pregnancy ; this difference was found statistically significant . Conclusion The results of this study suggest including vitamin C in the guidelines of multivitamin prevention for pregnant women , especially in developing countries where seasonal availability of fruits and vegetables could result in adverse clinical outcomes National Institutes of Health ( NIH ) consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1 ) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality ( AHRQ ) , 2 ) presentations by investigators working in areas relevant to the conference questions during a 2-day public session , 3 ) questions and statements from conference attendees during open discussion periods that are part of the public session , and 4 ) closed deliberations by the panel during the remainder of the second day and the morning of the third . This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government . The statement reflects the panel 's assessment of medical knowledge available at the time the statement was written . Thus , it provides a snapshot in time of the state of knowledge on the conference topic . When reading the statement , keep in mind that new knowledge is inevitably accumulating through medical research . At least half of American adults take a dietary supplement , the majority of which are multivitamin/multimineral ( MVM ) supplements . As more and more Americans seek strategies for maintaining good health and preventing disease , and as the marketplace offers an increasing number of products to fulfill that desire , it is important that consumers have the best possible information to make their choices . Assessing the available scientific evidence on the benefits of MVM supplement use for chronic disease prevention , identifying the gaps in the evidence , and recommending an appropriate research agenda to meet the shortfalls are subjects considered in this report . The word vitamine was coined in 1912 , as an abbreviated term meant to capture the notion of important factors in the diet , or vital amines . This was preceded more than 150 years earlier by British navy physician James Lind 's discoveryin the first recorded controlled trialthat citrus juice , a good source of what was found 2 centuries later to be vitamin C , could prevent scurvy in sailors . In 1913 , the first vitamin was isolated : thiamin , the deficiency of which caused beriberi . Thirteen vitamins and 15 essential minerals have now been identified as important to human nutrition . Large-scale fortification of diets began in the United States with the addition of iodine to table salt in 1924 to prevent goiter , followed by the addition of vitamin D to milk in 1933 to prevent rickets and the addition of thiamin , riboflavin , niacin , and iron to flour in 1941 . Multivitamin/multimineral products providing more than vitamins A and D became available in pharmacies and grocery stores in the mid-1930s . In the early 1940s , the first MVM tablet was introduced . Although clinical deficiency of vitamins or minerals , other than iron , is now uncommon in the United States , growth in supplement use has accelerated rapidly with marketing spurred by cl aims some based on scientific studies that chronic conditions could be prevented or treated by supplement use . Annual sales of supplements to Americans are now reported at about $ 23 billion , a substantial share of which is spent on vitamins and minerals . Because of such widespread use of MVM , increasing public and medical confusion over apparently contradictory results from studies , and reports of possible adverse effects from overuse in certain circumstances , the Office of Dietary Supplements and the Office of Medical Applications of Research of the NIH convened a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention , held on 1517 May 2006 , in Bethesda , Maryl and . The goal of the conference was to assess the evidence available on MVM use and outcomes for chronic disease prevention in the generally healthy population of adults and to make recommendations for future research . The conference focused on vitamins and minerals and did not deal with botanicals , hormones , or other supplements . It also did not address the treatment of vitamin or mineral deficiencies . Except for considerations of safety , the conference also did not review issues of primary relevance to pregnant women or children . Specifically , the conference explored the following key questions : 1 ) What are the current patterns and prevalence of the public 's use of MVM supplements ? 2 ) What is known about the dietary nutrient intake of MVM users versus nonusers ? 3 ) What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention ? 4 ) What is the efficacy of MVM  in chronic disease prevention in the general population of adults ? 5 ) What is known about the safety of MVM  for the generally healthy population ? and 6 ) What are the major knowledge gaps and research opportunities regarding MVM use ? During the first 2 days of the conference , experts presented information on each of the key questions . After weighing the scientific evidence , including the data presented by the speakers and a formal evidence report commissioned through AHRQ , an independent panel prepared and presented a draft of this state-of-the-science statement addressing the conference questions . The evidence report prepared for the conference is available at www.ahrq.gov/clinic/tp/multivittp.htm . For the purpose of this statement , the term MVM refers to any supplement containing 3 or more vitamins and minerals but no herbs , hormones , or drugs , with each component at a dose less than the tolerable upper level determined by the Food and Nutrition Boardthe maximum daily intake likely to pose no risk for adverse health effects . Our review also included studies of the relationship of single-nutrient supplements and 2-nutrient supplements to certain disease outcomes . The term primary prevention refers to preventing the development of disease in a person who does not have the disease in question . The chronic conditions assessed include cancer ; age-related sensory loss ; and cardiovascular , endocrine , neurologic , musculoskeletal , gastroenterologic , renal , and pulmonary diseases . A word is warranted about the nature of the evidence base considered by the panel . The range of vitamins and minerals of possible interest was so broad that the conference planning committee chose to focus the evidence report on nutrients for which the potential for impact had been most strongly suggested and on conditions for which supplements were thought to have the most potential influence . The planning committee also limited the scope of the evidence report to consideration of r and omized , controlled trials ( RCTs ) , which are generally considered the gold st and ard for evidence -based decision making . These are studies in which participants are allocated by chance alone to receive or not to receive 1 of 2 or more clinical interventions . For example , while folate supplementation was initially shown to decrease the risk for neural tube defects in animal studies , outcome data in nonhuman models were not considered sufficient evidence on which to base policy recommendations . At the next level of evidence , observational studies in humans suggested efficacy of folate supplementation to prevent such defects . However , these were criticized because they were not r and omized and were potentially subject to bias . Not until these findings were confirmed by RCTs in humans was public policy implemented , including fortification of cereal grains with folate . An observational study is one in which the exposure or treatment of interest is not assigned to the participant by the investigator . Such studies suggested that -carotene intake might protect against the development of some types of cancer . However , RCTs of -carotene supplementation not only showed no benefit , they also found an increased risk for lung cancer in persons who smoked cigarettes or who were exposed to asbestos . These examples illustrate both the risk of relying only on observational studies and the advantage of RCTs in identifying both benefits and risks of MVM supplementation . Limiting the focus of our statement to RCTs has some inherent limitations , given the potential of other types of studies to provide important insights . Observational studies , for example , are particularly useful for generating hypotheses , defining adverse effects , and documenting long-term treatment consequences . They are often essential precursors to the well-conducted RCTs important for policy formation . Our principal recommendations focus on the compelling research activities that must be supported to better inform the decisions that millions of Americans are making each day to use or not to use MVM supplements to prevent chronic disease . At the same time , mindful of the constraints of the available evidence base , we have also taken care not to make premature recommendations about whether generally healthy Americans should or should not take MVM supplements . Because of the need for more reliable information on MVMs , we have made strong recommendations for research and for increased U.S. Food and Drug Administration ( FDA ) oversight of the MVM industry . 1 . What Are the Current Patterns and Prevalence of the Public 's Use of MVM Supplements ? More than half of American adults take dietary supplements in the belief that they will make them feel better , give them greater energy , improve their health , and prevent and treat disease . The use of supplements has been steadily increasing , and growth appears likely to continue . Currently , users spend more than $ 23 billion per year on supplements , and among this supplement-using population , MVM is the major category of supplements , used by about one third of Americans . Uncertainty remains in estimating prevalence of use because of problems defining these products ; increasing complexity in the formulation of supplements , including more non-MVM components and specialized formulas ; and varying frequency of use . It appears that use is higher Objective To examine low maternal vitamin D  status as a potential risk factor for high levels of depressive symptoms in a pregnant population . Methods In the Amsterdam Born Children and Their Development cohort , maternal serum vitamin D  ( n = 4236 ) was measured during early pregnancy ( median , 13 weeks ) and labeled “ deficient ” ( ⩽29.9 nM ) , “ insufficient ” ( 30–49.9 nM ) , “ sufficient ” ( 50–79.9 nM ) , and “ normal ” ( ≥80 nM ) . Maternal depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale at 16-week gestation . The association of vitamin D status with high levels of depressive symptoms ( Center for Epidemiological Studies Depression score ≥16 ) was assessed by multivariate logistic regression ( final sample , 4101 ) . Results Overall , 23 % of women had vitamin D deficiency , and 21 % of women had vitamin D insufficiency . Women with high levels of depressive symptoms ( 28 % ) had lower vitamin D concentrations than women with low levels of depressive symptoms ( p < .001 ) . After adjustment for constitutional factors , life-style and psychosocial covariates , and sociodemographic factors , vitamin D deficiency ( odds ratio [ OR ] , 1.48 ; 95 % confidence interval [ CI ] , 1.13–1.95 ) and insufficiency ( OR , 1.44 ; 95 % CI , 1.12–1.85 ) were significantly associated with high levels of depressive symptoms . Additional analyses revealed a linear trend , with an OR of 1.05 ( 95 % CI , 1.02–1.08 ) for each 10-nM decrease in vitamin D status . Conclusions In this study , low early-pregnancy vitamin D status was associated with elevated depressive symptoms in pregnancy . Further research , using a r and omized controlled design , would be required to confirm the causality of this association and the potential benefits of higher vitamin D intake for psychosocial health Purpose This study aim ed to determine whether there is a relationship between iron status and bone metabolism , and to compare the effects of the consumption , as part of the usual diet , of an iron or iron and vitamin D-fortified skimmed milk on bone remodelling in iron-deficient women . Methods Young healthy iron-deficient or iron-sufficient women ( serum ferritin ≤30 ng/mL or > 30 ng/mL , respectively ) were recruited . Iron-deficient women were assigned to a nutritional intervention consisting of a r and omised , controlled , double-blind , parallel design trial of 16 weeks during winter . They consumed , as part of their usual diet , an iron ( Fe group , n = 54 ) or iron and vitamin D-fortified ( Fe+D group , n = 55 ) flavoured skimmed milk ( iron , 15 mg/day ; vitamin D3 , 5 μg/day , 200 IU ) . The iron-sufficient women followed their usual diet without supplementation ( R group , n = 56 ) . Dietary intake , body weight , iron biomarkers , 25-hydroxyvitamin D ( 25OHD ) , parathyroid hormone ( PTH ) , procollagen-type 1 N-terminal propeptide ( P1NP ) , and aminoterminal telopeptide of collagen I ( NTx ) were determined . Results Negative correlations were found between baseline log-ferritin and log-NTx ( p < 0.001 ) , and between transferrin and P1NP ( p = 0.002 ) . Serum 25OHD increased ( from 62 ± 21 to 71 ± 21 nmol/L , mean ± SD , p < 0.001 ) while P1NP and NTx decreased in Fe+D during the assay ( p = 0.004 and p < 0.001 , respectively ) . NTx was lower in Fe+D compared to Fe at week 8 ( p < 0.05 ) and was higher in Fe and Fe+D compared to R throughout the assay ( p < 0.01 ) . PTH did not show changes . Conclusions Iron deficiency is related with higher bone resorption in young women . Consumption of a dairy product that supplies 5 μg/day of vitamin D3 reduces bone turnover and increases circulating 25OHD to nearly reach an optimal vitamin D status , defined as 25OHD over 75 OBJECTIVES  Postpartum depression ( PPD ) is a common disorder that affects 10 - 15 % of postpartum women , and it can have negative effects on both the mother and newborn . Recent studies have suggested that low levels of vitamin D are associated with poor mood and depression . The aim of this prospect i ve study was to evaluate a possible association between PPD and serum levels of 25-hydroxy vitamin D3 ( 25(OH)D3 ) , a reliable measurement of vitamin D , during mid-pregnancy . STUDY DESIGN The source population consisted of all pregnant women between 24 and 28 gestational weeks from June 2012 to October 2012 at Bornova Health Research and Application Hospital , Sifa University . In order to better evaluate a possible effect between vitamin D levels and PPD , individuals with characteristics that put them at risk for developing PPD were excluded from the study . Serum 25(OH)D3 levels were evaluated mid-pregnancy in the study group . Serum 25(OH)D3 concentrations ≤20ng/mL ( 50nmol/L ) were classified as a mild deficiency and those ≤10ng/mL ( 25nmol/L ) were classified as a severe deficiency . Pregnant subjects having complications during birth or with the newborn after delivery were excluded from the study . The Edinburgh Postnatal Depression Scale ( EPDS ) was used to assess maternal PPD 1 week , 6 weeks , and 6 months after delivery . A Pearson correlation was used to measure the strength of the associations between the EPDS scores and vitamin D levels analyzed during the three time periods . A logistic regression analysis was used to determine the independent effects of vitamin D on PPD . RESULTS Six hundred and eighty-seven pregnant women were included in this study . After excluding women due to PPD risk factors ( in two stages ) , 179 pregnant women were screened for vitamin D levels during mid-pregnancy and in the 6th month postpartum . Eleven percent of our study group had severe vitamin D deficiency and 40.3 % had mild vitamin D deficiency . The frequency of PPD was 21.6 % at the 1st week , 23.2 % at 6th week , and 23.7 % at the 6th month . There was a significant relationship between low 25(OH)D3 levels in mid-pregnancy and high EPDS scores , which is indicative of PPD for all three follow-up periods ( p=0.003 , p=0.004 and p<0.001 , respectively ) . In addition , there was a significant negative correlation between vitamin D levels and EDPS at all three time points ( r=-0.2 , -0.2 , -0.3 , respectively ) . CONCLUSIONS Vitamin D deficiency in mid-pregnancy may be a factor affecting the development of PPD . More extensive studies are required to be carried out on this subject
Meta-analyses of r and omized controlled trials ( RCTs ) document that physiological vitamin D supplementation during pregnancy is safe and improves vitamin D and calcium status , thereby protecting skeletal health .
Although certain RCTs and /or meta-analyses reported some other beneficial effects , it is still not clear whether vitamin D supplementation  improves fertility or decreases the risk of adverse pregnancy outcomes such as low birth weight , pre-eclampsia and neonatal mortality , or reduces wheeze/asthma in the infants .
Vitamin D deficiency is common and there exists a huge gap between recommended dietary vitamin D intakes and the poor vitamin D supply in the general population .
While vitamin D is important for musculoskeletal health , there are accumulating data suggesting that vitamin D may also be important for fertility , pregnancy outcomes and lactation .
Significant changes in vitamin D metabolism during pregnancy such as increased production of the " active vitamin D hormone " calcitriol support the important role of vitamin D in this setting .
Observational studies show that vitamin D deficiency is a risk marker for reduced fertility and various adverse pregnancy outcomes and is associated with a low vitamin D content of breast milk .
Nevertheless , vitamin D supplementation in pregnant women is frequently required to achieve a sufficient vitamin D status as recommended by nutritional vitamin D guidelines .