Vitamin D

Because of its importance in increasing calcium retention, recommended intakes of vitamin D are doubled during pregnancy. Vitamin D deficiency during pregnancy causes disorders of calcium metabolism, including neonatal hypocalcemia and tetany, hypoplasia of infants' tooth enamel, and maternal osteomalacia. Because the prevalence of vitamin D deficiency during pregnancy is high during the winter months at northern latitudes in regions such as Europe, the United States, and Canada, and Japan, vitamin D supplements may be necessary for women who live in these regions or who have little exposure to sunlight. A national survey in the United States conducted in the 1990s revealed that approximately 40% of African American women in the southeastern region had low blood levels of 25-hydroxyvita-min D, and that not drinking vitamin D-fortified milk was a risk factor for deficiency. In the absence of vitamin D fortification or supplementation, infants in Paris, for example, have higher plasma levels of parathyroid hormone and other indications of vitamin D deficiency if they are born soon after the winter months. Vitamin D supplements reversed the indications of vitamin D deficiency. High maternal intakes of vitamin D are toxic and were implicated as the cause of a syndrome that included mental and physical growth retardation and hyper-calcemia in British infants between 1953 and 1957. Excessive amounts of vitamin D taken during gestation have also caused aortic stenosis and abnormal skull development in infants. The upper limit for vitamin D in pregnancy is 50 mg per day, the same as for nonpregnant women.

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