Ealing Hospital NHS Trust

1. Ealing Hospital NHS Trust Antenatal vitamin D supplementation in a multicultural population in a West London hospital Galea P, Lo H, Kalkur S, Tan Toh Lick Department of Obstetrics & Gynaecology, Ealing Hospital NHS Trust, London, United Kingdom INTRODUCTION Vitamin D deficiency in pregnancy has been associated with a variety of pregnancy complications including an increased risk of pre-eclampsia and gestational diabetes [1]. It also plays a role in fetal development, imprinting and immunological function, with a raised susceptibility to chronic disease in later life [2]. Furthermore, fetuses of vitamin D deficient mothers are at risks of neonatal hypoglycaemia, seizures, heart failure and rickets [3]. In 2008, the National Institute for Health and Clinical Excellence (NICE) recommended vitamin D supplementation for all pregnant women with special emphasis to those at risk of Vitamin D deficiency including women from South Asia, Africa, Caribbean and Middle East and obese women [4]. Both groups are in high prevalence in our population. We audited the compliance of this guidance in pregnant women booked in our hospital to improve our care. METHODS A prospective audit of 162 mothers delivered during a 2-month period (5th February 2011 – 5th April 2011) at Ealing Hospital Trust. Women were verbally consented and interviewed by a team member using a standardized questionnaire as regards to prescribing, usage and compliance of vitamin D supplementation in pregnancy. Their demographics were collected from their medical records. The audit was registered with our hospital’s Clinical Governance audit department. National Research Ethics Service (NRES UK) exempted the project from ethics approval as it was considered an Audit. RESULTS One hundred and sixty two women consented to be interviewed and were recruited for analysis. A significant 75% of those interviewed were of ‘high risk’ ethnicities and a further 23% were obese. Overall, only 52 of mothers (32%) took vitamin D supplements, with a third starting pre-conceptually or in the first trimester. Within the ‘high risk’ ethnicities, the overall compliance in vitamin D supplementation was less than a third with Caribbean and Middle Eastern women more likely to be left out (South Asia 53%, Africa 52%, Caribbean 75% and Middle East 70%)(Figure 1). Similarly, only 37% of women with a BMI >30 kg/m2 were given vitamin D supplements (Figure 2). Figure 1. Vitamin D intake according to ethnicity. The data labels denote the actual number of in that group (n=162) CONCLUSIONS Despite the NICE guidance, implementation of vitamin D supplement is poor even in mothers at greatest risk of vitamin D deficiency. To improve our standards, we have recommended various measures including successful implementation of staff education sessions, identification of women at risk and pro-actively offer them vitamin D supplements in our early pregnancy unit. Figure 2. Vitamin D intake in pregnant women with a BMI≥30kg/m2. The data labels are the actual number of patients (n=36). Correspondence: paula.galea@doctors.net.uk References: 1. Lewis, S., et al., Vitamin D deficiency and pregnancy: from preconception to birth. MolNutr Food Res. 54(8): p. 1092-102. 2. Kovacs, C.S., Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies. Am J ClinNutr, 2008. 88(2): p. 520S-528S. 3.  Mulligan, M.L., et al., Implications of vitamin D deficiency in pregnancy and lactation. Am J Obstet Gynecol. 202(5): p. 429 e1-9. 4. Antenatal Care: Routine care for the healthy pregnant woman. National Institute for Health and Clinical Excellence: Guidance, ed. R. press. 2008, London: National Collaborating Centre for Women' and Children's Health (UK).