The Indian Journal of Nutrition and Dietetics

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Calcium and vitamin D supplementation to pregnant women in urban hospital and community settings


Affiliations
1 Division of Public Health Nutrition, Nutrition Foundation of India, New Delhi, Delhi - 110 016, India
2 National Institute of Nutrition, Hyderabad - 500 007., India
     

   Subscribe/Renew Journal


In India, calcium intake is low and the prevalence of Vitamin D deficiency in pregnant women is high. The National Guidelines envisage elemental calcium 500 mg (as calcium carbonate salt) and 250 IU vitamin D supplements should be provided to pregnant and lactating women. In Delhi, iron folic acid tablets are given twice a day after meals in anaemic women and one tablet of calcium and vitamin D daily after a meal in all pregnant women. A study was taken up to assess the availability and compliance with calcium and vitamin D supplementation in primary health care institutions under research (Group 1 - 387 women) and service conditions (Group 2 - 400 women) and in urban community setting (Group 3 - 448 women). Women in Group 1 received Ca and Vitamin D tablets regularly from the research staff. In Group 2 and Group 3 tablets, were provided as and when government supplies were available and prescriptions were given when they were not available. Ca and Vitamin D tablets were expensive; families bought the tablets as and when they had the funds. As a result, the number of tablets available for consumption was lower in Group 2 and 3. In all three groups, side effects were rare and nearly all available tablets were consumed. In Group 1, Vitamin D estimation was done at enrolment and after supplementation for three months; 83% of women at enrolment and 68% of women after three months of supplementation had serum vitamin D levels below 20 ng/ml. These data suggest that one tablet of Ca and Vit D per day is insufficient for correcting maternal vitamin D deficiency. It is essential to carry out studies to assess the impact of supplementation with two tablets of Ca and Vit D on maternal vitamin D levels.


Keywords

Vitamin D Deficiency in Pregnancy, Calcium and Vitamin D Supplementation, Availability of Calcium and Vitamin D Supplements, Compliance With Supplementation, Impact of Supplementation
User
Notifications

  • Teotia, S.P.S. and Teotia, M. Nutritional osteomalacia with raised therapeutic requirements of vitamin D. The Lancet, 1972, 299, 543-544.

  • Teotia, M., Teotia, S.P.S. and Singh, R.K. Maternal hypovitaminosis and congenital rickets. Bull. Intern. Pediatr. Assoc., 1979, 3, 39-46.

  • Teotia, M., Teotia, S.P.S. and Nath, M. Metabolic studies in congenital vitamin D deficiency rickets. The Ind. J. Pediat., 1995, 62, 55-61.

  • Teotia, M. and Teotia, S.P.S. Nutritional and metabolic rickets. The Ind. J. Pediatr., 1997, 64, 153-157.

  • Teotia, S.P.S. and Teotia, M. Nutritional bone disease in Indian population. Ind. J. Med. Res., 2008, 127, 219-228.

  • Goswami, R., Gupta, N., Goswami, D., Marwaha, R.K., Tandon, N. and Kochupillai, N. Prevalence and significance of low 25-hydroxyvitamin D concentrations in healthy subjects inDelhi. The Am. J. Clin. Nutr., 2000, 72, 472-475.

  • Sofi, N.Y., Jain, M., Kapil, U., Seenu, V., Ramakrishnan, L., Yadav, C.P. and Pandey, R.M. Status of serum vitamin D and calcium levels in women of reproductive age in national capital territory of India. Ind. J. Endocrinol. Metabol., 2017, 21, 731.

  • Harinarayan, C.V., Ramalakshmi, T., Prasad, U.V., Sudhakar, D., Srinivasarao, P.V., Sarma, K.V. and Kumar, E. G. T. High prevalence of low dietary calcium, high phytate consumption and vitamin D deficiency in healthy south Indians. The Am. J. Clin. Nutr., 2007, 85, 1062-1067.

  • Harinarayan, C.V., Ramalakshmi, T., Prasad, U.V. and Sudhakar, D. Vitamin D status in Andhra Pradesh: A population based study. Ind. J. Med. Res., 2008, 127, 211.

  • Goswami, R., Mishra, S.K. and Kochupillai, N. Prevalence and potential significance of vitamin D deficiency in Asian Indians. Ind. J. Med. Res., 2008, 127, 229-238.

  • Harinarayan, C.V., Sachan, A., Reddy, P.A., Satish, K.M., Prasad, U.V. and Srivani, P. Vitamin D status and bone mineral density in women of reproductive and postmenopausal age groups: A cross-sectional study from south India. JAPI., 2011, 59, 5.

  • Harinarayan, C.V. Vitamin D deficiency in sun drenched India- Can D-lightful sunlight be a respite?- sunlight D lemma. In Proc. Ind. Natl. Sci. Acad., 2018, 84, 923-935.

  • Balasubramanian, K., Rajeswari, J., Govil, Y. C., Agarwal, A.K., Kumar, A. and Bhatia, V. Varying role of vitamin D deficiency in the etiology of rickets in young children vs. adolescents in northern India. J. Trop. Pediat., 2003, 49, 201-206.

  • Balasubramanian, S. and Ganesh, R. Vitamin D deficiency in exclusively breast-fed infants. Ind. J. Med. Res., 2008, 127, 250-256.

  • Jain, V., Gupta, N., Kalaivani, M., Jain, A., Sinha, A. and Agarwal, R. Vitamin D deficiency in healthy breastfed term infants at 3 months and their mothers in India: Seasonal variation and determinants. The Ind. J. Med. Res., 2011, 133, 267.

  • Marwaha, R.K., Tandon, N., Reddy, D.R.H., Aggarwal, R., Singh, R., Sawhney, R.C. and Singh, S. Vitamin D and bone mineral density status of healthy school children in Northern India. The Am. J. Clin. Nutr., 2005, 82, 477-482.

  • Marwaha, R.K. and Sripathy, G. Vitamin D and bone mineral density of healthy school children in northern India. Ind. J. Med. Res., 2008, 127, 239-245.

  • Sachan, A., Gupta, R., Das, V., Agarwal, A., Awasthi, P.K. and Bhatia, V. High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India. The Am. J. Clin. Nutr., 2005, 81, 1060-1064.

  • Marwaha, R.K., Tandon, N., Chopra, S., Agarwal, N., Garg, M.K., Sharma, B. and Puri, S. Vitamin D status in pregnant Indian women across trimesters and different seasons and its correlation with neonatal serum 25-hydroxy vitamin D levels. Br. J. Nutr., 2011, 106, 1383-1389.

  • Hemalatha, N. A prospective study to assess the association of vitamin D deficiency and insufficiency with adverse pregnancy outcomes. Int. J. Clin. Obstet. Gynaecol., 2021, 5, 38-44.

  • Abrams, S.A. In utero physiology: Role in nutrient delivery and fetal development for calcium, phosphorus, and vitamin D. The Am. J. Clin. Nutr., 2007, 85, 604S-607S.

  • Cross, N. A., Hillman, L.S., Allen, S.H., Krause, G.F. and Vieira, N.E. Calcium homeostasis and bone metabolism during pregnancy, lactation, and post weaning: A longitudinal study. The Am. J. Clin. Nutr., 1995, 61, 514-523.

  • Hollis, B.W. and Wagner, C.L. New insights into the vitamin D requirements during pregnancy. Bone Res., 2017, 5, 1-16.

  • Hollick, M.F., Binkley, N.C., Bischoff-Ferrari, H.A., Gordon, C.M., Hanley, D.A., Heaney, R.P. and Weaver, C.M. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. The J. Clin. Endocrinol. Metabol., 2011, 96, 1911-1930.

  • Hodgkin, P., Hine, P.M., Kay, G.H., Lumb, G.A. and Stanbury, S.W. Vitamin-D deficiency in Asians at home and in Britain. The Lancet, 1973, 302, 167-172.

  • Brooke, O.G., Brown, I. R., Bone, C.D., Carter, N.D., Cleeve, H.J., Maxwell, J.D. and Winder, S. M. Vitamin D supplements in pregnant Asian women: Effects on calcium status and fetal growth. Br. Med. J., 1980, 280, 751-754.

  • De-Regil, L.M., Palacios, C., Lombardo, L. K. and Peña-Rosas, J.P. Vitamin D supplementation for women during pregnancy. Cochrane database of systematic reviews, 2016 , 1, CD008873.

  • MOHFW (2014) National Guidelines for calcium supplementation during pregnancy and lactation. Available from: http://www.nrhmhp.gov.in/sites/default/files/files/NG_calcium.pdf. accessed on 1.9.2022

  • MOHFW (2013). Guidelines for Control of Iron Deficiency Anaemia. Available from: http://www.pbnrhm.org/docs/iron_plus_guidelines.pdfaccessed on 1.9.2022

  • International Committee on standards: expert Panel on haemoglobinometry: Recommendation for reference method for haemoglobinometry in human blood. J. Clin. Pathol., 1996, 49, 271-274.

  • Kalaivani, K. and Prema Ramachandran Hb estimation at point of care using cyanmethaemoglobin method. Int. J. Comm. Med. Public Healt., 2021, 8, 4498-4505

  • Aknes, L. A Simplified high performance liquid chromatographic method for of the vitamin D3, 25- hydrroxy vitamin D2, and 25- hydroxy vitamin D3 in human sera. Scend. J. Clinic. Lab Invest., 1992, 52, 177-182.

  • Ministry of Health and Family Welfare. Anemia Mukt Bharat. Intensified National Iron Plus Initiative (I-NIPI): 2 018. Available from https://www.fitterfly.com/site/pdf/anemia-mukt-bharat. pdf accessed on 1.9.2022

  • Ramachandran, P., Pramanik, A. and Kalaivani, K. Can iron and folic acid-IFA and Ca and vitamin D supplementation in pregnancy be fitted into habitual pattern of three meals a day? The Ind. J. Nutr. Diet., 2019, 56, 341-350.


Abstract Views: 250

PDF Views: 1




  • Calcium and vitamin D supplementation to pregnant women in urban hospital and community settings

Abstract Views: 250  |  PDF Views: 1

Authors

Amrita Pramanik
Division of Public Health Nutrition, Nutrition Foundation of India, New Delhi, Delhi - 110 016, India
Ravindranadh Palika
National Institute of Nutrition, Hyderabad - 500 007., India
Raghu Pullakhandam
National Institute of Nutrition, Hyderabad - 500 007., India
Kalaivani K
Division of Public Health Nutrition, Nutrition Foundation of India, New Delhi, Delhi - 110 016, India
Prema Ramachandran
Division of Public Health Nutrition, Nutrition Foundation of India, New Delhi, Delhi - 110 016, India

Abstract


In India, calcium intake is low and the prevalence of Vitamin D deficiency in pregnant women is high. The National Guidelines envisage elemental calcium 500 mg (as calcium carbonate salt) and 250 IU vitamin D supplements should be provided to pregnant and lactating women. In Delhi, iron folic acid tablets are given twice a day after meals in anaemic women and one tablet of calcium and vitamin D daily after a meal in all pregnant women. A study was taken up to assess the availability and compliance with calcium and vitamin D supplementation in primary health care institutions under research (Group 1 - 387 women) and service conditions (Group 2 - 400 women) and in urban community setting (Group 3 - 448 women). Women in Group 1 received Ca and Vitamin D tablets regularly from the research staff. In Group 2 and Group 3 tablets, were provided as and when government supplies were available and prescriptions were given when they were not available. Ca and Vitamin D tablets were expensive; families bought the tablets as and when they had the funds. As a result, the number of tablets available for consumption was lower in Group 2 and 3. In all three groups, side effects were rare and nearly all available tablets were consumed. In Group 1, Vitamin D estimation was done at enrolment and after supplementation for three months; 83% of women at enrolment and 68% of women after three months of supplementation had serum vitamin D levels below 20 ng/ml. These data suggest that one tablet of Ca and Vit D per day is insufficient for correcting maternal vitamin D deficiency. It is essential to carry out studies to assess the impact of supplementation with two tablets of Ca and Vit D on maternal vitamin D levels.


Keywords


Vitamin D Deficiency in Pregnancy, Calcium and Vitamin D Supplementation, Availability of Calcium and Vitamin D Supplements, Compliance With Supplementation, Impact of Supplementation

References