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South Australian Perinatal Practice Guideline 

Vitamin D Status in 
Pregnancy  

  Department for Health and Wellbeing, Government of South Australia. All rights reserved.  

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Note:
This guideline provides advice of a general nature.  This statewide guideline has been prepared to promote and facilitate 
standardisation and consistency of practice, using a multidisciplinary approach.  The guideline is based on a review of 
published evidence and expert opinion.  
Information in this statewide guideline is current at the time of publication.  
SA Health does not accept responsibility for the quality or accuracy of material on websites linked from this site and does not 
sponsor, approve or endorse materials on such links. 
Health practitioners in the South Australian public health sector are expected to review specific details of each patient and 
professionally assess the applicability of the relevant guideline to that clinical situation. 
If for good clinical reasons, a decision is made to depart from the guideline, the responsible clinician must document in the 
patient s medical record, the decision made, by whom, and detailed reasons for the departure from the guideline. 
This statewide guideline does not address all the elements of clinical practice and assumes that the individual clinicians are 
responsible for discussing care with consumers in an environment that is culturally appropriate and which enables respectful 
confidential discussion. This includes: 

  The use of interpreter services where necessary, 
  Advising consumers of their choice and ensuring informed consent is obtained, 
  Providing care within scope of practice, meeting all legislative requirements and maintaining standards of 

professional conduct, and  
  Documenting all care in accordance with mandatory and local requirements 

 
 
Explanation of the aboriginal artwork: 
The aboriginal artwork used symbolises the connection to country and the circle shape shows the strong relationships amongst families and the aboriginal culture. The horse shoe shape 
design shown in front of the generic statement symbolises a woman and those enclosing a smaller horse shoe shape depicts a pregnant women. The smaller horse shoe shape in this 
instance represents the unborn child. The artwork shown before the specific statements within the document symbolises a footprint and demonstrates the need to move forward together in 
unison. 
 

     

 

 

 

 

 

 

Purpose and Scope of Perinatal Practice Guideline (PPG) 
To guide clinicians with the management of women and their newborns who are at risk of, or are 
found to have, vitamin D insufficiency/deficiency in pregnancy. 

Australian Aboriginal Culture is the oldest living culture in the world yet 
Aboriginal people continue to experience the poorest health outcomes when 
compared to non-Aboriginal Australians. In South Australia, Aboriginal women are 
2-5 times more likely to die in childbirth and their babies are 2-3 times more likely to 
be of low birth weight.  The accumulative effects of stress, low socio economic 
status, exposure to violence, historical trauma, culturally unsafe and discriminatory 
health services and health systems are all major contributors to the disparities in 
Aboriginal maternal and birthing outcomes. Despite these unacceptable statistics 
the birth of an Aboriginal baby is a celebration of life and an important cultural 
event bringing family together in celebration, obligation and responsibility. The 
diversity between Aboriginal cultures, language and practices differ greatly and so 
it is imperative that perinatal services prepare to respectively manage Aboriginal 
protocol and provide a culturally positive health care experience for Aboriginal 
people to ensure the best maternal, neonatal and child health outcomes. 

 



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Flowchart 1: Management of Vitamin D Status in Pregnancy 
 

  



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Flowchart 2: Newborn Management 

  



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Table of Contents 
 

Purpose and Scope of Perinatal Practice Guideline (PPG) ............................................................ 1 
Flowchart 1: Management of Vitamin D Status in Pregnancy ......................................................... 2 
Flowchart 2: Newborn Management ............................................................................................... 3 
Abbreviations ................................................................................................................................... 5 
Definitions ........................................................................................................................................ 5 
Introduction ...................................................................................................................................... 5 

Food sources of Vitamin D .......................................................................................................... 5 
Other sources of Vitamin D ......................................................................................................... 5 
Vitamin D content of multivitamins .............................................................................................. 6 

Vitamin D status in pregnancy ......................................................................................................... 6 
Antenatal screening and treatment ................................................................................................. 7 

First appointment (booking) screening of at risk women ............................................................. 7 
Vitamin D supplementation for ALL pregnant women ................................................................. 7 
First follow-up of at risk women ................................................................................................... 7 
Subsequent follow-up of at risk women ....................................................................................... 7 
Discharge ..................................................................................................................................... 7 

Neonatal management .................................................................................................................... 8 
References ...................................................................................................................................... 9 
Appendix I: Fact Sheet: Vitamin D Supplementation in Pregnancy .............................................. 10 
Appendix 2: Fact Sheet: Vitamin D Insufficiency / Deficiency in Pregnancy ................................. 10 
Appendix 2: Parent information: Vitamin D Deficiency in Babies .................................................. 12 
 

 

Summary of Practice Recommendations  
All women should be screened for risk factors at their first antenatal visit. 
All women not at risk of vitamin D deficiency should commence colecalciferol 400 units daily as 
part of routine supplementation. 
Women at risk of vitamin D deficiency should have blood taken for 25-hydroxy vitamin D level 
Women at risk of vitamin D deficiency should commence 1,000 units (25 micrograms) of 
colecalciferol per day.  
Subsequent management of women and their babies is dependent on 25-OHD levels at 28 
weeks gestation. 

  



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Abbreviations   
AI Adequate intake 
a.m. Ante meridiem (before noon) 
BMI Body mass index (kg/m2) 
e.g. For example 
et al.  And others 
MED Minimal erythemal dose 
mL Millilitre(s) 
nmol/L Nanomoles per litre 
25-OHD 25-hydroxy-vitamin D 
PTH Parathyroid hormone 
p.m. Post meridiem (after noon) 
Vit Vitamin 

Definitions 
Vitamin D 
sufficiency 

Serum 25-OHD levels &gt;50 nmol/L 

Vitamin D 
insufficiency 

Serum 25-OHD levels of 30 to 50 nmol/L  
 

Vitamin D 
deficiency 

Serum 25-OHD levels &lt;30 nmol/L 
 

Introduction 
Vitamin D plays an essential role in calcium metabolism, bone growth and mineralisation   
Around 90 % of our vitamin D requirement comes from exposure of the skin to sunlight.  The 
average diet contains only about 10 % of our requirements   insufficient to prevent vitamin D 
deficiency1. 
The highest rates of vitamin D deficiency occur in dark-skinned, veiled, pregnant women (80%), 
with similarly high rates found in mothers of infants treated for rickets2,3. 
High rates of vitamin D deficiency have been found in low risk South Australian antenatal 
populations, with risk-based screening failing to detect over half of deficient women4. 
BMI is inversely proportional to serum vitamin D levels, with one study showing a BMI ?40 was 
associated with a 24% lower serum 25-OHD (25-hydroxy-vitamin D) level compared to those with 
BMI &lt;255. 
Women with darker skin produce less vitamin D for a given sunlight exposure6,7. 
Neonatal vitamin D deficiency is always caused by maternal deficiency8.  

Food sources of Vitamin D 
Few foods contain significant amounts of vitamin D (e.g. fish with a high fat content such as 
salmon, tuna, herring, mackerel and sardines).   Other sources include meat, milk and eggs  
In Australia, some margarine and milk and milk products are fortified with vitamin D2.  
Breast milk is an inadequate source of vitamin D and exclusive breastfeeding is a risk factor for 
neonatal rickets8. 

Other sources of Vitamin D 
The optimum route of vitamin D intake is via skin exposure.  
However, deliberate sun exposure between 10.00 a.m. and 2.00 p.m. in summer (11.00 a.m. and 
3:00 p.m. daylight saving time) is not advised3.   
 



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It has been shown that whole body exposure to 10-15 minutes of midday sun in summer (about 1 
minimal erythemal dose [MED] or the amount of sun exposure that just produces a faint redness 
of skin) is comparable to taking 15,000units (375 micrograms) of vitamin D (colecalciferol) orally3. 
On this basis, exposure of hands, face and arms (around 15 % of body surface) to around 1/3 
MED should produce around 1,000units of vitamin D (colecalciferol) for people with moderately 
fair skin3.    
Exposure times for people with highly pigmented skin would be 3-4 times greater3. 

Vitamin D content of multivitamins 
A large proportion of women take multivitamins in pregnancy9. 
The vitamin D content of commonly used pregnancy multivitamins are as follows: 
&gt; Blackmores Pregnancy &amp; Breastfeeding Gold 

o 500units per capsule = 1000units/day (i.e. 2 tablets) 
&gt; Elevit Pregnancy Multivitamin 

o 200 units per tablet = 200units/day 
&gt; Swisse Pregnancy + Ultivite 

o 600units per capsule = 600units/day 

Vitamin D status in pregnancy 
Recent consensus guidelines recommend the following classification of vitamin D status8. These 
are in line with those already in use by The Royal Australian and New Zealand College of 
Obstetricians and Gynaecologists10. 
&gt; Vitamin D sufficiency 

o Serum 25-OHD levels &gt;50 nmol/L 
&gt; Vitamin D insufficiency 

o Serum 25-OHD levels of 30 to 50 nmol/L  
&gt; Vitamin D deficiency 

o Serum 25-OHD levels &lt;30 nmol/L 
 
Women with vitamin D insufficiency/deficiency are at risk of: 
&gt; Osteomalacia 
&gt; Accelerated osteoporosis due to secondary hyperparathyroidism 
&gt; Muscle weakness 

Vitamin D insufficiency/deficiency in pregnancy may be associated with: 
&gt; Hypertension 
&gt; Pre-eclampsia 
&gt; Increased primary Caesarean section rates11 

Babies of women with vitamin D insufficiency/deficiency during pregnancy are at risk of: 
&gt; Hypocalcaemia and seizures 
&gt; Rickets  
&gt; Myopathy 
&gt; Reduced intrauterine long bone growth12 
 
Although there is some evidence for risk reduction with vitamin D supplementation, further 
randomised controlled trials are required to confirm the benefits13. Despite this, a strategy for 
supplementation and treatment of maternal vitamin D deficiency is recommended10,11. 

  



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Antenatal screening and treatment  
First appointment (booking) screening of at risk women 
Pregnant women at risk of vitamin D insufficiency/deficiency (see below) are to be offered vitamin 
D screening at booking.  They include: 
&gt; All veiled women e.g. Muslim, including those wearing headscarves 
&gt; Darker skinned women e.g. Aboriginal, North African, Indian and Sri Lankan 
&gt; Newly arrived refugees 
&gt; Women with limited sun exposure for any reason e.g. night shift or office workers 

Vitamin D supplementation for ALL pregnant women 
Pregnant women without known risk factors  
Commence colecalciferol 400 units daily as part of routine supplementation e.g. 0.2ml Ostelin 
Vitamin D Liquid  (1,000 units/0.5ml) or half tablet of OsteVit-D  (equivalent to 500 units) (which 
may be purchased from a community pharmacy without a prescription). See appendix 1 for 
information for women. 
Note: Also consider the vitamin D content of the woman s pregnancy multivitamin, then 
supplement if required.  

Pregnant women with known risk factors 
Request blood 25-hydroxy vitamin D (25-OHD) level 
Commence 1,000 units (25 micrograms) of colecalciferol daily (e.g. one capsule of Ostelin , one 
tablet of OsteVit-D  or 0.5mL Ostelin Vitamin D Liquid  (1,000 units/0.5ml) (which may be 
purchased from a community pharmacy without a prescription). See appendix 2 for information 
for women. 
Note: Also consider the vitamin D content of the woman s pregnancy multivitamin and then adjust 
the supplement if required. 

First follow-up of at risk women 
Check the report of the original 25-OHD assay at the next appointment: 

Vitamin D ?50 nmol/L 
&gt; Continue vitamin D 1,000 units daily 
&gt; Repeat 25-OHD level at 28/40 to see if it has normalised   

Vitamin D &gt; 50 nmol/L 
&gt; Decrease vitamin D to 400 units daily 

Subsequent follow-up of at risk women 
Depending on the second 25-OHD assay: 

If 25OHD &gt; 50 nmol/L 
&gt; Continue vitamin D 1,000 units daily 

If 25OHD ? 50 nmol/L 
&gt; Increase dose to vitamin D 2,000 units daily 

Discharge 
All at risk women require a follow-up letter to their General Practitioner with a recommendation 
for a repeat 25-OHD assay at 6 weeks and vitamin D should be resumed then if indicated. 

  



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Neonatal management 
Universal supplementation of infants with vitamin D is recommended in global consensus 
guidelines8. However, Australian and New Zealand guidelines recommend targeted 
supplementation of infants with the following risk factors: maternal vitamin D deficiency, exclusive 
breast feeding, and dark skin and/or social or cultural factors that could lead to lack of exposure 
to sunlight14. 
 
The following considerations are the basis for recommendations for neonatal supplementation, 
taking into account published recommendations and an approach to protocol implementation that 
optimises adherence and minimises harm. See appendix 3 for information for parents. 
&gt; In the absence of maternal risk factors (women not normally screened and are receiving 

400units of colecalciferol), babies do not need routine vitamin D supplementation. 
&gt; Vitamin D supplementation at 400units daily is safe in babies. There is a wide therapeutic 

safety window for 25-OHD in neonates, with toxicity unlikely below levels of 250nmol/L14. 
&gt; Breast milk vitamin D content approximates 4units per 100mL15, and term infant formula 

(fortified with vitamin D) approximates 40units per 100mL (typical range 30-48units referenced 
from manufacturer labelling). Daily intake from formula is unlikely to meet the recommended 
adequate intake (AI is 400units assuming minimal sun exposure), whereas the addition of 
400units daily supplement is unlikely to cause toxicity. 

&gt; Supplementation of both breast milk and formula fed babies with risk factors increases the 
simplicity of the protocol, and may reduce a maternal perception that breast milk is inadequate. 

&gt; Even if maternal vitamin D sufficiency is assumed at full term on the basis of supplementation 
and normal maternal 25-0HD levels, the lifestyle, social and cultural factors that affected the 
mother may persist after the baby s birth and impact the baby. Supplementation based on risk 
factors even if maternal supplementation has normalised maternal levels is reasonable. 

&gt; Serum 25-OHD levels are not generally measured in babies &lt;3 months of age. However where 
a clinician has measured 25-OHD levels, definitions of deficiency and treatment follow the SA 
Paediatric Clinical Practice Guideline: Vitamin D Deficiency in Children (available 
at www.sahealth.sa.gov.au/paediatric) and the SA Neonatal Medication Guidelines: 
Colecalciferol and Multivitamins (available at www.sahealth.sa.gov.au/neonatal).  

&gt; Sunlight exposure in babies needs to balance risks of skin damage with the benefit of vitamin D 
synthesis and no firm recommendations can be made. The following suggested advice to 
parents is modified from the ANZ position statement14. 
 

 Light to olive skin Brown, dark brown and black skin 
UV index ?3 Full protection advised   sunscreen, 

hat, clothing, shade 
Hat, clothing, shade, intermittent sun 
exposure of arms and legs without 
sunscreen for approximately 10-15 
minutes per day encouraged 

UV index &lt;3 Sunscreen not required. Intermittent 
sun exposure of arms and legs for 
10-15 minutes encouraged. 

Encourage sun exposure of arms and 
legs during outdoor activity 

  





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References 
1. Nozza JM,  Rodda CP.  Vitamin D deficiency in mothers of infants with rickets.  MJA 
2001; 175:  253-255.  Available at 
URL:   http://www.mja.com.au/public/issues/175_05_030901/nozza/nozza.html 
2. Nowson CA, Margerison C.   Vitamin D intake and vitamin D status of Australians.  MJA 
2002; 177:  149-152.  Available at  
URL: http://www.mja.com.au/public/issues/177_03_050802/now10763_fm.html 
3. Diamond TH, Eisman JA, Mason RS, Nowson CA, Pasco JA, et al.  Working Group of 
the Australian and New Zealand Bone and Mineral Society, Endocrine Society of Australia and 
Osteoporosis Australia.  Vitamin D and adult bone health in Australia and New Zealand:  a 
position statement.  MJA 2005; 182:  281-285.  Available at 
URL:  http://www.mja.com.au/public/issues/182_06_210305/dia10848_fm.html 
4. De Laine KM, Matthews G, Grivell RM. Propspective audit of vitamin D levels of women 
presenting for their first antenatal visit. Aust N Z J Obstet Gynaecol. 2013 Aug;53(4):353-7. 
Available at URL: 
https://doi.org/10.1111/ajo.12052 
5. Konradsen S, Ah H, Lindberg F, Hexeberg S, R. J. Serum 1,25-dihydroxy vitamin D is 
inversely associated with body mass index. Eur J Nutr. 2008;47(2). Available at URL: 
http://www.ncbi.nlm.nih.gov/pubmed/18320256 
6. Grover SR, Morley R.  Vitamin D deficiency in veiled or dark-skinned pregnant women.  
MJA 2001; 175:  251-252.  Available at 
URL:  http://www.mja.com.au/public/issues/175_05_030901/grover/grover.html 
7. McCullough ML.  Vitamin D deficiency in pregnancy:  Bringing the issues to light.  J 
Nutrition 2007; 137:  305-306. 
8. Munns C, Shaw N, Kiely M, Specker B, Thacher T et al. Prevention and treatment of 
infant and childhood vitamin D deficiency in Australia and New Zealand:  a consensus statement.  
JCEM 2016; 101(2): 394-415.  Available at URL:  
http://press.endocrine.org/doi/pdf/10.1210/jc.2015-2175 
9. Sullivan KM, Ford ES, Fuad Azrak M, Mokdad AH. Multivitamin Use in Pregnant and 
Nonpregnant Women: Results from the Behavioral Risk Factor Surveillance System. Public 
Health Rep. 2009 May-Jun; 124(3): 384 390. Available at URL: 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2663874/ 
10. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. 
Vitamin and mineral supplementation and pregnancy. RANZCOG 2015. Available at 
URL: https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-
MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Vitamin-
and-mineral-supplementation-in-pregnancy-(C-Obs-25)-Review-Nov-2014,-Amended-May-
2015.pdf?ext=.pdf 
11. Royal College of Obstetricians and Gynaecologists. Vitamin D in Pregnancy (Scientific 
Impact Paper No.43). 2014. Available at 
URL: https://www.rcog.org.uk/globalassets/documents/guidelines/scientific-impact-
papers/vitamin_d_sip43_june14.pdf. 
12. Morley R, Carlin JB, Pasco JA, Wark JD.  Maternal 25-hydroxyvitamin D and parathyroid 
hormone concentrations and offspring birth size.  J Clin Endocrinol Metab 2006; 91: 906-912. 
13. De-Regil LM, Palacios C, Lombardo LK, Pe a-Rosas JP. Vitamin D supplementation for 
women during pregnancy. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: 
CD008873. DOI: 10.1002/14651858.CD008873.pub3. Available at URL:  
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008873.pub3/pdf 
14. Paxton GA, Teale GR, Nowson CA, Mason RS, McGrath JJ, Thompson MJ, Siafarikas A, 
Rodda CP and Munns CF. Vitamin D and health in pregnancy, infants, children and adolescents 
in Australia and New Zealand: a position statement. MJA 2013; 198 (3): 142-143. Available at 
URL: 
https://www.mja.com.au/journal/2013/198/3/vitamin-d-and-health-pregnancy-infants-children-and-
adolescents-australia-and 
15. National Health and Medical Research Council. Eat for Health Infant Feeding Guidelines 
Information for health workers. Canberra: NHMRC, 2012. Available at URL: 
https://nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers 
 





















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Appendix I: Fact Sheet: Vitamin D Supplementation in Pregnancy 
 

 

Fact Sheet 

Routine Vitamin D Supplementation            
in Pregnancy   
About Vitamin D 
Vitamin D is needed to keep bones healthy and strong. 

&gt; Most (90%) vitamin D comes from exposing your skin to the sun. A balance of sun 
exposure and sun protection is needed to make enough Vitamin D. 

&gt; Some (10%) vitamin D comes from food such as oily fish, meat, milk and eggs. 

What happens if you do not have enough vitamin D? 
Many people with low vitamin D do not have symptoms. 
Vitamin D deficiency can cause: 

&gt; Rickets (soft bones) in children 
&gt; Muscle cramps 
&gt; Seizures (fits) due to low calcium 

Low vitamin D may be linked to other health problems such as: a higher risk of bowel 
cancer, heart disease, problems with immunity (how the body fights infections) and 
autoimmune diseases (e.g. diabetes). 

Vitamin D supplementation 
Routine supplementation with Vitamin D (400units daily) is recommended for all pregnant 
women. 
This can be achieved by a vitamin D supplement which may be purchased from a 
community pharmacy without a prescription e.g. 

&gt; 0.2ml Ostelin Vitamin D Liquid  (1,000 units/0.5ml) or 
&gt; half tablet of OsteVit-D  (equivalent to 500 units) 

 
You may be taking a pregnancy multivitamin already, however the vitamin D content varies 
so you may need additional supplementation. The vitamin D content of commonly used 
pregnancy multivitamins is as follows: 

&gt; Blackmores Pregnancy &amp; Breastfeeding Gold 
o 500units per capsule = 1000 units/day (i.e. 2 tablets) 

&gt; Elevit Pregnancy Multivitamin 
o 200 units per tablet = 200 units/day 

&gt; Swisse Pregnancy + Ultivite 
o 600units per capsule = 600 units/day 

Further Information 
1. Well for Life 
https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-d 
2.  NHMRC Nutrient Reference Values for Australia and NZ Vitamin D  
www.nrv.gov.au/nutrients/vitamin-d 
 

 

 




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Appendix 2: Vitamin D Deficiency in Pregnancy  

Fact Sheet 

Vitamin D Insufficiency / Deficiency 
in Pregnancy   
About Vitamin D 
Vitamin D is needed to keep bones healthy and strong. 

&gt; Most (90%) vitamin D comes from exposing your skin to the sun. A balance of sun 
exposure and sun protection is needed to make enough Vitamin D. 

&gt; Some (10%) vitamin D comes from food such as oily fish, meat, milk and eggs. 

What happens if you do not have enough vitamin D? 
Many people with low vitamin D do not have symptoms. 
Vitamin D deficiency can cause: 

&gt; Rickets (soft bones) in children 
&gt; Muscle cramps 
&gt; Seizures (fits) due to low calcium 

Low vitamin D may be linked to other health problems such as: a higher risk of bowel 
cancer, heart disease, problems with immunity (how the body fights infections) and 
autoimmune diseases (e.g. diabetes). 

Vitamin D supplementation 
Supplementation with vitamin D (1000units) is recommended for women with risk factors or 
whose vitamin D level is known to be low. 
This can be achieved by a vitamin D supplement which may be purchased from a 
community pharmacy without a prescription e.g. 

&gt; 0.5mL Ostelin Vitamin D Liquid  (1,000 units/0.5mL) or 
&gt; One tablet of OsteVit-D  (1,000 units) or 
&gt; One capsule of Ostelin Vitamin D (1,000 units) 

 
You may be taking a pregnancy multivitamin already, however the vitamin D content varies 
so you may need additional supplementation. The vitamin D content of commonly used 
pregnancy multivitamins is as follows: 

&gt; Blackmores Pregnancy &amp; Breastfeeding Gold 
o 500units per capsule = 1000 units/day (i.e. 2 tablets) 

&gt; Elevit Pregnancy Multivitamin 
o 200 units per tablet = 200 units/day 

&gt; Swisse Pregnancy + Ultivite 
o 600units per capsule = 600 units/day 

Further Information 
1. Well for Life 
https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-d 
2.  NHMRC Nutrient Reference Values for Australia and NZ Vitamin D  
www.nrv.gov.au/nutrients/vitamin-d 

 
 




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Appendix 2: Parent information: Vitamin D Deficiency in Babies    

 

  

Parent Information 

Vitamin D Deficiency in Babies 
About Vitamin D 
Vitamin D is needed to keep bones healthy and strong. 

&gt; Most (90%) vitamin D comes from exposing your skin to the sun. A balance of sun 
exposure and sun protection is needed to make enough Vitamin D. 

&gt; Some (10%) vitamin D comes from food such as oily fish, meat, milk and eggs. 

What happens if you do not have enough vitamin D? 
Many people with low vitamin D do not have symptoms. 
Vitamin D deficiency can cause: 

&gt; Rickets (soft bones) in children 
&gt; Muscle cramps 
&gt; Seizures (fits) due to low calcium 

Low vitamin D may be linked to other health problems such as: a higher risk of bowel 
cancer, heart disease, problems with immunity (how the body fights infections) and 
autoimmune diseases (e.g. diabetes). 

Breast Feeding 
Breast feeding is the best way to feed your baby. Breast feeding is important for your 
baby s health and wellbeing. You can still breast feed your baby if your Vitamin D level is 
low. 

Vitamin D Supplementation for Babies 
All breastfed and formula fed babies born to mothers who have had persistently low vitamin 
D levels in pregnancy or who are at risk of vitamin D deficiency (e.g. due to darker skin 
colour, veiled), should be given a 400 units daily vitamin D supplement for the first 12 
months of life. The preparations used in SA hospitals are Ostelin Vitamin D Liquid  
(1,000units/0.5mL) and Penta-vite Infant Drops . 

Ostelin Vitamin D Liquid (1,000units/0.5mL) 
Ostelin Vitamin D Liquid  contains vitamin D. The dose is 0.2mL daily, and it is the 
preferred vitamin D liquid in term babies as it tastes better than Penta-vite Infant Drops . 
You can buy a bottle of Ostelin Vitamin D Liquid  from your local chemist. 

Penta-vite Infant Drops 
Penta-vite Infant Drops  contain vitamins A, B1, B2, B3, B6, C and D. The dose is 0.45mL 
daily. You can buy a bottle of Penta-vite Infant Drops  from your local chemist. 

Further Information 
Speak with your GP (General Practitioner) if you have any questions about your or your 
baby s Vitamin D levels. 
1. Well for Life 
https://www.betterhealth.vic.gov.au/health/HealthyLiving/vitamin-d 
2.  NHMRC Nutrient Reference Values for Australia and NZ Vitamin D  
www.nrv.gov.au/nutrients/vitamin-d 
 

 

 




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Acknowledgements 
The South Australian Perinatal Practice Guidelines gratefully acknowledge the contribution of 
clinicians and other stakeholders who participated throughout the guideline development process 
particularly:  

Write Group Lead 
Dr Kate Gowling 
 

Write Group Members 
A/Prof Rosalie Grivell 
Catherine Leggett 
Dr Scott Morris 
Rebecca Smith 
Sheree Wynne 
 

Other contributors 
Dr Feisal Chenia 
Cassandra Mosel 
SAPPG Management Group Members 2018 
 

SAPPG Management Group Members 
Sonia Angus 
Dr Kris Bascomb 
Lyn Bastian 
Elizabeth Bennett 
Dr Feisal Chenia 
John Coomblas 
A/Prof Rosalie Grivell 
Dr Sue Kennedy-Andrews 
Jackie Kitschke 
Catherine Leggett 
Dr Anupam Parange 
Dr Andrew McPhee 
Rebecca Smith 
A/Prof John Svigos 
Dr Laura Willington 
  



Vitamin D Status in Pregnancy 
 
 

 
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Document Ownership &amp; History 
Developed by: SA Maternal, Neonatal &amp; Gynaecology Community of Practice 
Contact: HealthCYWHSPerinatalProtocol@sa.gov.au 
Endorsed by: SA Health Safety and Quality Strategic Governance Committee 
Next review due:  10/05/2024  
ISBN number:  978-1-76083-126-4 
PDS reference:  CG251 
Policy history: Is this a new policy (V1)?  N 
 Does this policy amend or update and existing policy?   Y  
 If so, which version? 3 
 Does this policy replace another policy with a different title?  Y  
 If so, which policy (title)? Vitamin D Deficiency 
 
 

Approval 
Date Version 

Who approved New/Revised 
Version Reason for Change 

10/05/2019 V4 SA Health Safety and Quality Strategic Governance Committee Formally reviewed 

24/12/2007  V3 SA Maternal &amp; Neonatal Clinical Network Minor amendment 

20/09/2007  V2 SA Maternal &amp; Neonatal Clinical Network Minor amendment 

18/09/2007  V1 SA Maternal &amp; Neonatal Clinical Network 
Original SA Maternal &amp; Neonatal 
Clinical Network approved version. 

 



	Purpose and Scope of Perinatal Practice Guideline (PPG)
	Flowchart 1: Management of Vitamin D Status in Pregnancy
	Flowchart 2: Newborn Management
	Abbreviations
	Definitions
	Introduction
	Food sources of Vitamin D
	Other sources of Vitamin D
	Vitamin D content of multivitamins

	Vitamin D status in pregnancy
	Antenatal screening and treatment
	First appointment (booking) screening of at risk women
	Vitamin D supplementation for ALL pregnant women
	First follow-up of at risk women
	Subsequent follow-up of at risk women
	Discharge

	Neonatal management
	References
	Appendix I: Fact Sheet: Vitamin D Supplementation in Pregnancy
	Appendix 2: Vitamin D Deficiency in Pregnancy
	Appendix 2: Parent information: Vitamin D Deficiency in Babies

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