Prenatal Visit

Assess

Ask about maternal vitamin D adequacy—maternal vitamin D deficiency is associated with subclinical and clinically relevant vitamin D deficiency in infants.

• Only 35% of Americans (>12 months) have sufficient vitamin D levels (>75 nmol/L of 25-hydroxyvitamin D [25-(OH)-D]). (ref)
  • Prevalence of deficiency is greatest in non-Hispanic Black Americans, women, individuals aged 20 to 29 years, and during winter.
  • There is little justification for measuring serum 25-(OH)-D levels in the general population. (ref)
• Prenatal vitamin D supplementation is associated with increased birth weight and increased levels of maternal and neonatal 25-(OH)-D concentrations.
  • 2 RCTs of vitamin D supplementation during pregnancy showed a significant protective effect against childhood asthma and recurrent wheeze up to age 3.

Discuss

Breastfeeding, including the following topics:

• The benefits of breastfeeding
• Any concerns about the mother’s ability to breastfeed
  • Bariatric surgery
  • Breast reduction
• Initiating breastfeeding as soon as possible after birth
• Plans for exclusive breastfeeding for approximately 6 months
  • Exclusive breastfeeding to 6 months is associated with significantly decreased risk of infant ear, respiratory, and GI infections and childhood leukemias, eczema, and asthma. Breastfeeding to 2 years continues to offer these benefits and additionally significantly decreases the mother's risk of breast and ovarian cancer, cardiovascular disease, and postmenopausal osteoporosis.

Issues that affect infant nutrition

• Dietary preferences, including vegetarianism or veganism.
  • Vegetarian mothers should be counseled on vitamin B₁₂ supplementation to ensure adequate availability of B₁₂ for their breastfed infants.
  • Food avoidance habits (eg, gluten, dairy).
  • Weight loss techniques or “fad” diets.
• Maternal intake of medications (including GLP-1 agonists), herbs, drugs, alcohol, and tobacco.
• If parents have overweight, children are at increased risk of having overweight. Begin discussing changes in lifestyle that decrease the risk of obesity, including breastfeeding and parental activity levels.
• If appropriate, inform parents of the availability of supplemental food programs.