research article

Knowledge, Attitudes and Practices of Family Medicine Physicians Regarding Vitamin D Measurement and Treatment During Pregnancy in PHC, Riyadh, Saudi Arabia

Abdulelah Bin Hotan1*, Shatha Murad2, Mostafa Kofi3

1 Family and Community Medicine- Resident, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

2 Family and Community Medicine- Consultant, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

3 Professor, Family and Community Medicine- Consultant, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

*Corresponding author: Abdulelah Saud Bin Hotan, Family and Community Medicine- Resident, Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Received Date: 25 January, 2023

Accepted Date: 03 February, 2023

Published Date: 08 February, 2023

Citation: Hotan AB, Murad S, Kofi M (2023) Knowledge, Attitudes and Practices of Family Medicine Physicians Regarding Vitamin D Measurement and Treatment During Pregnancy in PHC, Riyadh, Saudi Arabia. J Family Med Prim Care Open Acc 7: 212. DOI: https://doi.org/10.29011/2688-7460.100212

Abstract

Background: The mother and the unborn child both experience a multitude of problems as a result of vitamin D insufficiency. The evaluation of medical professionals' knowledge in measuring vitamin D levels and treating deficits is the main objective of this study. According to recent studies, low vitamin D levels have been associated with unfavorable outcomes for mothers, including pregnancy-induced hypertension, high blood pressure in diabetic pregnancies, gestational diabetes mellitus, recurrent miscarriages, preterm delivery, primary Caesarean section, and postpartum depression. Aim and objective: The major goal of this study is to find out how family medicine doctors at PHC, Riyadh, Saudi Arabia, feel about measuring and treating pregnant women for vitamin D deficiency. Methodology: In a cross-sectional research at PSMMC, Riyadh, family medicine practitioners are asked to complete a self-administered questionnaire to assess their knowledge of diagnosing and treating vitamin D deficiency during pregnancy. Utilizing the Statistical Package for Social Studies, data were examined IBM Corp., New York, NY, USA; SPSS 22). The categorical variables' expressed percentages. The chi square test was used to categorical variables. A p-value of 0.05 was used to determine statistical significance. Conclusion: Most PHC and PSMMC physicians recommend using vitamin D supplementation during pregnancy. The majority of respondents did routinely suggest vitamin D supplements to their patients in pregnancy. Doctors at PHC and PSMMC's average level of vitamin D awareness is associated to gender, kind of specialization, personal vitamin D supplement use, and suggesting others take supplements.

Keywords: Vitamin D; Pregnancy; Pregnant women; Vitamin D deficiency

Introduction

The steroid element vitamin D comes from a class of prohormones that are fat-soluble. Pregnancy and vitamin D are both crucial. For both their personal health and the proper development of their unborn child, expectant moms must ensure that they consume the required levels of vitamin D during pregnancy. D2 and D3 are the most important substances for human growth [1].

Vitamin D has a variety of important biological effects that support the growth of strong bones, teeth, and muscles in addition to improving the intestinal absorption of calcium, magnesium, and phosphate. Vitamin D supplementation is thought to modify metabolic profile and may have an impact on fertility and results. Consequently, this investigation was carried out to learn the extent to which the doctor tests for vitamin D insufficiency and treats it throughout pregnancy. Unfortunately, the majority of doctors are ignorant when it comes pertaining to vitamin D treatment for expectant mothers, the dosage during pregnancy, and the significance of measuring vitamin D levels [2].

The physiologically greater 1,25-dehydroxy vitamin D levels seen in the second and third trimesters suggest that pregnant women have higher vitamin D requirements. Even though 1,25(OH)2D levels do not directly correlate with 25 hydroxy vitamin D concentrations, the physiological increase in the active metabolite, the improved intestinal calcium absorption, and the increased fetal calcium requirement (250 mg/day in the third trimester) all point to the significance of vitamin D biology in pregnancy [3].

Since roughly a century ago, rickets and osteomalacia have been linked to vitamin D deficiency, exhibiting the disease's well-known musculoskeletal symptoms. Currently being uncovered are several metabolic and nonskeletal connections with vitamin D insufficiency. Several researchers have shown links between low vitamin D levels and various features of the metabolic syndrome. Others discuss vitamin D's potential for immunomodulation, anabolism, anti-infection, and anti-tumor effects [3]. Numerous authors have reported on and extensively explored a variety of issues, including maternal secondary hyperparathyroidism, osteomalacia, neonatal hypocalcemia, tetany, delayed cranial vertex ossification, enlarged cranial fontanelles, and abnormal fetal bones ossification.

Low vitamin D levels have been linked to adverse maternal outcomes, such as pregnancy-induced high blood pressure, hypertension in diabetic pregnancies, gestational diabetes mellitus, reoccurring miscarriages, premature delivery, primary Cesarean delivery, and postnatal depression, according to recent studies [4].

There is mounting evidence that the vitamin D status of mothers has an impact on the long-term health of their offspring. There is conflicting evidence about how maternal vitamin D affects a child's skeleton's integrity. In one research that measured bone mass at age 9, high maternal vitamin D levels were positively correlated with bone mass, but no meaningful link could be identified in another analysis of the same longitudinal cohort.

Although a population-based cohort of infants at genetic risk for type 1 diabetes has not shown vitamin D intake from food or supplements to increase this risk, nested case control studies have shown a high risk of type 1 diabetes in the offspring of women with low levels of vitamin D during pregnancy. Asthma and weakened lung function in kids have been linked by other writers to maternal vitamin D insufficiency [5].

The best approach to actually guarantee ample vitamin D, though, is with a simple pill. You will have an option between two types of vitamin D while taking supplements. Cholecalciferol, an animal-derived type of vitamin D, is frequently made from sheep's lanolin or fish liver oil. The vegetarian version of vitamin D is ergocalciferol. Ergocalciferol is preferable if you're vegan, whereas cholecalciferol is more readily absorbed and used by the body. Quality is crucial. The natural form of cholecalciferol, Vitamin D3 from Nordic Naturals (1000 IU per soft gel), is advised [5].

Vitamin D deficiency causes a number of issues for both the mother and the unborn child. This study's primary goal is to assess and ascertain how well-versed medical professionals are in measuring vitamin D levels and treating deficiencies. A self-administered questionnaire will be used in a cross-sectional study at PSMMC, Riyadh, to gauge family medicine doctors' understanding of how to measure and treat vitamin D insufficiency during pregnancy. Our goal is to determine the attitude and practices of family medicine physicians related to the Vitamin D and evaluate their knowledge about measuring the levels of Vitamin D during pregnancy and also treat if levels were found to be insufficient.

Aim and Objective

The main aim of this study is to determine the knowledge, attitudes and practices of family medicine physicians regarding vitamin d measurement and treatment during pregnancy in PHC, Riyadh, Saudi Arabia.

Specific Objectives

· To evaluate the expertise of family care doctors on the detection and treatment of vitamin D insufficiency during pregnancy.

· To explain family medicine doctors' procedures for assessing and treating vitamin D insufficiency in pregnant women in PHC.

Materials and Methods

Study Approach: Cross Sectional.

Target population: Physicians in PHC, PSMMC

Sampling Method: Comprehensive sample of 332 physicians of PHC and PSMMC.

Inclusion Criteria: PHC and PSMMC physicians.

Working definition: The degree to which a doctor orders a vitamin D level and treats a deficit when pregnant

Software for Data Management: SPSS

Study duration: one year (March 2021 to March 2022).

Data Collection Form: We will utilize a questionnaire that was created by the researcher and has been approved as follows:

  • Two experts checked the research's validity, and it was amended as recommended.
  • A two-pilot study with five physicians was conducted.

Statistical Plan: Descriptive statistics, Observational study

Types of Bias and Their Control: Type error occurs when the alternative hypothesis (the availability of doctors' knowledge on the timing of diagnosing and treating vitamin D deficiency during pregnancy) is accepted even when it is incorrect. Accepting the null hypothesis while knowing it to be incorrect is type, and doing so would be a mistake.

Sample size calculation: Qualitative of one proportional, One group


Where: n= sample size (332 physicians) Zα/2=1.96 (The critical value that divides the central 95% of the Z distribution from the 5% in the tail) proportion of physicians=the prevalence of the outcome variable= 50% E = the margin of error (=width of confidence interval) = 95%.

Statistical Analysis

Utilizing the Statistical Package for Social Studies, data were examined (SPSS 22; IBM Corp., New York, NY, USA). The percentages used to express categorical variables. Categorical variables were subjected to the chi square test. Statistical significance was defined as a p-value 0.05.

Results

The cross sectional study of 332 physicians from PHC and PSMMC showed the demographic characteristics as follows:

Most of the physicians were in the age range of 25-35 years (52.10%) followed by 36-45 years’ age group (21.26%). Majority of the physicians are male (61.08%) followed by 38.92% female. About 61.98% were Saudi nationals and 38.02% were Non-Saudi. The level of education is 31.44% are residents; 23.95% are registrar; 22.75% are senior registrar and 12.87% are general practitioners and 8.98% are consultants. 33.83% have more than 5 years of practicing experience (Table 1).

   

Number

%

Age

25-35

174.00

52.10

36-45

71.00

21.26

46-55

60.00

17.96

56-65

28.00

8.38

66-75

1.00

0.30

Gender

Male

204.00

61.08

Female

130.00

38.92

Nationality

Saudi

207.00

61.98

Non-Saudi

127.00

38.02

Level of Education

Consultant

30.00

8.98

Senior registrar

76.00

22.75

Registrar

80.00

23.95

Resident

105.00

31.44

General Practitioner

43.00

12.87

Practicing years

<5 years

113.00

33.83

5-10 years

78.00

23.35

11-15 years

93.00

27.84

16-20 years

43.00

12.87

>20 years

7.00

2.10

Table 1: Demographic characteristics of the participants (n=334).

The figure 1 showed 44.9% fortified dairy products as the source of vitamin D; 52.1% green leafy vegetables as the source of vitamin D; 58.4 fatty fish as the source of vitamin D; 54.5 fortified cereals as the source of vitamin D; 66.5 vitamin D supplements as the source of vitamin D; 44.3 sun exposure as the source of vitamin D; 17.4 fish oils as the source of vitamin D; 9.3 animal liver as the source of vitamin D.

 

Figure1: Sourcesof vitamin D.

50.3% got online source of information about vitamin D; 51.5% got journals as the source; 54.8% got textbooks as the source of information; 58.1% had medical training as the source to learn about vitamin D deficiency. While remaining 16.5% and 10.5% of the information was obtained by literatures and colleagues respectively (Figure 2).

 

Figure 2: Source of Information about Vitamin D Deficiency.

The causes to request vitamin D level in pregnancy are: obesity (44.9%); malabsorption syndrome (68.9%); gastric bypass surgery (72.2%); family history of osteoporosis (47%). The outcomes of Vitamin D deficiency if not treated were selected as follows: small for gestational age (30.8%); osteoporosis (55.7%); Bone fracture (61.7%); week immunity (50%); colon cancer (41%); cardiovascular disease (36.5%); impaired glucose metabolism (22.5%); preclampsia (17.4%) preterm labor (7.2%) (Tables 2 and 3).

 

Number

%

What are the vitamin D Sources?

   

Fortified dairy products

150

44.9

Green leafy vegetables

174

52.1

Fatty fish

195

58.4

Fortified cereals

182

54.5

Vitamin D supplements

222

66.5

Sun exposure

148

44.3

Fish oils

58

17.4

Animal liver

31

9.3

What is the source of Information about Vitamin D Deficiency?

   

Online

168

50.3

Journals

172

51.5

Textbooks

183

54.8

Medical training

194

58.1

Colleagues

35

10.5

Literatures

55

16.5

What are the causes to request vitamin D level in pregnancy

   

Obesity

150

44.9

malabsorption syndrome

230

68.9

gastric bypass surgery

241

72.2

family history of osteoporosis

157

47.0

What are the outcomes of vitamin D deficiency if not treated

   

Small for gestational age

103

30.8

Osteoporosis

186

55.7

Bone fracture

206

61.7

week immunity

167

50.0

Colon Cancer

137

41.0

Cardiovascular disease

122

36.5

Impaired Glucose metabolism

75

22.5

Preeclampsia

58

17.4

Preterm labor

24

7.2

Table 2: Answers of knowledge questions of family medicine physician toward measure and treat vitamin D deficiency during pregnancy.

   

Number

%

Does Vitamin D supplementation during pregnancy safe?

Agree

250

74.9

Disagree

84

25.1

Does Vitamin D supplementation during pregnancy usually not necessary

Agree

89

26.6

Disagree

245

73.4

Would you screen pregnant Women for vitamin D deficiency?

Never

103

30.8

Rarely

109

32.6

Often

80

24.0

Always

42

12.6

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

145

43.4

10000 IU\ day for 8 weeks

58

17.4

4000 IU\ day for 6 weeks

56

16.8

1000 IU\ day for 6 weeks

44

13.2

400 IU\ Day for 6 weeks

31

9.3

Table 3: Answers of practice questions of family medicine physician toward measure and treat vitamin D deficiency during pregnancy.

74.9% of medical professionals support the safety of vitamin D supplementation during pregnancy. 73.4% of the participants disagree that vitamin D supplements are often not required during pregnancy. 32.6% of the physicians would rarely screen pregnant women for vitamin D deficiency. 43.4% thinks that 50000 IU\week for 8 weeks is the recommended dose for pregnant with vitamin D deficiency (Figure 3) (Tables 4-13).

 

Figure 3: Causes to request vitamin D level in pregnancy.

 

Male

Female

p value

 

Number

%

Number

%

What are the vitamin D Sources?

         

Fortified dairy products

97

47.5

53

40.8

0.225

Green leafy vegetables

108

52.9

66

50.8

0.698

Fatty fish

118

57.8

77

59.2

0.802

Fortified cereals

114

55.9

68

52.3

0.522

Vitamin D supplements

134

65.7

88

67.7

0.705

Sun exposure

93

45.6

55

42.3

0.556

Fish oils

37

18.1

21

16.2

0.641

Animal liver

21

10.3

10

7.7

0.424

What is the source of Information about Vitamin D Deficiency?

         

Online

111

54.4

57

43.8

0.060

Journals

109

53.4

63

48.5

0.376

Textbooks

111

54.4

72

55.4

0.862

Medical training

117

57.4

77

59.2

0.735

Colleagues

18

8.8

17

13.1

0.216

Literatures

30

14.7

25

19.2

0.277

What are the causes to request vitamin D level in pregnancy

         

Obesity

95

46.6

55

42.3

0.445

Malabsorption syndrome

140

68.6

90

69.2

0.908

Gastric bypass surgery

142

69.6

99

76.2

0.193

Family history of osteoporosis

92

45.1

65

50.0

0.381

What are the outcomes of vitamin D deficiency if not treated

         

Small for gestational age

63

30.9

40

30.8

0.983

Osteoporosis

116

56.9

70

53.8

0.588

Bone fracture

130

63.7

76

58.5

0.335

week immunity

105

51.5

62

47.7

0.501

Colon Cancer

86

42.2

51

39.2

0.596

Cardiovascular disease

71

34.8

51

39.2

0.413

Impaired Glucose metabolism

47

23.0

28

21.5

0.749

Preeclampsia

31

15.2

27

20.8

0.190

Preterm labour

13

6.4

11

8.5

0.471

Table 4: Assessing the knowledge of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by gender.

 

Saudi

Non-Saudi

p value

 

Number

%

Number

%

What are the vitamin D Sources?

         

Fortified dairy products

102

49.3

48

37.8

0.041*

Green leafy vegetables

108

52.2

66

52.0

0.971

Fatty fish

119

57.5

76

59.8

0.672

Fortified cereals

106

51.2

76

59.8

0.124

Vitamin D supplements

145

70.0

77

60.6

0.077

Sun exposure

105

50.7

43

33.9

0.003*

Fish oils

43

20.8

15

11.8

0.036*

Animal liver

25

12.1

6

4.7

0.025*

What is the source of Information about Vitamin D Deficiency?

         

Online

118

57.0

50

39.4

0.002*

Journals

102

49.3

70

55.1

0.300

Textbooks

109

52.7

74

58.3

0.317

Medical training

118

57.0

76

59.8

0.610

Colleagues

23

11.1

12

9.4

0.630

Literatures

34

16.4

21

16.5

0.979

What are the causes to request vitamin D level in pregnancy

         

Obesity

92

44.4

58

45.7

0.827

malabsorption syndrome

140

67.6

90

70.9

0.536

gastric bypass surgery

144

69.6

97

76.4

0.178

family history of osteoporosis

99

47.8

58

45.7

0.701

What are the outcomes of vitamin D deficiency if not treated

         

Small for gestational age

69

33.3

34

26.8

0.207

Osteoporosis

125

60.4

61

48.0

0.027*

Bone fracture

134

64.7

72

56.7

0.142

week immunity

108

52.2

59

46.5

0.310

Colon Cancer

79

38.2

58

45.7

0.176

Cardiovascular disease

60

29.0

62

48.8

<0.001*

Impaired Glucose metabolism

36

17.4

39

30.7

0.005*

Preeclampsia

29

14.0

29

22.8

0.039*

Preterm labour

20

9.7

4

3.1

0.018*

* Significant p value

Table 5: Assessing the knowledge of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by Nationality.

 

25-35

36-45

46-55

>55

p value

 

Number

%

Number

%

Number

%

Number

%

What are the vitamin D Sources?

                 

Fortified dairy products

89

51.1

31

43.7

18

30.0

12

41.4

0.040*

Green leafy vegetables

89

51.1

45

63.4

28

46.7

12

41.4

0.126

Fatty fish

92

52.9

50

70.4

31

51.7

22

75.9

0.011*

Fortified cereals

86

49.4

41

57.7

36

60.0

19

65.5

0.235

Vitamin D supplements

116

66.7

44

62.0

44

73.3

18

62.1

0.538

Sun exposure

88

50.6

19

26.8

28

46.7

13

44.8

0.008*

Fish oils

33

19.0

6

8.5

14

23.3

5

17.2

0.125

Animal liver

22

12.6

2

2.8

5

8.3

2

6.9

0.106

What is the source of Information about Vitamin D Deficiency?

                 

Online

111

63.8

34

47.9

14

23.3

9

31.0

<0.001*

Journals

85

48.9

35

49.3

35

58.3

17

58.6

0.505

Textbooks

96

55.2

35

49.3

31

51.7

21

72.4

0.191

Medical training

102

58.6

39

54.9

34

56.7

19

65.5

0.797

Colleagues

15

8.6

10

14.1

4

6.7

6

20.7

0.123

Literatures

27

15.5

9

12.7

13

21.7

6

20.7

0.492

What are the causes to request vitamin D level in pregnancy

                 

Obesity

73

42.0

36

50.7

27

45.0

14

48.3

0.634

malabsorption syndrome

114

65.5

48

67.6

43

71.7

25

86.2

0.154

gastric bypass surgery

123

70.7

50

70.4

42

70.0

26

89.7

0.183

family history of osteoporosis

79

45.4

31

43.7

33

55.0

14

48.3

0.561

What are the outcomes of vitamin D deficiency if not treated

                 

Small for gestational age

57

32.8

24

33.8

16

26.7

6

20.7

0.478

Osteoporosis

114

65.5

32

45.1

25

41.7

15

51.7

0.002*

Bone fracture

111

63.8

43

60.6

37

61.7

15

51.7

0.663

week immunity

89

51.1

31

43.7

33

55.0

14

48.3

0.600

Colon Cancer

65

37.4

35

49.3

25

41.7

12

41.4

0.394

Cardiovascular disease

51

29.3

30

42.3

26

43.3

15

51.7

0.029*

Impaired Glucose metabolism

28

16.1

19

26.8

17

28.3

11

37.9

0.019*

Preeclampsia

21

12.1

15

21.1

12

20.0

10

34.5

0.016*

Preterm labour

13

7.5

5

7.0

6

10.0

0

0

0.395

* Significant p value

Table 6: Assessing the knowledge of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by age.

 

Consultant

Senior registrar

Registrar

Resident

General Practitioner

p value

Number

%

Number

%

Number

%

Number

%

Number

%

   

What are the vitamin D Sources?

                       

Fortified dairy products

12

40.0

34

44.7

29

36.3

59

56.2

16

37.2

0.057

 

Green leafy vegetables

13

43.3

48

63.2

43

53.8

47

44.8

23

53.5

0.134

 

Fatty fish

18

60.0

43

56.6

56

70.0

56

53.3

22

51.2

0.158

 

Fortified cereals

23

76.7

43

56.6

47

58.8

47

44.8

22

51.2

0.028*

 

Vitamin D supplements

24

80.0

42

55.3

52

65.0

80

76.2

24

55.8

0.009*

 

Sun exposure

15

50.0

24

31.6

29

36.3

67

63.8

13

30.2

<0.001*

 

Fish oils

6

20.0

12

15.8

13

16.3

22

21.0

5

11.6

0.686

 

Animal liver

1

3.3

4

5.3

4

5.0

19

18.1

3

7.0

0.006*

 

What is the source of Information about Vitamin D Deficiency?

                       

Online

11

36.7

33

43.4

30

37.5

72

68.6

22

51.2

<0.001*

 

Journals

15

50.0

49

64.5

42

52.5

42

40.0

24

55.8

0.026*

 

Textbooks

15

50.0

41

53.9

48

60.0

56

53.3

23

53.5

0.862

 

Medical training

18

60.0

35

46.1

45

56.3

70

66.7

26

60.5

0.093

 

Colleagues

7

23.3

7

9.2

9

11.3

8

7.6

4

9.3

0.168

 

Literatures

7

23.3

13

17.1

14

17.5

18

17.1

3

7.0

0.411

 

What are the causes to request vitamin D level in pregnancy

                       

Obesity

15

50.0

37

48.7

33

41.3

37

35.2

28

65.1

0.016*

 

malabsorption syndrome

24

80.0

55

72.4

61

76.3

63

60.0

27

62.8

0.066

 

gastric bypass surgery

23

76.7

61

80.3

58

72.5

72

68.6

27

62.8

0.254

 

family history of osteoporosis

19

63.3

27

35.5

38

47.5

60

57.1

13

30.2

0.002*

 

What are the outcomes of vitamin D deficiency if not treated

                       

Small for gestational age

8

26.7

27

35.5

19

23.8

35

33.3

14

32.6

0.512

 

Osteoporosis

14

46.7

37

48.7

43

53.8

70

66.7

22

51.2

0.088

 

Bone fracture

22

73.3

53

69.7

39

48.8

67

63.8

25

58.1

0.042*

 

week immunity

17

56.7

35

46.1

45

56.3

49

46.7

21

48.8

0.601

 

Colon Cancer

16

53.3

31

40.8

31

38.8

39

37.1

20

46.5

0.518

 

Cardiovascular disease

12

40.0

27

35.5

41

51.3

25

23.8

17

39.5

0.004*

 

Impaired Glucose metabolism

9

30.0

25

32.9

20

25.0

13

12.4

8

18.6

0.014*

 

Preeclampsia

9

30.0

12

15.8

15

18.8

15

14.3

7

16.3

0.366

 

Preterm labour

3

10.0

6

7.9

5

6.3

9

8.6

1

2.3

0.673

 

* Significant p value

 
                               

Table 7: Assessing the knowledge of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by level of education.

 

<5 years

5-10 years

11-15 years

>15

p value

Number

%

Number

%

Number

%

Number

%

What are the causes to request vitamin D level in pregnancy

                 

Obesity

43

38.1

41

52.6

42

45.2

24

48.0

0.242

malabsorption syndrome

74

65.5

56

71.8

59

63.4

41

82.0

0.102

gastric bypass surgery

76

67.3

54

69.2

70

75.3

41

82.0

0.209

family history of osteoporosis

61

54.0

22

28.2

46

49.5

28

56.0

0.002*

What are the outcomes of vitamin D deficiency if not treated

                 

Small for gestational age

38

33.6

28

35.9

26

28.0

11

22.0

0.315

Osteoporosis

76

67.3

47

60.3

44

47.3

19

38.0

0.001*

Bone fracture

72

63.7

53

67.9

50

53.8

31

62.0

0.265

week immunity

53

46.9

40

51.3

45

48.4

29

58.0

0.602

Colon Cancer

41

36.3

29

37.2

49

52.7

18

36.0

0.064

Cardiovascular disease

29

25.7

22

28.2

43

46.2

28

56.0

<0.001*

Impaired Glucose metabolism

12

10.6

16

20.5

30

32.3

17

34.0

<0.001*

Preeclampsia

12

10.6

10

12.8

20

21.5

16

32.0

0.004*

Preterm labour

8

7.1

3

3.8

8

8.6

5

10.0

0.536

* Significant p value

Table 8: Assessing the knowledge of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by practicing years.

   

25-35

36-45

46-55

>55

p value

Number

%

Number

%

Number

%

Number

%

Does Vitamin D supplementation during pregnancy safe?

agree

136

78.2

57

80.3

37

61.7

20

69.0

0.042*

Disagree

38

21.8

14

19.7

23

38.3

9

31.0

Does Vitamin D supplementation during pregnancy usually not necessary

agree

45

25.9

17

23.9

17

28.3

10

34.5

0.725

Disagree

129

74.1

54

76.1

43

71.7

19

65.5

Would you screen pregnant Women for vitamin D deficiency?

Never

55

31.6

20

28.2

22

36.7

6

20.7

0.599

Rarely

58

33.3

23

32.4

18

30.0

10

34.5

Often

38

21.8

16

22.5

17

28.3

9

31.0

Always

23

13.2

12

16.9

3

5.0

4

13.8

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

75

43.1

33

46.5

26

43.3

11

37.9

0.007*

10000 IU\ day for 8 weeks

25

14.4

19

26.8

8

13.3

6

20.7

4000 IU\ day for 6 weeks

30

17.2

12

16.9

10

16.7

4

13.8

1000 IU\ day for 6 weeks

32

18.4

5

7.0

4

6.7

3

10.3

400 IU\ Day for 6 weeks

12

6.9

2

2.8

12

20.0

5

17.2

* Significant p value

Table 9: Assessing the practice of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by age.

   

Male

Female

p value

Number

%

Number

%

Does Vitamin D supplementation during pregnancy safe?

agree

159

77.9

91

70.0

0.103

Disagree

45

22.1

39

30.0

Does Vitamin D supplementation during pregnancy usually not necessary

agree

54

26.5

35

26.9

0.927

Disagree

150

73.5

95

73.1

Would you screen pregnant Women for vitamin D deficiency?

Never

63

30.9

40

30.8

0.999

Rarely

66

32.4

43

33.1

Often

49

24.0

31

23.8

Always

26

12.7

16

12.3

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

92

45.1

53

40.8

0.443

10000 IU\ day for 8 weeks

37

18.1

21

16.2

4000 IU\ day for 6 weeks

32

15.7

24

18.5

1000 IU\ day for 6 weeks

22

10.8

22

16.9

400 IU\ Day for 6 weeks

21

10.3

10

7.7

Table 10: Assessing the practice of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by gender.

   

Saudi

Non-Saudi

p value

Number

%

Number

%

Does Vitamin D supplementation during pregnancy safe?

agree

160

77.3

90

70.9

0.189

Disagree

47

22.7

37

29.1

Does Vitamin D supplementation during pregnancy usually not necessary

agree

62

30.0

27

21.3

0.081

Disagree

145

70.0

100

78.7

Would you screen pregnant Women for vitamin D deficiency?

Never

65

31.4

38

29.9

0.111

Rarely

71

34.3

38

29.9

Often

41

19.8

39

30.7

Always

30

14.5

12

9.4

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

85

41.1

60

47.2

0.243

10000 IU\ day for 8 weeks

34

16.4

24

18.9

4000 IU\ day for 6 weeks

34

16.4

22

17.3

1000 IU\ day for 6 weeks

34

16.4

10

7.9

400 IU\ Day for 6 weeks

20

9.7

11

8.7

Table 11: Assessing the practice of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by nationality.

   

Consultant

Senior registrar

Registrar

Resident

General Practitioner

p value

   

Number

%

Number

%

Number

%

Number

%

Number

%

Does Vitamin D supplementation during pregnancy safe?

agree

23

76.7

55

72.4

58

72.5

79

75.2

35

81.4

0.823

Disagree

7

23.3

21

27.6

22

27.5

26

24.8

8

18.6

Does Vitamin D supplementation during pregnancy usually not necessary

agree

10

33.3

13

17.1

23

28.8

32

30.5

11

25.6

0.265

Disagree

20

66.7

63

82.9

57

71.3

73

69.5

32

74.4

Would you screen pregnant Women for vitamin D deficiency?

Never

6

20.0

27

35.5

23

28.8

30

28.6

17

39.5

0.137

Rarely

11

36.7

16

21.1

30

37.5

38

36.2

14

32.6

Often

11

36.7

20

26.3

21

26.3

20

19.0

8

18.6

Always

2

6.7

13

17.1

6

7.5

17

16.2

4

9.3

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

14

46.7

38

50.0

27

33.8

46

43.8

20

46.5

0.034*

10000 IU\ day for 8 weeks

4

13.3

13

17.1

22

27.5

10

9.5

9

20.9

4000 IU\ day for 6 weeks

7

23.3

8

10.5

14

17.5

20

19.0

7

16.3

1000 IU\ day for 6 weeks

3

10.0

9

11.8

6

7.5

23

21.9

3

7.0

400 IU\ Day for 6 weeks

2

6.7

8

10.5

11

13.8

6

5.7

4

9.3

* Significant p value

Table 12: Assessing the practice of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by level of education.

   

<5 years

5-10 years

11-15 years

>15

p value

Number

%

Number

%

Number

%

Number

%

Does Vitamin D supplementation during pregnancy safe?

agree

91

80.5

68

87.2

60

64.5

31

62.0

<0.001*

Disagree

22

19.5

10

12.8

33

35.5

19

38.0

Does Vitamin D supplementation during pregnancy usually not necessary

agree

30

26.5

15

19.2

22

23.7

22

44.0

0.016*

Disagree

83

73.5

63

80.8

71

76.3

28

56.0

Would you screen pregnant Women for vitamin D deficiency?

Never

36

31.9

24

30.8

28

30.1

15

30.0

0.002*

Rarely

44

38.9

29

37.2

26

28.0

10

20.0

Often

16

14.2

12

15.4

33

35.5

19

38.0

Always

17

15.0

13

16.7

6

6.5

6

12.0

What is the recommended dose for pregnant with vitamin D deficiency?

50000 IU\ week for 8 weeks

50

44.2

35

44.9

39

41.9

21

42.0

0.154

10000 IU\ day for 8 weeks

13

11.5

16

20.5

21

22.6

8

16.0

4000 IU\ day for 6 weeks

21

18.6

9

11.5

15

16.1

11

22.0

1000 IU\ day for 6 weeks

23

20.4

9

11.5

7

7.5

5

10.0

400 IU\ Day for 6 weeks

6

5.3

9

11.5

11

11.8

5

10.0

* Significant p value

 

Table 13: Assessing the practice of family medicine physician toward measure and treat vitamin D deficiency during pregnancy by Practicing years.

Discussion

The physiologically greater 1,25-dehydroxy vitamin D levels seen in the second and third trimesters suggest that pregnant women have higher vitamin D requirements. The physiological rise in the active metabolite, the increased fetal calcium need (250 mg/day in the third trimester), and the better intestinal calcium absorption all testify to the importance of vitamin D biology in pregnancy.

In healthy, non-pregnant individuals, the optimal vitamin D level is thought to be the quantity required to maintain blood parathormone levels and prevent secondary hyperparathyroidism. This notion states that normal levels during pregnancy should be the same as those in non-pregnant adults. However, the extra factors of prenatal health and subsequent child health make the situation more complicated. There is little information available on the impact of raising vitamin D levels on birth weight, neonatal health, long-term health, and mother outcomes.

Due to a lack of evidence, the World Health Organization (WHO) presently does not advise giving vitamin D supplements to pregnant women as part of standard prenatal care, which is in accordance with recommendations made by the American Congress of Obstetricians and Gynecologists.

In this study, the majority of the participants had strong understanding of how to prevent vitamin D insufficiency while pregnant. Apartment life and the unavailability of women-only public spaces were also highlighted as obstacles to getting adequate vitamin D from sunshine. Although participants had a strong understanding of how to prevent vitamin D insufficiency during pregnancy, their performance in activities like eating foods high in vitamin D and receiving vitamin D from sunshine, which is the major source of this vitamin, was only average. Perceived self-efficacy was the key factor in determining the behaviors pregnant women used to prevent vitamin D insufficiency. This information can be used to inform the creation of the required treatments to improve how well this group does in obtaining enough vitamin D.

April 2015 cross sectional study by Miranda Davies-Tuck and associates. In this study, the status of vitamin D throughout pregnancy was examined, along with the relationships between early-pregnancy vitamin D levels and variations in vitamin D throughout pregnancy. Among 1550 women, 55% had insufficient vitamin D (50 nmol/L), 37% had insufficient vitamin D (50-74 nmol/L), and 8% had sufficient vitamin D (>75 nmol/L). Although vitamin D insufficiency is frequent among expectant mothers, it is seldom harmful [6].

A cross-sectional research completed on August 25, 2016 by Sara A. Mohamed and colleagues This research was conducted to assess the doctor's screening and supplementing practices for pregnant women. 101 (45%) of the 225 randomly chosen practicing obstetricians and gynecologists responded to the survey. Most pregnant patients would benefit from vitamin D treatment, according to 66.3% of the practicing doctors, who reported that vitamin D deficiency affects their patient group. Only 25% of the patients will have their vitamin D status checked when pregnant, but half of the patients (52.5%) will prescribe vitamin D treatment throughout pregnancy. To guide practice, higher quality evidence is required. Current clinical studies may give the necessary direction, but until more conclusive outcomes are obtained clinical practice in US [7].

Sina Gallo, et al. conducted a systematic review in 2019 to analyze the connections between maternal 25(OH)D levels, vitamin D supplementation, and health outcomes. Research indicates that vitamin D supplementation during pregnancy raises mother and fetal levels of 25(OH)D and may be connected to Insulin resistance in the mother and fetal development.

2019 retrospective research by Buse Güler et al. In this study, 697 pregnant women between the ages of 18 and 40 were studied to determine the frequency of first-trimester vitamin and mineral supplement recommendations. According to the women's requests to the doctor for laboratory testing, ferritin was 18.4%, mean corpuscular hemoglobin (MCH) was 99.7%, folic acid was 10.2%, vitamin D was 6.3% (the least), vitamin B12 was 17.2%, and calcium was 20.4%. It was discovered that the levels of ferritin, vitamins B12 and D, calcium, folic acid, iron, and iodine were not routinely examined [8].

2015 cohort research by Yuan-Hua Chen, et al. This study sought to ascertain whether there is a correlation between maternal vitamin D deficiency during pregnancy and the chance of having SGA and LBW infants in a Chinese population. And last, the study shows that maternal vitamin D deficiency during pregnancy raises the frequency of SGA and LBW newborns in a Chinese population [9].

2018 review research by Michelle Rockwell and colleagues. This study was conducted to evaluate how doctors handle low vitamin D levels in this challenging setting. The standardization of rules and practices for vitamin D testing and medical treatment, according to authors of various studies that have been evaluated, would be beneficial for patient care. A better knowledge of how doctors handle ambiguity in clinical practice might prevent overuse [10].

2016 cohort research carried out by Fariba Aghajafari and colleagues. In this study, it was determined whether or not pregnant women were getting the appropriate amounts of vitamin D through their diets alone or via supplements. b) If women who are pregnant may reach the recommended levels of vitamin D when their reported dietary consumption of the vitamin complied with those guidelines. Last but not least, Canada and the current vitamin D guidelines for Canadian expectant women should be reassessed [11].

According to a cross-sectional research conducted in 2020 by Ashima Taneja et al., they split the 189 women who participated in the study into Group A and Group B. 105 Group A: Before giving birth, deficient women (30 ng/ml) between 26 and 28 weeks were given supplements and retested. Group B (84): Women who were deficient after 34 weeks but did not get prenatal supplements. Preeclampsia, gestational diabetes, and premature delivery have greater incidences when there is a vitamin D shortage. To enhance maternal outcomes, maternal screening in the targeted group and its augmentation are advised [12].

Research conducted cross-sectionally in 2018 by Arif Abu-Abed et al. On a scale of 1 to 10, dermatologists received a mean recommendation score of 4.7, endocrinologists a mean recommendation score of 4.2, and general physicians a mean recommendation score of 6.4. The purpose of this study was to assess and compare the opinions and suggestions of general practitioners, dermatologists, and endocrinologists about sun exposure and vitamin D. These medical practitioners, whether specialists or primary care physicians, have only sporadic consensus about sun exposure. Family doctors recommended a mean daily sun exposure of 67.4 minutes as opposed to 41.4 minutes and 47.1 minutes from dermatologists and endocrinologists, respectively [13].

In order to compare the vitamin D status of two distinct populations of pregnant women in Australia and New Zealand and investigate the relationship between vitamin D status and pregnancy outcome, Rebecca L. Wilson et al. undertook a prospective cohort study in 2018. 1156 (41%) of the 2800 were hired in Adelaide, while 1644 (59%) were hired in Auckland. In conclusion, it has been demonstrated that having high blood 25(OH)D levels at 15 1 weeks of gestation can prevent the onset of GDM [14].

The age group of 36-45 years had the second-highest percentage of doctors (21.26%), followed by that of 25-35 years (52.10%). The majority of doctors (61.08%) are men, with women making up 38.92% of the workforce. 38.02% of the population was non-Saudi, while 61.98% were Saudi citizens. The degree of education is 12.87% general practitioners, 23.95% registrars, 22.75% senior registrars, 31.44% residents, and 8.98% consultants. More than 5 years of professional experience are included in 33.83%.

Among the sources of vitamin D, fortified dairy products account for 44.9% of consumption, followed by 52.1% of green leafy vegetables, 58.4% of fatty fish, 54.5 percent of fortified cereals, 66.5 percent of vitamin D supplements, 44.3 percent of sun exposure, 17.4 percent of fish oils, and 9.3 percent of animal liver. 50.3% of respondents found material on vitamin D online; 51.5% found it in periodicals; 54.8% found it in textbooks; and 58.1% used their medical knowledge to learn about vitamin D insufficiency. While the remaining 16.5% and 10.5% of the data were gathered from colleagues and the literature, respectively.

Obesity (44.9%), malabsorption syndrome (68.9%), gastric bypass surgery (72.2%), and family history of osteoporosis (47%) are the main reasons why vitamin D levels are requested during pregnancy. The following outcomes of vitamin D insufficiency were chosen if untreated: Preterm labor (7.2%), small for gestational age (30.8%), osteoporosis (55.7%), bone fracture (61.7%), weakened immunity (50%) colon cancer (41%), cardiovascular disease (36.5%), impaired glucose metabolism (22.5%), preclampsia (17.4%), and week immunity (50%) are all pregnancy-related conditions.

Conclusion

The majority of PHC and PSMMC doctors advise using vitamin D supplements. The majority of responders did frequently advise their patients to use vitamin D supplements. The average degree of vitamin D knowledge among doctors at PHC and PSMMC is correlated with gender, kind of specialization, personal vitamin D supplementing experience, and advising others to take supplements. Our research found that doctors' attitudes on vitamin D supplementation are influenced by their degree of expertise, which also influences how they suggest it to patients, loved ones, and healthy individuals.

According to the study, medical professionals at PHC and PSMMC would benefit from increased training in vitamin D in order to reduce the population of Saudi Arabia's steadily growing vitamin D deficit. Male doctors who are pursuing surgical specialties and do not supplement their own vitamin D should receive further instruction in particular. Along with improving their own health, patients would gain from this.

Ethical Consideration

1. Consent of physician before participation was obtained.

2. Confidently all personal date will be confection

3. Information will be used in this Serace

4. We will seek for Institutional Review Board of PSMMC approval Before Conducting the research.

Transparency Declaration: The primary investigator has no conflict of interest to declare. 

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