From the Research
Management of a 37-year-old female at 34 weeks gestation with elevated 1,25-dihydroxy vitamin D levels should prioritize avoiding excessive vitamin D supplementation and monitoring for potential adverse effects on the fetus, as high maternal 1,25(OH)2D levels can reduce fetal bone mass and lead to neonatal lethality, as evidenced by a study published in the journal Bone in 2013 1. The patient's elevated 1,25-dihydroxy vitamin D levels, which are above the reference range of 20-79 pg/mL, require a comprehensive evaluation to identify the underlying cause.
- Testing for parathyroid hormone (PTH), calcium, phosphorus, and 25-hydroxy vitamin D levels should be conducted to distinguish between pregnancy-related physiological changes and pathological conditions.
- If the elevation is mild and associated with normal calcium levels, close monitoring without specific intervention may be appropriate.
- For significant elevations, especially with hypercalcemia, consultation with maternal-fetal medicine and endocrinology specialists is essential, as seen in a case report published in BMJ case reports in 2017 2. Treatment depends on the cause but may include:
- Increased hydration
- Limited calcium intake (1000-1200 mg daily)
- Avoidance of vitamin D supplements, as recommended by the American College of Obstetricians and Gynecologists in 2011 3 In cases of granulomatous diseases or lymphoma causing elevated 1,25-dihydroxy vitamin D, low-dose corticosteroids (prednisone 5-10 mg daily) may be considered after specialist consultation. Weekly monitoring of calcium and vitamin D levels is recommended until delivery, taking into account the opinions and practices of US-based obstetrician-gynecologists regarding vitamin D screening and supplementation of pregnant women, as reported in the Journal of Pregnancy in 2016 4. Elevated 1,25-dihydroxy vitamin D during pregnancy can occur physiologically due to increased placental production, but pathological causes include granulomatous disorders, lymphomas, and rare genetic conditions, making accurate diagnosis crucial for appropriate management, as discussed in the American Journal of Clinical Nutrition in 2008 5.