Mamas on Bedrest: Could Taking Vitamin D have Prevented My Pregnancy Problems?

February 21st, 2014

TGIF Mamas!!!

I presented the Teleseminar yesterday, “Do You or Don’t You Need Vitamin D”, and I have to say that I was blown away by all that I learned in researching the topic.  The role of Vitamin D in overall health is still under investigation, but what I found in my research to be the general consensus is this:

  • ks15435wVitamin D is important in that is aids in the intestinal absorption of Calcium, Iron, Magnesium, phosphate and zinc.
  • Vitamin D does not appear to “cure” anything, but in “adequate levels” in the blood, it seems to augment many bodily systems and functions so as to help ward off disease
  • Vitamin D levels need to be at the recommended levels all the time and before illness begins to be of most benefit.
  • Adequate Vitamin D levels definitely improve bone health in conjunction with adequate calcium levels.
  • Adequate Vitamin D levels in Pregnancy seem to prevent pre-eclampsia and preterm labor. Low levels are associated with Gestational Diabetes, Pre-eclampsia and Low birth weight in infants.
  • Most vitamins on the market don’t contain enough Vitamin D, including most prenatal vitamins. The Institute of Medicine recommends that adults take 2000IU-4000IU Vitamin Daily. Most vitamins contain 600IU
  • The Institute of Medicine and the March of Dimes both recommend that pregnant women take 4000IU of Vitamin D Daily
  • Target blood levels are 50 nmol/l according to the Institute of Medicine. However, the International Osteoporosis Foundation recommends that individuals with risk factors for osteoporosis aim for blood levels around 75nmol/l.
  • Dark-skinned people are more likely to be Vitamin D deficient because the melanin in our skin does not allow in the sun rays needed to convert cholesterol to Vitamin D in the body. Dark Skinned people should take a Vitamin D supplement because as on researcher said, “Black and brown people are urged to take Vitamin D supplements. There is very little potential risk for harm and the potential benefits are significant.”

 

I first had my Vitamin D level checked in 2009 when I was feeling awful and my doctor was trying to figure out why I was so tired and listless. At that time, my Vitamin D level was 23 nmol/l, well below the recommended 50 nmol/l. I have been taking Vitamin D ever since and now have a level of 53 nmol/l, down from my last year’s check up of 59 nmol/l.  And I have to admit, I have been feeling good and some days, “I just didn’t get around to taking my vitamins”. Well, the dip in my Vitamin D level and learning all of this research has made a believer out of me!

This whole debate really got me thinking. I don’t know how long I had been Vitamin D deficient, but according to what I have read, it may be for most of my life given that I am a dark-skinned black woman born and raised in Massachusetts. As it relates to pregnancy, I wonder if my low Vitamin D levels have anything to do with me developing uterine fibroids? One of the effects of low vitamin D in pregnant women is preterm labor which seems to be due to uterine irritability and/or placental inflammation. Well, fibroids certainly were irritating my uterus! Lost a pregnancy before having them out. Then got pregnant with my daughter and had some spotting, “cramping” (which I now know was preterm contractions) and ended up delivering her at 36 weeks and 6 days at 5 lbs 3 oz (low birth weight). If I had started taking Vitamin D at age 29 when I was first diagnosed with fibroids, would I have had the problems with my uterus/fibroids? Would I have had the miscarriage? Would my daughter have been born early and small?

I know that there are far too many variables to even make this a plausible argument. Likewise, my daughter is now 11 and I had a healthy term baby after her (well, actually after a second miscarriage!). So would Vitamin D have made a difference? I’ll never know. But it’s like the researcher alluded, Taking Vitamin D would not have hurt me and most likely would have helped me. I can’t take back what happened as I was childbearing, but I can and will regularly take 4000 IU Vitamin D daily to keep my immune system working “happily” (there is some talk that a happy immune system is “immune” to developing cancer!), to keep my bones strong and to lower my risk of falls, to ward off autoimmune diseases and to help stave off Diabetes.

Mamas, I am sure that many of you are unsure of whether or not to take vitamin D supplements. Discuss these findings with your doctor or a nutritionist. The evidence is mounting that taking Vitamin D supplements is a good thing for most people. Find out if its a good thing for you! There isn’t much if any risk of injury or harm, and yet taking Vitamin D can do much to improve your overall health. Investigate this for yourself!

I am working on the recording and will make it available soon.  If you have questions or comments about Vitamin D, ask me in the comments section below. I have compiled a lot of information and a great resource for Vitamin D supplements and will gladly share!

 

Mamas on Bedrest: Talk To Your Doctor About Your Vitamin D Level!

April 1st, 2013

ks15440wGood Monday Morning, Mamas!

While Today is April Fool’s Day, the news below is certainly no joke. Yet another study has reported that low levels of Vitamin D in pregnant women is associated with adverse pregnancy outcomes.

Fariba Aghajafari, MD, CCFP, and colleagues from the University of Calgary in Alberta, Canada, published their findings after performing a systematic review and meta-analysis of the available data online March 26 in in the British Medical Journal. Reviewing data from studies published on MEDLINE, PubMed, Embase, CINAHL, the Cochrane Database of Systematic Reviews and the Cochrane database of registered clinical trials, the researchers reviewed 31 studies and found the following results:

  • Low levels of 25-OHD Vitamin D (the best indicator of Vitamin D status in Humans) is associated with increased risk of Gestational Diabetes
  • Low levels of 25-OHD Vitamin D is associated with increased risk of pre-eclampsia
  • Low levels of 25-OHD Vitamin D is associated with small for gestational age infants.

And these findings are only from this one study! We here at Mamas on Bedrest & Beyond have reported in several of our blog posts the effects of low levels of Vitamin D and adverse pregnancy outcomes. Here is what we have found in the literature to date:

We have also found that while current medical recommendations are only 200-400 IU of Vitamin D for daily supplementation, Studies we have seen recommend far more for optimum function (upwards of 2000-4000IU daily).

So what should you do with all of this information? Talk To Your Doctor!! While you may initially experience a bit of push back from your OB, if you bring in these citations, they will take you seriously. Leading medical experts are recognizing the importance of Vitamin D supplementation and noting that the vast majority of individuals in the United States are deficient. Interestingly enough, darker skinned people are at increased risk of Vitamin D Deficiency because Vitamin D is absorbed through the skin from the sun and darker skin protects against penetration from the sun’s rays, so less Vitamin D is absorbed by darker skinned individuals.

Personally, I think that there is a growing body of evidence to support Vitamin D supplementation. The question becomes, at what dose? You will have to discuss this with your doctor. My guess is that optimum dosage may have to be done individually and for that, you may need to have blood levels of Vitamin D assessed in order to figure out how much (if any) supplementation you need.

I warn you now that not all OB’s have jumped on the Vitamin D bandwagon. Many are content to simply prescribe a prenatal vitamin and leave it at that as they, “Don’t believe the hype”. But I suggest to you that if you are at increased risk for any of he aforementioned conditions for which low vitamin D levels increase the risk, then at the very least a discussion with your physician is in order. It may not be the ultimate cure for what ails you, but if it can help you decrease your risk of pregnancy complications and adverse outcomes, a simple pill or 2 a days seems easy enough for your OB to prescribe and for you to take, and there is little to no risk of toxicity or overdose.

Mamaonbedrest on the phoneTalk with your doctor about your Vitamin D levels and see if you need supplementation. It’s easy, and it may well vastly improve your health, the health of your baby and your ability to have a healthy, full term infant.

Mamas on Bedrest: Link Found Between Vitamin D and Gestational Diabetes

October 19th, 2012

Mamas, do you know your vitamin D level? Recent research suggests that if you are deficient in vitamin D early on in pregnancy, you are at risk for developing gestational diabetes.

At the the European Association for the Study of Diabetes (EASD) 48th Annual Meeting in Berlin Germany, Marilyn Lacroix, a master’s degree candidate from the Faculty of Medicine and Health Sciences at the University of Sherbrooke in Quebec, Canada reported that women with lower serum levels of vitamin D during the first trimester of pregnancy are at greater risk for developing gestational diabetes mellitus (GDM) later in pregnancy.

Study Design

According to Lacroix’s research, the association between vitamin D level and GDM risk was independent of age, season of blood sampling, vitamin D supplementation, and adiposity (fatness) of the mother. Women aged 18 years or older (n = 655) who were in their sixth to 13th week of pregnancy and in good health were recruited from the Sherbrooke area in Canada, which lies at about 45 degrees north latitude and therefore gets relatively less sun exposure than more southerly locations. The researchers made anthropometric (fat determination) measurements and determined 25OHD (Vitamin D) levels at the time of recruitment. Between the 24th and 28th weeks of pregnancy, they performed a 75-g fasting oral glucose tolerance test (OGTT) to determine normal glucose tolerance or GDM according to criteria of the International Association of the Diabetes and Pregnancy Study Groups (fasting glucose ≥ 5.1 mmol/L; 1 hour post-OGTT glucose ≥ 10.0 mmol/L; 2-h post-OGTT glucose ≥ 8.5 mmol/L)

Results

54 women, 8.2% of the study population developed GDM. These women were on average older and had larger waist circumferences  than their cohorts. According to Lacroix,

“The mean total 25OHD levels in our cohort was about 63 nmol/L, and participants with gestational diabetes mellitus had lower levels of 25OHD compared to [women with] normal glucose tolerance,” Lacroix reported. “The overall prevalence of vitamin D deficiency in our cohort was about 27%.”

Lower levels of Vitamin D were associated with an increased risk of incident GDM. When the data was adjusted for age, season of blood sampling, vitamin D supplementation, and waist circumference, the risk for GDM increased by 40% for each standard deviation (SD) decrease in Vitamin D level. Translation, for each decrease in Vitamin D by 18.8nmol/L, the risk for developing GDM increased 40%.  This result was consistent regardless of the measurement of adiposity used (waist circumference, body mass index, or percentage body fat). At these second trimester measurements, women with GDM also had lower insulin sensitivity. Lacroix also noted that women with lower levels of Vitamin D, higher waist circumference and lower insulin sensitivity also had lower B cell compensation. B cells are the insulin producing cells in the pancreas. However, B cell compensation was found to be independent of Vitamin D level.

Overall,  Lacroix and her colleagues concluded that lower vitamin D levels in the first trimester are associated with increased risk of developing GDM, independent of age, season of blood sampling, vitamin D supplementation, and adiposity measurements. Lower vitamin D levels are associated with insulin resistance but not with insulin secretion or β cell compensation after adjustment for confounders.

Discussion at the meeting

Anne Dornhorst, BM, BCh, from the Department of Diabetes and Endocrinology at Imperial College Healthcare NHS Trust in London, United Kingdom, commented,

“If you take women from sub-Saharan Africa and Muslim women who are not only dark skinned but covered, you can say to yourself, is there any point measuring it? Just give them vitamin D.

She said also that blacks are at high risk for type 2 diabetes and gestational diabetes. Indians, too, have a very high level of vitamin D deficiency along with a high level of type 2 and gestational diabetes.

As of publication of the Abstract at the (EASD) 48th Annual Meeting October 3, 2012, there currently isn’t a recommended amount of Vitamin D for supplementation.

Other Research

Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health has studied Vitamin D extensively. He states,

“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less pre-vitamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice, yet experts say it is rarely possible to consume adequate amounts through foods.

Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Hudson Street Press, 2010), said in an interview,

“We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found.”

Recommendations

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula.

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

Implications for Mamas on Bedrest

I don’t know about any of you, but my Vitamin D levels were not measured either time that I was pregnant. In fact, they were only measured recently when I was seeing a gynecologists for hormonal imbalances related to perimenopause. Given the significance of vitamin D deficiency and its link to GDM, I hope that OB’s will begin screening for this very important vitamin and replacing it accordingly.

However, Vitamin D deficiency can have even farther reaching, more deleterious effects for mamas on bed rest. Vitamin D is important in calcium metabolism and bone formation. Judy Maloni, PhD has done extensive research on the effects of bed rest. She notes that in as little as 2 weeks, women on bed rest begin losing bone mass. So if women on bed rest are already at risk for bone loss, coupling that with low levels of Vitamin D only makes them at greater risk. While Bedrest is often a necessity, we can at least fight back against GDM and bone loss by providing adequate vitamin D supplementation. As Drs. Giovannucci and Holick have both stated, our diets and many of our supplements (speaking about prenatal vitamins here!) don’t provide adequate vitamin D supplementation.

Speak with your healthcare provider about the importance of Vitamin D and whether or not you need supplementation. If you have questions about how to go about finding a good Vitamin D supplement, e-mail us at info@mamasonbedrest.com.

References

MedScape News: OB/GYN & Women’s Health. “Low First-Trimester Vitamin D Predicts Gestational Diabetes” Marilyn Lacroix, Master’s Degree candidate from the Faculty of Medicine and Health Sciences at the University of Sherbrooke in Quebec, Canada. Presented at European Association for the Study of Diabetes (EASD) 48th Annual Meeting. Abstract 82. Presented October 3, 2012.

What Do You Lack? Probably Vitamin D-The New York Times

Astronauts and Pregnancy Bed Rest: What NASA is teaching us about inactivity Judith A Maloni, PhD, FAAN

Antepartum Bed Rest For Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth-Judith A Maloni, PhD, FAAN