Vitamin D in pregnancy -- NEW info.
Y'all see that I recommend testing for D during pregnancy (that's the 0,25(OH)D test) along with PTH -- this is the help ensure that you have bones after you get done baking your baby.
But there's some new studies that recently came out. This was in the Vitamin D Council's December newsletter:
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman.
Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean? We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make. Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D. The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled.
Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm. It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D." What are they really saying? First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs." If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Andrea's notes: Keep in mind that these are normal women without designer guts -- so 4,000iu is really a drop in a very large bucket for those of us with malabsorption. 10k probably would be minor for us, even while pregnant -- and if we have a deficiency, then it's vital to get those numbers up.
Vitamin D is vital for our overall health -- and now, it's being found to be healthy for our unborn children as well. Too many of the normies are deficient, and postops of all stripe are popping up deficient without even breaking a sweat.
Be sure you are getting tested. (oh geez, now I sound like an HIV PSA)
But there's some new studies that recently came out. This was in the Vitamin D Council's December newsletter:
Five million dollar randomized controlled trial sponsored by Thrasher Research Fund and NIH
Scientists around the world presented their work at the recent Vitamin D conference in Brugge, Belgium. Many, but not all, of the scientists opined that we have to wait for randomized controlled trials (RCT) before recommending Vitamin D. In a future newsletter, I will review many of these presentations.
However, one was extraordinary. Professor Bruce Hollis presented findings from his and Carol Wagner’s five million dollar Thrasher Research Fund and NIH sponsored randomized controlled trials of about 500 pregnant women. Bruce and Carol’s discoveries are vital for every pregnant woman.
Their studies had three arms: 400, 2,000, and 4,000 IU/day.
1. 4,000 IU/day during pregnancy was safe (not a single adverse event) but only resulted in a mean Vitamin D blood level of 27 ng/ml in the newborn infants, indicating to me that 4,000 IU per day during pregnancy is not enough.
2. During pregnancy, 25(OH)D (Vitamin D) levels had a direct influence on activated Vitamin D levels in the mother’s blood, with a minimum Vitamin D level of 40 ng/ml needed for mothers to obtain maximum activated vitamin D levels. (As most pregnant women have Vitamin D levels less than 40 ng/ml, this implies most pregnant women suffer from chronic substrate starvation and cannot make as much activated Vitamin D as their placenta wants to make.)
3. Complications of pregnancy, such as preterm labor, preterm birth, and infection were lowest in women taking 4,000 IU/day, Women taking 2,000 IU per day had more infections than women taking 4,000 IU/day. Women taking 400 IU/day, as exists in prenatal vitamins, had double the pregnancy complications of the women taking 4,000 IU/day.
What does this huge randomized controlled trial mean? We have long known that blood levels of activated Vitamin D usually rise during very early pregnancy, and some of it crosses the placenta to bathe the fetus, especially the developing fetal brain, in activated vitamin D, before the fetus can make its own. However, we have never known why some pregnant women have much higher activated Vitamin D levels than other women. Now we know; many, in fact most, pregnant women just don’t have enough substrate, the 25(OH)D building block, to make all the activated Vitamin D that their placenta wants to make. Of course fetal tissues, at some time in their development, acquire the ability to make and regulate their own activated Vitamin D. However, mom’s activated Vitamin D goes up very quickly after conception and supplies it to baby, during that critical window when fetal development is occurring but the baby has yet to acquire the metabolic machinery needed to make its own activated Vitamin D. The other possibility, that this is too much activated Vitamin D for pregnancy, cannot stand careful scrutiny. First, the amount of activated vitamin D made during pregnancy does not rise after the mother’s 25(OH)D reaches a mean of 40 ng/ml, so the metabolism is controlled.
Second, levels above 40 ng/ml are natural, routinely obtained by mothers only a few short decades ago, such as President Barack Obama’s mom probably did, before the sun scare. (President Obama was born in Hawaii in late August before the sun-scare to a mother with little melanin in her skin) Third, higher blood levels of Vitamin D during pregnancy reduce risk of infection and other pregnancy complications, the opposite may be expected if 25(OH)D levels above 40 ng/ml constituted harm. It is heartening to see the Thrasher Research Fund and NIH support such a large randomized controlled trial. In fact the Thrasher Research Fund has already funded a three year follow up and the NIH request for a follow up grant is pending. Nevertheless, a large number of medical scientists keep saying, “We need even more science before recommending Vitamin D." What are they really saying? First they said we need randomized controlled trials (RCT) before we do anything. Well here is a big one. Then they say, as they did in Brugge, “We don’t believe this RCT, we need more money for more RCTs." If you think about it, they are saying pregnant women should remain Vitamin D deficient until scientists get all the money for all the RCTs they want, which may take another ten years. How many children will be forever damaged in that ten years?
Andrea's notes: Keep in mind that these are normal women without designer guts -- so 4,000iu is really a drop in a very large bucket for those of us with malabsorption. 10k probably would be minor for us, even while pregnant -- and if we have a deficiency, then it's vital to get those numbers up.
Vitamin D is vital for our overall health -- and now, it's being found to be healthy for our unborn children as well. Too many of the normies are deficient, and postops of all stripe are popping up deficient without even breaking a sweat.
Be sure you are getting tested. (oh geez, now I sound like an HIV PSA)
My Vit. D was low so my surgeon recommended 50,000 IUs per week. I was amazed at how drastic my numbers went up in just over a month of the additional supplementation. I also have to have a dexascan after delivery to see how much damage has been done to my bones because of this. I just wi**** was this easy to get my ferritin up. It was 2 after my first pregnancy. It was 37 last month and 9 this month and I'm only at 32 weeks!
Thanks for passing on your PSA.
Thanks for passing on your PSA.
Momma to Alex 1/08/2007
Andrea,
I have been wanting to ask you some vitamin questions. I just went back to my MD because I feel lousy and finally saw PA who figured out my Vit D is a 16 ( he said should be around 50? I am 30YO) and my ferritin is low...I want to say 6 but have labs in car and my HGB/HCT are border normal as well as every other lab, normal but low end. Here is his plan..what do you think
VIT D Shot 3 weekly then OTC
B12 back for 3 weekly then seasonally
Oral FE 1x a day
Magnesium Citrate 2x a day
PS I am not preggo, I am an oldie but remember you are so knowledgeable on this subject
Thanks,
Sheryl
Probiotics 1x daily
I have been wanting to ask you some vitamin questions. I just went back to my MD because I feel lousy and finally saw PA who figured out my Vit D is a 16 ( he said should be around 50? I am 30YO) and my ferritin is low...I want to say 6 but have labs in car and my HGB/HCT are border normal as well as every other lab, normal but low end. Here is his plan..what do you think
VIT D Shot 3 weekly then OTC
B12 back for 3 weekly then seasonally
Oral FE 1x a day
Magnesium Citrate 2x a day
PS I am not preggo, I am an oldie but remember you are so knowledgeable on this subject
Thanks,
Sheryl
Probiotics 1x daily
Sheryl
DS Zachary 10/6/04
DD Alexa Marie 8/2/07
I'd be curious about the D shot. Is it D2? D3? If it's D2, it's still crap. Doesn't matter if it's in a shot or a little green gelcap. You'd be better off taking off all your clothes and running naked in the street for an hour at the north pole (which, this time of year, isn't much good -- even nekkid). So find out -- D3, D2.
Okay, I shoulda looked, assuming RNY. I'd actually suggest you (in a non "I don't make medical suggestions" sorta way) go to vitalady.com and order her d3-50 and do THAT 3x a week if he's sqeamish. I did it daily for 90 days when I was low, but I know some docs get the wibbles with 50k doses. It's OTC, btw.
B12 should be taken all the time.. not seasonally. If you aren't doing shots yourself, then at least take it sublingally daily.
If your ferritin is a 6, you'd better be doing some massive FE at home.
Whats the mag for?
Okay, I shoulda looked, assuming RNY. I'd actually suggest you (in a non "I don't make medical suggestions" sorta way) go to vitalady.com and order her d3-50 and do THAT 3x a week if he's sqeamish. I did it daily for 90 days when I was low, but I know some docs get the wibbles with 50k doses. It's OTC, btw.
B12 should be taken all the time.. not seasonally. If you aren't doing shots yourself, then at least take it sublingally daily.
If your ferritin is a 6, you'd better be doing some massive FE at home.
Whats the mag for?
Maybe.
There are typically three numbers given on a lab sheet for D. You could get 1, 2 or all 3.
1,25(OH)D
0,25(OH)D
and something that is marked strangely that is an addition of the first two.
It really depends. We only care about 0.
Now, the labcorp book I saw last night only had it listed as 25(OH)D and very specifically stated in the book that it was NOT 1,25(OH)D and that if you wanted 1,25, then you needed to draw test number blah blah blah. So it depends on where they are drawing for and how they are doing.
If you doubt it, ask them to draw for everything and I can help you to interpret. Cause, btw, you want to get your own labs and have your own eyeballz on them. As in, PUT YOUR HANDS ON THEM.
There are typically three numbers given on a lab sheet for D. You could get 1, 2 or all 3.
1,25(OH)D
0,25(OH)D
and something that is marked strangely that is an addition of the first two.
It really depends. We only care about 0.
Now, the labcorp book I saw last night only had it listed as 25(OH)D and very specifically stated in the book that it was NOT 1,25(OH)D and that if you wanted 1,25, then you needed to draw test number blah blah blah. So it depends on where they are drawing for and how they are doing.
If you doubt it, ask them to draw for everything and I can help you to interpret. Cause, btw, you want to get your own labs and have your own eyeballz on them. As in, PUT YOUR HANDS ON THEM.
Got the labs covered - I keep mine in a spreadsheet since pre-op that I provide to all my docs every time I go in. LOL, my PCP is great about pulling whatever labs I ask for even if she doesn't think they are absolutely necessary.
Just found this on medlineplus - Looks like it is the right test
The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in your body.
Just found this on medlineplus - Looks like it is the right test
The 25-hydroxy vitamin D test is the most accurate way to measure how much vitamin D is in your body.
Alternative Names
25-OH vitamin D test; Calcidiol 25-hydroxycholecalciferol test
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