Video of the Week 

Public Health Initiative: Meeting the Vitamin D Requirements of the Pregnant Woman and Improving Health Outcomes; NICHD Vitamin D Lactation Summary Data

Carol L. Wagner, MD, is a professor at the Medical University of South Carolina. She received her doctorate at the Boston University School of Medicine. She is board certified in pediatrics, neonatal-perinatal medicine. She is a practicing neonatologist at the Children's Hospital in Charleston, South Carolina. Her clinical interests include: growth factors in human milk, human milk gut maturation, hypoxic ischemic encephalopathy, international health and vitamin D.

What are the implications of a women being vitamin D deficient? Dr. Wagner describes many of the health outcomes caused by vitamin D deficiency for both early childhood and the mother's health.

Dr. Wagner and Dr. Bruce Hollis conducted the Thrasher study in 2011 with over 500 women in South Carolina. She goes into detail about how the study was conducted, the types of women in the study, how they were supplemented, and the outcomes. The Thrasher study is one of the few studies where a higher  supplement was given (4000 IU/day) and this presentation explains how that was accomplished. The outcomes of this study were very significant and if moved into standard practice would significantly change how pregnant women are treated.

Dr. Wagner was also involved with two studies that focused on vitamin D in breast milk. There are many that say that vitamin D is not transferred to the baby through breast milk - but they are wrong! It is transferred if the mother is vitamin D sufficient and regular with her vitamin D exposure.

Vitamin D levels affect pregnancy outcomes

GrassrootsHealth collaborated with Dr. Carol Wagner of the Medical University of South Carolina, and other researchers to publish a new paper that demonstrates 1) maternal vitamin D status closest to delivery date is more significantly associated with preterm birth, suggesting that later intervention as a rescue treatment may positively impact the risk of preterm delivery and 2) participants with a serum 25(OH)D concentration of at least 40 ng/ml in the 3rd trimester had a 47% reduction in preterm birth when compared to those with a concentration less than 40 ng/ml.

This paper was published on-line ahead of print on November 13, 2014 in the Journal of Steroid Biochemistry & Molecular Biology and can also be found in pubmed.

Why is preterm birth important?

According to the March of Dimes, in the US in 2012, 11.5% of all births were preterm births (<37 weeks). Premature infants are at greater risk for short and long term complications, including disabilities and impediments in growth and mental development. Significant progress has been made in the care of premature infants, but not enough in reducing the prevalence of preterm birth. Preterm birth is among the top causes of death in infants worldwide.

In 2007, the Institute of Medicine reported that the cost associated with premature birth in the United States was $26.2 billion each year. Costs are associated with medical and health care costs for the baby, labor and delivery costs for the mother, early intervention services, and special education services. The March of Dimes also states that preterm babies can have more difficulties in school and in their adult work life.  

What was the study?

There was a school of thought that said that vitamin D level at conception was what determined risk for preterm birth regardless of changes in vitamin D status that might occur during pregnancy. If this were true, then vitamin D education and intervention during pregnancy would not affect outcomes. If this were true, then instead of educating and supplementing pregnant women - we would want to educate and supplement all women of child-bearing age.

Dr. Wagner used two data sets - Thrasher Research Fund (n=154) and NICHD (n=333). These data sets collected vitamin D serum levels at baseline, 1st trimester (<16 weeks), 2nd trimester (16-26 weeks), and 3rd trimester (>27 weeks). The data sets also reported whether or not the pregnancy was a preterm birth (<37 weeks). Both studies followed the women from 12-16 weeks through delivery. During the studies the relationship between vitamin D status and preterm birth was not known, and therefore, women were not counseled regarding this potential risk factor.   

Vitamin D can greatly affect pregnancy outcomes

Dr. Wagner found that vitamin D status measured in the 3rd trimester was the best indicator of preterm birth. This means that even if someone is diagnosed with vitamin D deficiency during pregnancy, they may benefit from vitamin D given as a "rescue" therapy. Or, that it is beneficial to educate and supplement pregnant women.

Also, the data showed that if the serum 25(OH)D was greater than 40 ng/ml, there was a 47% reduction in preterm birth compared to those who did not reach the 40 ng/ml mark. If we extrapolate this reduction with the numbers for preterm birth, that would reduce preterm birth to about 6% of all births, and total costs by 50% to $13 billion/year vs $26 billion. 

Protect our Children NOW!

These numbers are staggering. Many of you already are part of D*action, a study which gives you your serum level every 6 months and also collects data on your health habits and outcomes. You heard about the benefits of vitamin D. You signed up for D*action. You received your first test and your serum level was low (less than the recommended 40-60 ng/ml). After some education through GrassrootsHealth and others you raised your level into the optimal zone (as the average serum level of D*action participants is 44 ng/ml).

What if we could reach out to every pregnant woman and let them know this data? Test their vitamin D level and increase it to 40 ng/ml by the time they deliver? Would that be possible? Would that reduce their chance of preterm birth by 47% and set their child up for health success? Could we get whole groups of women involved? - an OB's practice; all patients from a community wellness group; all women in a community?

That is what GrassrootsHealth is doing with Protect our Children NOW! We will explain more in the coming weeks, but if you know an OB or a community center that would like to participate, please let us know.