September 10, 2015

Director's Letter
Carole Baggerly
Director, GrassrootsHealth

Medical University of South Carolina Leads the Way

EVERY new prenatal patient at the Medical University of South Carolina (MUSC) will now be screened for vitamin D deficiency, and, they will have recommended supplementation to get their 25(OH)D serum levels to at least 40 ng/ml as part of the GrassrootsHealth Protect our Children NOW! Project, a Quality Improvement Program at MUSC.

According to Dr. Roger Newman, Director of Women's Health Research, "MUSC OBGYN is trying to get ahead of the curve in terms of appreciating the importance and measurable benefits of an informed and proactive approach to optimal maternal nutrition and vitamin supplementation during pregnancy.  We have been aware of the vitamin D deficiency state in the vast majority of our Caucasian patients and almost all our African-American patients for far too long.  Now the evidence has accumulated of the high price we pay in terms of prematurity and other obstetrical complications from our failure to systemically address these deficiencies in maternal vitamin D levels."

There are over 2000 births per year at MUSC, including approximately 16%, or 320, as preterm births.  Based on research done at MUSC by Drs Hollis and Wagner, the risk of preterm births could be reduced by roughly 50% simply by getting the vitamin D levels of pregnant women to 40 ng/ml.  The March of Dimes estimates the average cost of premature birth to be $50,000 greater than a term birth. A potential reduction of 160 preterm births at MUSC alone would result in a cost reduction of $8MM annually.

The Protect our Children NOW! Project had as an initial goal the participation of at least 500 women but Dr. Newman said "We'll do it for them all!"  His vision and willingness to fully implement the demonstrated research from his co-workers in only 3 years instead of the usual 15-20 is a major milestone for the entire vitamin D research and public health effort.
What does it take to make this happen? 

The key components are:
  • Scientists who created a consensus to support the move to get everyone's D levels to the 40-60 ng/ml mark, organized by GrassrootsHealth.
  • Key research, in this case by Drs Hollis and Wagner, demonstrating the explicit impact on pregnancy.
  • Methods of education and engagement for practitioners and staff; a method of engagement of the pregnant women with an online forum, basic messages, games, rewards; full analysis of the de-identified data from the MUSC system to show everything necessary to help make both immediate and long term decisions about care-from the basic serum levels and how they change to the actual practitioners involvement in providing tests; and monitoring the ongoing rates of any preterm births and other comorbidities of pregnancy.  These programs are provided by the Protect our Children NOW! Project of GrassrootsHealth.
  • KEY: The implementer:  Someone who knows both the what and the how of his/her own organization. At MUSC, this role has been filled by Dr. Roger Newman who is also playing a significant role with GrassrootsHealth in helping make the Protect our Children NOW! Project an easily replicated Quality Improvement Program in other communities.
  • Support of and partnership with many other very significant people including the patients themselves, the nursing staff and of course, the physicians/midwives.
  • Community Implementation Partners:  SelectHealth, the first Medicaid managed care organization in the nation to join the Protect our Children NOW! effort, is leading the way for other such organizations to participate.  They will educate its First Choice health plan members and providers about the benefits of vitamin D using some of the educational materials. They will also be recipients of ongoing analyses about the overall health outcomes of their group of members, allowing them to make more informed decisions with their plan.
We applaud the Medical University of South Carolina for taking action to implement both the ethical and very practical thing to do - moving key vitamin D research into practice. They are leaders!

My heartfelt appreciation to all.

Please take a look at the Protect our Children NOW! Project information to see the basics of the project.  We are actively moving this project into other communities.  If your community/medical center is interested in such a project, please contact Jen Aliano, our Project Manager.

Carole Baggerly 
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
"To him who devotes his life to science, nothing can give more happiness than increasing the number of discoveries, but his cup of joy is full when the results of his studies immediately find practical applications." 
- Louis Pasteur 

Feature Story
Why has it been taking 17 years to bring research into practice?    

17 years! Yes, that is what researchers at the University of Cambridge say is the average time to move research into practice. In their paper they call this process 'translation' - the process of converting basic science into patient benefit - and describe its two phases. The first is the conversion of basic scientific research into a potential clinical product for testing on human subjects. The second phase is when successful clinical trials are transitioned into common healthcare practice.

Morris et al. claim 17 years as the average and have a table of studies used to create that average.

It has been 8 years since GrassrootsHealth first released a consensus statement from a group of leading vitamin D researchers that states that the target vitamin D serum level to best impact the majority of known conditions is 40-60 ng/ml (100-150 nmol/L).  The results of the Hollis/Wagner randomized controlled trial on the importance of vitamin D during pregnancy have been public since 2013.

Can we wait another 9 - 15 years?


A paper from Brownson, et al. described how public health education could better reduce this timeframe. Brownson defined four steps in a pathway to change.  
  1. Discovery - investigate disease, develop strategies to combat it, and develop and test scientific methods.

    Done by vitamin D research community!
  2. Translation - synthesize research findings and convert them into a form applicable to a target population or audience in the context of the conditions in which its members live and interact.

    HIS is the major missing piece for most projects and/or it is totally left to every individual entity. This 'translation', creation of the 'form' stated here is what GrassrootsHealth has done for the pregnancy population and their caregivers through Protect our Children NOW!
  3. Dissemination - communicate and/or deliver translated research findings to populations in ways that are meaningful and relevant.

    GrassrootsHealth has also devised the content and methods for any group to implement.
  4. Change - improve health through long-term behavior change, program adoption, organizational change, policy adoption, and/or environmental change

    The long term nature is an expected result of the engagement of everyone in the implementation of Protect our Children NOW! as a 'Quality Improvement Program'.  There are activities and results for all to see.
Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

There are two major announcements in this newsletter and I hope you caught them both. The first is that MUSC, under the direction of Dr. Roger Newman, has implemented a new standard of care which includes testing the vitamin D level of every new pregnant woman, and if they are below 40 ng/ml, starting them on up to 4,000 IU/day of vitamin D supplements, then monitoring their D levels throughout the pregnancy. This is what GrassrootsHealth has always dreamed of - that the science of vitamin D would become a standard of care - Moving Research into Practice.

The second announcement is that we have a well defined plan to expand this reach. The key is that 'translation' can't be done by the medical community alone. They are too busy seeing patients. They don't have the resources or wherewithal to create a program that would translate research into standard of care in a timely manner. But we do! With Protect our Children NOW! (and we could modify this for other conditions) we have an infrastructure, education, and a process to translate the research of vitamin D into practice. It works beautifully with pregnant women because OBs like to stay up on the latest research, pregnant women are very conscious of their health, and pregnant women come in regularly for health visits.

If you know of a medical center or doctor who you think would embrace this process - please contact us. The more projects we have in place all over the globe, the faster we will move science into practice.

Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & 
Research Organization  
Moving Research into Practice NOW!
Order Now
Order Your Home Vitamin D Test TODAY!
Your participation in this project funds all the GrassrootsHealth research and promotion.
Carole Baggerly
Director, GrassrootsHealth answers questions about the Protect our Children NOW! Project 

Click here to submit your questions. 
We will only answer questions about this topic. Please do not send other questions at this time.

We will publish the answers in a future newsletter.  
Questions answered by
Carols A. Camargo, Jr.
MD, Dr. PH
Harvard Medical School

The effects of vitamin D below 20 ng/ml on cold and flu.

Vitamin D or flu shot?  

Open to any US woman, 18 years or older, at 12-17 weeks of pregnancy


D*certified Practitioners

Take two CME courses online to become D*certified

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The answer is 17 years, what is the question: understanding time lags in translational research

Morris, Z. S., et al.
Institute of Public Health, University of Cambridge
December 2011
Read Paper 

Translating Scientific Discoveries Into Public Health Action: How Can Schools Of Public Health Move Us Forward?

Brownson, et al.
February 2006
Read Paper 

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