June 9, 2016

Director's Letter
Carole Baggerly
Director, GrassrootsHealth

We Can't Wait!
.... the March of Dimes needs us to implement what is known about vitamin D while they continue to research the various biological causes of preterm births!  Their work is certainly important in the scientific understanding field, but in the meantime, per a recent article published in the June 2016 issue of JAMA Pediatrics:
"Preterm birth, defined as birth prior to 37 weeks gestation, is now the primary worldwide cause of morbidity and mortality in the newborn period and the top cause of child mortality among those younger than 5 years, accounting for 1 million deaths every year.  Nevertheless, it remains poorly understood."

The top cause of child mortality!
Why don't they mention vitamin D?  They specifically don't mention the randomized trial done by Hollis/Wagner which very clearly showed a decrease in the incidence of preterm births by 59% by achieving a vitamin D serum level of at least 40 ng/ml.

At present, the March of Dimes prevention plan is a set of progesterone shots (17P) given to women who are at risk of preterm birth. The shot sequence costs $50,000 and may reduce the probability of preterm birth by 30%.  
In contrast, the cost of vitamin D for the duration of a pregnancy is approximately $25. 
Both approaches should be taken to help the women. With vitamin D added, the requirement for any progesterone treatment would decrease dramatically.  
When will the time be right?
In March of 2007 I attended a National Cancer Institute workshop on vitamin D and cancer.  After over 100 presentations by the scientists, I was stunned.  There was so much information that said vitamin D is important to our health and, that we are deficient.  The leader of the group asked the professionals, 'what do we do next?The answer was 'more research'! I stood up to respond and said 'Where's your sense of URGENCY!' 

That was in 2007.  It was about cancer.  The situation is the same with preterm births... basic scientific research is being presented as more important than health and effective implementation.
It is now 2016, 9 years later.  We can't WAIT!  We don't need to wait! Lives are literally being lost to various vitamin D related conditions.  We know enough about vitamin D in many areas--it is definitely associated with pre-term births, asthma (from the prenatal experience), many cancers, and diabetes.  
We are ready now!
The D*action cohort has built a very strong picture of the safety of vitamin D supplementation. Additionally, vitamin D is inexpensive, and, can be monitored for appropriate levels for everyone. The randomized trial from Hollis/Wagner verified the safety of getting to 40 ng/ml in pregnant women. The combination of safety, measurement, benefits, and short implementation time make the project compelling.
We have now met with two hospitals and numerous other groups that could have been key in implementing a vitamin D testing and supplementation project within their prenatal populations, and we have explicitly been told 'NO, it would interfere with our 'study' with the March of Dimes; or, it would inhibit some other project (example: meeting with patients privately, etc.).'  In short, these groups with the best of scientific intentions are denying the women the right to know and decide how to best act to protect themselves and their children based on demonstrable evidence.
Groundbreaking hospitals
We DO have two major hospitals who ARE acting in the best interests of their patients already and, they are part of a growing trend of hospitals asking us (GrassrootsHealth) for implementation help.  The Medical University of South Carolina, where the original research quoted above by Hollis and Wagner was done, and the Western Montana Clinic in Missoula, Montana are now fully endorsing the woman's right to solve the vitamin D deficiency (by getting the serum levels to at least 40 ng/ml), and subsequently helping to address preterm birth.  
Below you can see the passion and commitment to this cause at the Medical University of South Carolina.

Dear Readers... 
Please help us.  Do you donate to the March of Dimes?  If so, please continue.  Their basic research is important. But, we ask you to consider adding an equal donation to GrassrootsHealth to implement something that can help now! We have many groups around the US that are ready to do this with us, using our scientific information, our educational modules, our core research and implementation team.  We want to make a difference in the health of 1000's of pregnant women within the next 12 months!  
The March of Dimes goal for South Carolina is to have a preterm rate of 8.1% by 2020 (from 10.8 in 2015).  This goal could be 5% in 2017.  They need our help.
Please help us expand our Protect Our Children NOW! implementation projects to new locations around the country.  Hospitals and medical groups are ready and waiting!  We need $1MM within the next 6 months to add more than 10,000 patients who could benefit within the year. 

That's only $100/patient.

We will be telling you more about the 'We Can't Wait' campaign in the next months, focusing initially on preterm births, but quickly on cancer and other vitamin D related conditions.  The time has come!  Let's ACT.
Please let us know how we can help you help us, take this short survey.
It's up to US!



Carole Baggerly 
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
The Importance of Vitamin D Sufficiency in Reproductive Age Women

Dr. Roger Newman
Project leader, Protect our Children NOW!
Medical University of South Carolina (MUSC)
Vice Chair, Women's Health Research
Professor and Maas Chair for Reproductive Sciences, Department of Obstetrics & Gynecology  
Dr. Newman is head of the OB clinic which services the women in need, which in his region of the country happens to be primarily African American women. We know that this population is typically vitamin D deficient. 
What is Dr. Newman's take away, after having run the project and changed the standard of care at MUSC? 
Let's hear from Dr. Newman:
"At MUSC and in our investigations of Vitamin D supplementation, we have been impressed by the lower rates of preterm birth seen in women who are able to achieve Vitamin D sufficiency (>40 ng/ml) compared to those who do not. The near universality of Vitamin D insufficiency and, in many cases severe deficiency, in our women of color certainly corresponds epidemiologically with our high rates of prematurity. We agree with the authors that the underpinning of much preterm birth may be immunological dysfunction. As a hormone with known immunologic activity, we believe that Vitamin D has significant biological plausibility as a contributor to our debilitating rates of preterm birth. Vitamin D sufficiency (>40 ng/ml) needs to be emphasized as an economical and achievable target for health maintenance for reproductive age women. The health benefits will far outweigh any reasonable consideration of risk or cost. "
    Dr. Carol Wagner
We know how to improve the vitamin D status of women - which lowers preterm birth. 
Let's do it!

Dr. Carol Wagner
Co-author of the randomized trial with vitamin D 
Co-leader in the Protect our Children NOW! project 
Medical University of South Carolina (MUSC)
Associate Director, Neonatal-Perinatal Fellowship Program
Associate Director, Clinical and Translational Research Center

Dr. Wagner is a board-certified neonatologist whose research focuses on understanding the vitamin D requirements of pregnant and lactating women and their infants and the long-term impact of vitamin D deficiency on health. Working with Dr. Bruce Hollis, she has been co-PI of a number of vitamin D studies which have demonstrated an association between the health status of pregnant women, comorbidities of pregnancy, and vitamin D status.

We can't afford to wait - let's address the vitamin D health status of pregnant women NOW!

From Dr. Wagner:

"As a neonatologist for more than two decades, I have always been perplexed that African American women were more likely to deliver preterm infants. Explanations such as poverty, nutrition, and stressors of life were given as explanations of the root cause, and yet, even among African American women of higher socioeconomic status, preterm birth rates are higher than in EuroAmericans of lighter skin tones, Asian and Hispanic women. That women who deliver preterm have higher inflammatory markers is not surprising and in fact makes sense from a disease perspective. Attention has been given to those agents and environmental factors that worsen inflammation, including vitamin D. 

Working with one of the foremost vitamin D researchers - Dr. Bruce Hollis, we sought to determine the vitamin D requirements of women during pregnancy and lactation. When we began conducting vitamin D supplementation trials now more than 15 years ago, we found profound vitamin D deficiency among women of darker pigmentation and yet with physiologic dosing of vitamin D supplements, we could reverse this deficiency. We discovered a startling association present during pregnancy: optimization of the conversion of 25(OH)D, the second metabolite of vitamin D, to the active hormone 1,25-dihdyroxy-vitamin D occurs when 25(OH)D is at least 40 ng/ml. Interestingly, when we look at preterm birth rates, those women who achieve vitamin D (25OHD) levels of 40 ng/mL or greater, the risk of preterm birth declines substantially. This has been shown by our group and others (Weiss et al 2016). Rates of preeclampsia also decrease with improved vitamin D status.

With such data, how can we afford to wait? While we may not fully understand the mechanism of action of vitamin D, to allow vitamin D deficiency to persist worldwide is a public health travesty. We must act now to improve the vitamin D status of pregnant women and their developing babies across the globe!"

Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

GrassrootsHealth is respected for the relationship it has with its scientists and for its large group of participants in D*action. As a group, we have power.  We look to you to help spread the word, and you have. We will be relying on you more in the near future - as we need to capture the attention of the big goliaths with a newfound force - to try and grab their attention, to elicit change. 
We have organizations ready to start a D*action or a Protect our Children NOW! project - we need to raise the funds to get them started. To move vitamin D up on their priority list of implementation changes. Every hospital, clinic, doctor's office wants healthier patients - we need vitamin D to be the top of their list.
Last week you replied to our survey about national sunshine month - thank you! We really appreciate your feedback. One big take-away was to provide more information, at a beginner level, that you can forward to friends and family. We will provide that in the future. We look forward to hearing your input this week!

Have a great week!
Susan Siljander
Marketing Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research Into Practice NOW!
Order Now
Your participation in this project provides information for your answers to D questions and helps fund the GrassrootsHealth projects.

We would like to hear your input (and elicit some help) in reaching out to get donations and support for vitamin D initiatives.

Scientists' Call to D*action
48 international vitamin D researchers join in promoting immediate public health action on vitamin D through achieving serum levels of 40-60 ng/ml.
Updated 8/11/2015

Disease Incidence Prevention Chart
A chart showing the required vitamin D serum levels for prevention of many diseases including cancers, falls, heart attacks and diabetes and several others. 
Updated 8/24/2012

Moving Research into Practice
A summary booklet of key vitamin D research findings by GrassrootsHealth

Vitamin D FAQs for Pregnancy, Breastfeeding & Babies
Answers to the most common vitamin D questions for pregnant women and new parents.

Disease Incidence Prevention Chart - Pregnancy
A chart showing the required vitamin D serum levels during pregnancy for prevention of many prenatal and childhood diseases.

Evidence of Global Vitamin D Deficiency During Pregnancy
A chart showing the incidence of vitamin D deficiency during pregnancy around the globe.

US Rates of Deficiency among Women of Childbearing Age
A chart showing rates of vitamin D deficiency among women of childbearing age, by race.

Preterm Birth vs. 25(OH)D: Results from 3 RCTs
Two charts showing data from 3 separate RCTs with similar results.

What is Protect our Children NOW!

Interview with Carole Baggerly and Dr. Carol Wagner, as they explain the program and its expected benefits.

Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
October 2015

Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery
Carol L. Wagner, et al.
The Journal of Steroid Biochemistry and Molecular Biology
April 2015

Maternal 25-Hydroxyvitamin D and Preterm Birth in Twin Gestations
Lisa M. Bodnar, et al.
Obstet Gynecol
July 2013

Mother-child vitamin D deficieny: an international perspective
Adekunle Dawodu
Carol L Wagner
May 2007

Vitamin D Supplementation During Pregnancy: Double-Blind, Randomized Clinical Trial of Safety and Effectiveness
Bruce W. Hollis, et al.
June 2011

Vitamin D Status During Pregnancy and Risk of Multiple Sclerosis in Offspring of Women in the Finnish Maternity Cohort
Kassandra L. Munger, et al.
JAMA Neurology
March 2016

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