June 16, 2016

Director's Letter
Carole Baggerly
Director, GrassrootsHealth

We are very excited to launch a Protect Our Children NOW! in Montana at the Western Montana Clinic (WMC). Vitamin D testing and supplementation 
will be available at no cost to all pregnant women receiving care at the clinic. The project will include patient and health care provider education, screening and vitamin D supplements--leading to the opportunity for better health for an entire generation. 
This is a wonderful opportunity to improve health outcomes and save lives, starting in utero. We aim to help reduce the incidence of preterm births, as well as positively influence the health of pregnant moms and lower the prevalence of early childhood diseases associated with vitamin D deficiency. When you start with vitamin D sufficiency in utero, it is like filling up the gas tank before your summer road trip - you are setting up for health success.

We couldn't have done this without the health advocacy of Mary Pittaway, MA RD, former public health official who understands the important of prevention with vitamin D. (Check out her talk at our last seminar, Vitamin D and Public Health Practice.) I also want to thank Maria Wines, PhD, RN, for her support with the faculty at the Montana State College of Nursing.

My thank yous wouldn't be complete without thanking the implementation team on the ground. They have been working tirelessly to start this project, helping connect the people and processes within WMC. Thank you Heidi Moretti, RD and Vince Colucci, PharmD. 

It is this kind of understanding - that we CAN bring research into practice - then making contacts and being the feet on the street to introduce this project to the staff, to the implementers.  Together, we make things happen. We implement change.



Carole Baggerly 
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice NOW!
We can't wait!

Donate now to help fund projects which move research into practice!

Source: May 2011 report from the CDC on asthma

"The number of people diagnosed with asthma grew by 4.3 million from 2001 to 2009. From 2001 through 2009 asthma rates rose the most among black children, almost a 50% increase. Asthma was linked to 3,447 deaths (about 9 per day) in 2007. Asthma costs in the US grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6% increase. Greater access to medical care is needed for the growing number of people with asthma."
We know that vitamin D sufficiency in utero protects children from asthma.

We know that 100% of black mothers are vitamin D deficient.


Why Missoula 
Can't Wait

Improvements to birth outcomes have the potential to save Montana $35MM in health care costs a year through vitamin D testing, monitoring and supplementation
According to the March of Dimes, approximately 1300 infants were born prematurely in Montana in 2013, giving the state a preterm birth rate of 9.3%.  The total annual cost is estimated to be $71MM.  Fully 50% of this cost, $35MM, could likely be saved annually based on demonstrated research, and, 650 babies and their families could possibly be saved from this trauma solely with vitamin D supplementation to the pregnant mother.  Montana currently holds a grade C in preterm birth rate, and is ranked 29th in the nation.
What will we do? Where?
GrassrootsHealth is launching a Protect Our Children
NOW! project in the Missoula area at the Western Montana Clinic (WMC).
As part of this project, WMC will add a 25(OH) vitamin D test to the panel of prenatal labs. Upon reviewing the results of the test, participants will receive free vitamin D supplements, compliments of NOW Foods and Carlson Labs, as well as educational materials, access to an online forum, and a local project educator for questions and support. 

Further blood tests will measure vitamin D serum levels at 24 weeks and at 36 weeks gestation. 

GrassrootsHealth will be receiving de-identified medical data for all prenatal patients at WMC to analyze not just the effects of vitamin D serum level on prenatal and newborn health outcomes, but also how vitamin D education to the medical staff affects treatment and care of the pregnant women.  

This monitored translational methodology allows research to be moved into practice very quickly (3 years) versus the standard 15-25 years. 
Educating the staff
One of the key parts of Protect our Children NOW! is the education of staff members. GrassrootsHealth provides five free CME courses for all health professionals. For this project, staff members will be encouraged to take:

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

Dr. Carol Wagner Carol L. Wagner, MD, Medical University of South Carolina, discusses how vitamin D status during pregnancy varies around the globe and the implications of maternal vitamin D deficiency for both the mother and her developing fetus.  Information is provided regarding the role of vitamin D during pregnancy, its role in maternal health and in reducing comorbidities of pregnancy, including preterm birth.  The talk is concluded with NICHD Vitamin D Lactation Summary Data to detail the importance of maternal supplementation during lactation, versus supplementing the baby alone, in order to maintain sufficiency for both the mother and the breastfeeding infant. 

Vitamin D, Sunshine, Optimal Health: Putting it all Together with Dr. Robert Heaney

Dr. Robert Heaney Vitamin D is an essential component of the mechanisms by which cells control gene transcription in response to a variety of extra-cellular stimuli. Adequate vitamin D enables an optimal response to a broad variety of signals, whereas low vitamin D status impairs this response, and thus impairs its protective mechanism against chronic disease. In this video, Robert P. Heaney, MD, Creighton University explores why vitamin D is important, how it works, how we get it and how much we need. He covers the key points of vitamin D physiology and the role it plays in the maintenance of health and specifies practitioner guidelines for implementing a plan to help create optimal health with sunshine and vitamin D.  
Paper of the Week

Preterm Birth as a Calendar Event or Immunologic Anomaly

Matthew B. Wallenstein, MD
Gary M. Shaw, Dr PH
David K. Stevenson, MD
Division of Neonatal and Developmental Medicine, Department of Pediatrics
Stanford University School of Medicine
March of Dimes Prematurity Research Center at Stanford
JAMA Pediatrics
June 2016

This opinion paper starts with a paragraph that is too powerful to be summarized:
"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."
The authors go on to suggest that the immune system is a fundamental component of pregnancy and childbirth and that we should gain an understanding through all the tools at our disposal - from population studies to individual analysis.  Vitamin D is not mentioned, but the importance of immune function is suggested to be key to understanding both normal and preterm birth as well as other conditions including cancer, autoimmune disorders, and cardiovascular disease.
Our researchers have found many links between vitamin D sufficiency, over 40 ng/ml, and an improved immune system (reduction in cancer, improvement in MS symptoms, lower rates of diabetes, etc.). We have also found, by analyzing two vitamin D pregnancy supplementation trials in comparison to the March of Dimes published norms that women who achieve sufficiency (>40 ng/ml), have a 59% lower risk of preterm birth as compared to women with vitamin D deficiency (< 20 ng/ml).
We can't wait! We are starting another project to change the standard of care in Missoula, Montana - and hope others will follow. These projects are a tool at our disposal - we know vitamin D is safe and effective in pregnancy. We can't wait, help us act now! <link to we can't wait donation site>
Editor's Letter
Susan Siljander
Marketing Director, GrassrootsHealth

What has excited me about Protect our Children NOW! from the beginning and still excites me today is the potential for major improvement, at a minor cost, with easy implementation, and short time frame. I think it is the perfect venue for demonstrating that vitamin D sufficiency should be the first step. Within 1-2 years we can show that getting pregnant women to 40 ng/ml or above decreases the rate of preterm birth. Preterm birth is very cut and dry (< 37 weeks), unlike cancer or diabetes which may be very gradual and subtle. So, preterm birth is easily measured and reported.
The March of Dimes' mission is to reduce preterm birth. We exposed the score sheet in the main article, but you may want to take a minute and check out your state. What grade does it have with respect to preterm birth? Are you in one of the four states with an "A"? If you delve into the details for each state they have percentages by race/ethnicity and in every state the "black" race is off the charts. In results from one national survey presented in last week's news, 100% of the black women included in the survey were deficient in vitamin D. I suspect the states with the worse scores have a higher percentage of people of color. Do you want to improve the score in your state? Join us in saving lives, donate today! 
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.

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.

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

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.
Journal of Steroid Biochemistry & Molecular Biology
November 2014

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 2011 Rates
Carol L. Wagner et al.
Journal of Steroid Biochemistry & Molecular Biology
January 2016

High-Dose Vitamin D3 Supplementation in a Cohort of Breastfeeding Mothers and Their Infants: A 6-Month Follow-Up Pilot Study 
Carol L. Wagner et al.
Breastfeeding Medicine
November 2006

Maternal 25-Hydroxyvitamin D and Preterm Birth in Twin Gestations
Lisa M. Bodnar et al.
American Journal of Obstetrics & Gynecology
July 2013

Does Maternal Vitamin D Deficiency Increase the Risk of Preterm Birth: A Meta-Analysis of Observational Studies
Lu-Lu Qin et al.
January 2016

Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years
Augusto A. Litonjua, MD, MPH et al.
Brigham and Women's Hospital, Boston
Harvard Medical School
January 26, 2016

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