Vitamin D insufficiency is associated with increased risk of first-trimester miscarriage in the Odense Child Cohort.
Am J Clin Nutr. 2015 Jul 15. pii: ajcn103655. [Epub ahead of print]
Andersen LB1, Jørgensen JS2, Jensen TK3, Dalgård C3, Barington T4, Nielsen J5, Beck-Nielsen SS6, Husby S7, Abrahamsen B8, Lamont RF9, Christesen HT10.
1Institute for Clinical Research and Hans Christian Andersen Children's Hospital.
2Institute for Clinical Research and Department of Obstetrics and Gynecology.
3Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark;
4Odense Patient Data Explorative Network (OPEN), Department of Clinical Immunology, and.
5Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark;
6Institute for Clinical Research and Department of Pediatrics, Hospital of Southwest Denmark, Esbjerg, Denmark;
7Institute for Clinical Research and Hans Christian Andersen Children's Hospital, Odense Child Cohort, Hans Christian Andersen Children's Hospital, Odense, Denmark;
8Institute for Clinical Research and Odense Patient Data Explorative Network (OPEN), Department of Medicine, Holbæk Hospital, Denmark; and.
9Institute for Clinical Research and Division of Surgery, University College London, Northwick Park Institute of Medical Research Campus, United Kingdom.10Institute for Clinical Research and Hans Christian Andersen Children's Hospital, henrik.christesen at rsyd.dk.
Miscarriage is the most common negative outcome of pregnancy, and identification of modifiable risk factors is potentially of great importance for public health. Low vitamin D concentrations in pregnancy are widespread worldwide, and vitamin D deficiency is implicated in immune cell regulation at the feto-maternal interface and several diseases of pregnancy.
We investigated whether 25-hydroxyvitamin D serum concentration was a modifiable risk factor for early miscarriage.
In a prospective cohort study of 1683 pregnant women donating serum before gestational week 22, we investigated the association between maternal serum concentrations of serum 25-hydroxyvitamin D [25(OH)D] and the risk of subsequent miscarriage (n = 58).
The adjusted hazard of first-trimester miscarriage was lower with higher 25(OH)D concentrations (HR: 0.98; 95% CI: 0.96, 0.99). Concentrations of 25(OH)D <50 nmol/L were associated with a >2-fold increased adjusted HR for miscarriage (HR: 2.50; 95% CI: 1.10, 5.69). Concentrations of 25(OH)D were not associated with an increased risk of second-trimester miscarriage.
We found an association between 25(OH)D and first-trimester miscarriages, suggesting vitamin D as a modifiable risk factor for miscarriage. To test this hypothesis, randomized controlled trials should investigate the possible effect of vitamin D supplementation to increase 25(OH)D concentrations in early pregnancy, or before conception, to decrease risk of miscarriage. This trial was registered at clinicaltrials.gov as NCT02434900.
© 2015 American Society for Nutrition.
- This study provides a good hint that a pregnant woman should try to have a good level of vitamin D (> 40 ng)as soon as possible
- A loading dose gets a good level in a week or so.
- A daily dose (Without loading dose) achieves a good level in a 8-12 weeks.
- Since 80% of all miscarriages occur before week 8, a loading dose appears to be essential to greatly reduce the miscarriage rate
- I will speculate that a loading dose,which quickly gets a woman to 40 ng, will reduce the miscarriage rate by 3X to 5X
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