Loading...
 
Translate Register Log In Login with facebookLogin and Register

Pregnancies helped a lot by Vitamin D (injection then 50,000 IU monthly) – RCT May 2018

Effectiveness of prenatal vitamin D deficiency screening and treatment program: a stratified randomized field trial.

J Clin Endocrinol Metab. 2018 May 18. doi: 10.1210/jc.2018-00109. [Epub ahead of print]

VitaminDWiki

Vitamin D did not get supplemented until the 14th week of pregnancy
This trial had 8 different treatment branches, but failed to report the results from each branch
Subjects with moderate deficiency:

  • I1: 50,000IU oral D3 weekly for a total duration of 6 weeks.
    • 300,000 IU total
  • I2: 50,000IU oral D3 weekly for a total duration of 6 weeks and then were on monthly maintenance dose of 50,000IU D3 until delivery.
    • 450,000 IU total
  • I3: A single dose of intramuscular administration of 300,000IU D3.
  • I4: A single dose of intramuscular administration of 300,000IU vitD3 and then were on monthly maintenance dose of 50,000IU D3 until delivery.
    • 450,000 IU total
    •    50% > 20 ng

Subjects with severe deficiency:

  • I5: 50,000IU of oral D3 weekly for a total duration of 12 weeks.
    • 600,000 IU total
  • I6: 50,000IU of oral D3 weekly for a total duration of 12 weeks and then were on monthly maintenance dose of 50,000IU D3 until delivery.
    • 750,000 IU total
  • I7: Intramuscular administration of 300,000IU D3; 2 doses for 6 weeks.
    • 600,000 IU total
  • I8: Intramuscular administration of 300,000IU D3; 2 doses for 6 weeks, followed by a monthly maintenance dose of 50,000IU vitD3 until delivery.
    • ~750,000 IU total
    •    53% > 20 ng

Across both? - only 2.3% > 30 ng
Clearly not enough vitamin D
Other studies getting to 40 ng have used 6,400 daily for 200 days = 1,300,000 IU total

Injection is one of the many ways to quickly restore vitamin D levels
Injections: 1 if deficient, 2 if very deficient (300,000 IU)

Reduction# Needed
To Screen/Treat
Pre-eclampsia60%11 women
Gestational diabetes mellitus 50%50 women
Preterm delivery 40%20 women

Note: Probably would have gotten more benefit from Vitamin D if given same total dose twice a month rather than once a month


Healthy pregnancies need lots of vitamin D has the following summary

Problem
ReducesEvidence
0. Chance of not conceiving3.4 times Observe
1. Miscarriage 2.5 times Observe
2. Pre-eclampsia 3.6 timesRCT
3. Gestational Diabetes 3 times RCT
4. Good 2nd trimester sleep quality 3.5 times Observe
5. Premature birth 2 times RCT
6. C-section - unplanned 1.6 timesObserve
     Stillbirth - OMEGA-3 4 timesRCT - Omega-3
7. Depression AFTER pregnancy 1.4 times RCT
8. Small for Gestational Age 1.6 times meta-analysis
9. Infant height, weight, head size
     within normal limits
RCT
10. Childhood Wheezing 1.3 times RCT
11. Additional child is Autistic 4 times Intervention
12.Young adult Multiple Sclerosis 1.9 timesObserve
13. Preeclampsia in young adult 3.5 timesRCT
14. Good motor skills @ age 31.4 times Observe
15. Childhood Mite allergy 5 times RCT
16. Childhood Respiratory Tract visits 2.5 times RCT

RCT = Randomized Controlled Trial


Rostami M1,2, Ramezani Tehrani F1, Simbar M3, Bidhendi Yarandi R4,1, Minooee S1, Hollis BW5, Hosseinpanah F6.
1 Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 Department of Medical Sciences, Islamic Azad University, Masjed-Soleyman Branch, Masjed-Soleyman, Khuzestan, Iran.
3 Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
5 Department of Pediatrics, Medical University of South Carolina, Charleston, USA.
6 Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

CONTEXT:
Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of a routine prenatal care.

OBJECTIVE:
We aimed at determining the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D(25(OH)D) levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D deficient pregnant women.

DESIGN:
Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran were selected as the screening and non-screening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women.

SETTING: Health centers of Masjed-Soleyman and Shushtar cities.

PATIENTS OR PARTICIPANTS: Pregnant women aged 18-40 years.

INTERVENTION: Women with moderate(25(OH)D:10-20ng/ml) and severe(25(OH)D<10ng/ml) deficiency were randomly divided into 4 subgroups and received D3 until delivery.

MAIN OUTCOME MEASURE: Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications.

RESULTS:
After supplementation, only 2% of the women in the non-screening site met the sufficiency level(>20ng/ml), versus 53% of the women in the screening site. Adverse pregnancy outcomes including pre-eclampsia, gestational diabetes mellitus and preterm delivery were decreased by 60,50 and 40% in the screening site. A D3 injection in addition to monthly 50,000IU maintenance therapy contributed the most to achievement of sufficient levels at delivery.

CONCLUSIONS:
Prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels and decreasing pregnancy adverse outcomes.

PMID: 29788364 DOI: 10.1210/jc.2018-00109

Created by admin. Last Modification: Monday May 28, 2018 02:32:24 GMT-0000 by admin. (Version 9)
See any problem with this page? Report it (FINALLY WORKS)