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Preterm birth rate reduced 57 percent by Vitamin D – Nov 2015

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.

J Steroid Biochem Mol Biol. 2015 Nov 7. pii: S0960-0760(15)30124-2. doi: 10.1016/j.jsbmb.2015.10.022. [Epub ahead of print]
Wagner CL1, Baggerly C2, McDonnell S2, Baggerly KA3, French CB2, Baggerly L2, Hamilton SA4, Hollis BW5.

Note that most of the benefit was to women of color - who typically have low vitamin D levels

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1 Medical University of South Carolina Children's Hospital, Charleston, SC, United States. Electronic address: wagnercl at musc.edu.
2 GrassrootsHealth, Encinitas, CA, United States.
3 Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
4 Eau Claire Cooperative Health Centers, Columbia, SC, United States.
5 Medical University of South Carolina Children's Hospital, Charleston, SC, United States.

BACKGROUND:
Two vitamin D pregnancy supplementation trials were recently undertaken in South Carolina: The NICHD (n=346) and Thrasher Research Fund (TRF, n=163) studies. The findings suggest increased dosages of supplemental vitamin D were associated with improved health outcomes of both mother and newborn, including risk of preterm birth (<37 weeks gestation). How that risk was associated with 25(OH)D serum concentration, a better indicator of vitamin D status than dosage, by race/ethnic group and the potential impact in the community was not previously explored. While a recent IOM report suggested a concentration of 20 ng/mL should be targeted, more recent work suggests optimal conversion of 25(OH)D to 1,25(OH)2D takes place at 40 ng/mL in pregnant women.

OBJECTIVE:
Post-hoc analysis of the relationship between 25(OH)D concentration and preterm birth rates in the NICHD and TRF studies with comparison to Charleston County, South Carolina March of Dimes (CC-MOD) published rates of preterm birth to assess potential risk reduction in the community.

METHODS:
Using the combined cohort datasets (n=509), preterm birth rates both for the overall population and for the subpopulations achieving 25(OH)D concentrations of ≤20 ng/mL, >20 to <40 ng/mL, and ≥40 ng/mL were calculated; subpopulations broken down by race/ethnicity were also examined. Log-binomial regression was used to test if an association between 25(OH)D serum concentration and preterm birth was present when adjusted for covariates; locally weighted regression (LOESS) was used to explore the relationship between 25(OH)D concentration and gestational age (weeks) at delivery in more detail. These rates were compared with 2009-2011CC-MOD data to assess potential risk reductions in preterm birth.

RESULTS:
Women with serum 25(OH)D concentrations ≥40 ng/mL (n=233) had a 57% lower risk of preterm birth compared to those with concentrations ≤20 ng/mL [n=82; RR=0.43, 95% confidence interval (CI)=0.22,0.83]; this lower risk was essentially unchanged after adjusting for covariates (RR=0.41, 95% CI=0.20,0.86). The fitted LOESS curve shows gestation week at birth initially rising steadily with increasing 25(OH)D and then plateauing at ∼40 ng/mL. Broken down by race/ethnicity, there was a

  • 79% lower risk of preterm birth among Hispanic women with 25(OH)D concentrations ≥40 ng/mL (n=92) compared to those with 25(OH)D concentrations ≤20 ng/mL (n=29; RR=0.21, 95% CI=0.06,0.69) and a
  • 45% lower risk among Black women (n=52 and n=50; RR=0.55, 95% CI=0.17,1.76).

There were too few white women with low 25(OH)D concentrations for assessment (n=3). Differences by race/ethnicity were not statistically significant with 25(OH)D included as a covariate.

Copyright © 2015. Published by Elsevier Ltd.

PMID: 26554936
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  • Notice the moderate and very preterms- poor response to 4,000 IU of Vitamin D by several women (black squares)
  • Suspect that these poor responses could have been avoided if more vitamin D and/or cofactors which increase the response had been give to high-risk women - such as obese

Fig. 1. 25(OH)D concentration within 6 weeks of delivery by gestational age (weeks) at birth (NICHD & TRF, N = 509).
Term birth is 37 weeks of gestation; late preterm birth is 34 to <37 weeks; moderately preterm is 32 to <34 weeks; and very preterm is <32 weeks.
White circles represent women assigned to the control group (400 IU/day);
gray triangles represent women assigned to the 2000 IU/day treatment group; and
solid black squares represent women assigned to the 4000 IU/day treatment group.
Black line represents fitted LOESS curve.
 Download the PDF from VitaminDWiki


See also VitaminDWiki

Healthy pregnancies need lots of vitamin D has the following summary

Problem
Vit. D
Reduces
Evidence
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

Intervention during Pregnancy studies on VitaminDWiki

Preterm birth rate reduced 57 percent by Vitamin D – Nov 2015        
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Attached files

ID Name Comment Uploaded Size Downloads
7713 Post-hoc analysis.pdf admin 23 Jan, 2017 492.73 Kb 720
7613 Preterm.jpg admin 03 Jan, 2017 46.55 Kb 785
6151 Preterm VitD vs week.pdf admin 12 Nov, 2015 1.01 Mb 1975
6150 Preterm VitD vs week.jpg admin 12 Nov, 2015 49.22 Kb 1393
6148 Preterm bar chart.pdf admin 12 Nov, 2015 42.86 Kb 541
6147 Preterm bar chart.jpg admin 12 Nov, 2015 47.51 Kb 2585
6146 Preterm accepted.pdf admin 12 Nov, 2015 373.25 Kb 786