300,000 IU of Vitamin D total is not enough during pregnancy – RCT

Created May 2018

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

The Journal of Clinical Endocrinology & Metabolism, jc.2018-00109, https://doi.org/10.1210/jc.2018-00109

Maryam Rostami, PhD Fahimeh Ramezani Tehrani, MD Masoumeh Simbar, PhD Razieh Bidhendi Yarandi, MS Sonia Minooee, MS Bruce W Hollis , PhD Farhad Hosseinpanah, MD

* 8 dosing branches this pregnancy RCT from Iran * Many of the branches included 50,000 IU of vitamin D during pregnancy * 50,000 IU weekly for 6 weeks or 300,000 IU injection resulted half getting> 20 ng, which other studies have found does not provide much benefit * However, all of the supplementation branches greatly reduced miscarriage rate --- 1. See also VitaminDWiki * Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017 * 10,000 IU of vitamin D during pregnancy resulted in spectacular infant development – Coimbra April 2018 * Pregnancies with more than 40 ng of vitamin D are great (Sweden, 2,000 pregnancies) – Feb 2018 * Pregnancies helped by Vitamin D – recommendations and trials underway – review Dec 2017 * Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015 * 200,000 IU once at 27 weeks Pregnancy trials getting most women above 40 ng used a total of > 1,300,000 IU (not just 300,000 IU total) (6,400 IU/day for 30 weeks) Healthy pregnancies need lots of vitamin D has the following summary {include} Editorial on this study Call to action – more Vitamin D for pregnancies, loading doses are OK – Holick Aug 2019

PDF is available free at Sci-Hub   10.1210/jc.2018-00109

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.

Tags: Intervention Intervention - non daily Pregnancy