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

Created 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]

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 | 1. Needed To Screen/Treat | | Pre-eclampsia | 60% | 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 * * Injection category listing has items along with related searches * Loading Dose of Vitamin D category listing has items along with related searches** * Monthly 120,000 IU Vitamin D plus daily Calcium was great during pregnancies – RCT Sept 2017 * Response to 150,000 IU vitamin D once vs 5,000 IU daily – RCT May 2014 * Note: 6,400 IU daily was found to be great during pregnancy by several other studies * Monthly dosing would need require at least 200,000 IU monthly to get same benefit as 6,400 IU daily --- 1. Healthy pregnancies need lots of vitamin D has the following summary {include}

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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