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
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
Most were taking 2,000 to 7,000 IU daily for >50% of pregnancy
Click on hyperlinks for details
Problem | Vit. D Reduces | Evidence |
| 0. Chance of not conceiving | 3.4 times | Observe |
| 1. Miscarriage | 2.5 times | Observe |
| 2. Pre-eclampsia | 3.6 times | RCT |
| 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 times | Observe |
| Stillbirth - OMEGA-3 | 4 times | RCT - 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 times | Observe |
| 13. Preeclampsia in young adult | 3.5 times | RCT |
| 14. Good motor skills @ age 3 | 1.4 times | Observe |
| 15. Childhood Mite allergy | 5 times | RCT |
| 16. Childhood Respiratory Tract visits | 2.5 times | RCT |
RCT = Randomized Controlled Trial
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.