Less medicine for labor pain (12 vs 18 mg) if high vitamin D (44 vs 26 ng avg) Oct 2014

Effect of Vitamin D Levels on Intrapartum Epidural Consumption

American Society of Anesthesiologists Abstract 4082 , October 14, 2014
Steven Ropers, M.D., Quy Tran, M.D., Andrew W. Geller, M.D., Amy Lamb, M.S.N., C.N.M., Ph.D., Calvin Hobel, M.D., Mark I. Zakowski, M.D.
Cedars-Sinai Medical Center, Los Angeles, California, United States

Introduction:
Vitamin D plays a vital role in many important physiologic functions, and its deficiency has been linked to both depression [1] and pain.[2] An estimated 41 % of pregnant women in the United States have deficient vitamin D levels, with an additional 41% having insufficient levels.[3] The American Congress of Obstetrics and Gynecology recommends vitamin D supplementation during pregnancy when deficiency is identified for maternal and fetal bone metabolism.[4] Currently no studies have established a link between low vitamin D levels and intrapartum pain. We hypothesized that parturients with lower vitamin D levels will have increased intrapartum pain.

Methods:
After IRB approval, pregnant women >18 years old were enrolled on routine OB visits at <25 weeks gestational age as part of a nested cohort of a larger study assessing vitamin D and depression. Patients admitted to labor and delivery in spontaneous labor or for labor induction had vitamin D levels measured at time of delivery. At our hospital, labor analgesia is obtained using ropivacaine 0.2% infusion without narcotic. Epidural analgesic consumption was quantified as area under the curve (AUC) and converted into ropivacaine equivalents per hour to normalize for duration of epidural infusion.[5] The AUC and narcotic consumption were compared in the high and low (above and below median) vitamin D levels and the two groups were compared using an unpaired t-test.

Results:
At the time of writing, serum vitamin D results (N=93) have been analyzed, but scheduled cesareans (N=22) were excluded from analysis. Demographics were similar for each group except the lower vitamin D group had a statistically significant higher BMI 31.7 ±5.7 vs 29 ± 4.0 kg/m2 (P=0.03). Mean vitamin D levels were 25.84 ±6.3 ng/ml for the low vitamin D group and 43.1 ± 5.9 ng/ml for the high vitamin D group. The lower vitamin D group had a significantly higher epidural ropivacaine equivalents per hour than those in the higher vitamin D group, 18.25±14.3mg and 12.4±8.8mg, respectively (p=0.046).

Conclusion:
Our study is the first to demonstrate that lower vitamin D levels are associated with higher intrapartum epidural consumption. This finding is consistent with emerging research associating hypovitaminosis D with pain. Vitamin D is thought to activate descending inhibitory and modulatory pain pathways.[6] However, one hypothesis proposes that once ascending pain pathways are activated, simple vitamin D repletion may not be enough to silence those pathways.[7] Thus the mechanisms underlying the association between hypovitaminosis D intrapartum and intrapartum pain as well as potentially postpartum pain warrant further investigation. Given the high prevalence of vitamin D deficiency and insufficiency in US parturients, effective prevention and treatment may have significant impact on decreasing labor pain in millions of women every year. Recommendations regarding vitamin D supplementation during pregnancy may need to be revisited. We conclude that vitamin D deficiency is an important risk factor for increased intrapartum pain.

References:

1) Br J Psychiatry. 2013 Feb;202:100-7
2) Ann Rheum Dis. 2009 Jun;68(6):817-22
3) Am J Perinatol 2011; 28:7-12
4) ACOG Committee Opinion 495, 2011.
5) Br J Anaesth. 1999 Mar;82(3):371-3.
6) J Bone Miner Res 2008;23:S223
7) Letters to the Editor / PAIN 143 (2009) 159-160

Note: Only patients who requested and received an epidural were included.

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See also VitaminDWiki

• Pregnancy category listing has 922 items along with related searches
• Overview Pregnancy and vitamin D
• How 60 ng of vitamin D enabled pregnancy - a personal story
• Less labor pain if higher level of vitamin D – August 2021

Healthy pregnancies need lots of vitamin D many more benefits besides reducing labor pain
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