Obstetric and neonatal outcomes of maternal vitamin D supplementation: Results of an open label randomized controlled trial of antenatal vitamin D supplementation in Pakistani women.
J Clin Endocrinol Metab. 2014 Mar 19:jc20133491. [Epub ahead of print]
Hossain N1, Kanani FH, Ramzan S, Kausar R, Ayaz S, Khanani R, Pal L.
Objective: to determine, if vitamin D (vitD) supplementation during pregnancy, affects obstetric and neonatal outcomes Setting: University hospital, Karachi, Pakistan.
Methods: Single center, open label, randomized, controlled trial of routine care (Group A, Ferrous Sulfate 200 mg and calcium 600 mg daily) versus vitD supplementation (4000IU D3 daily, Group B ), started at 20 weeks, and continued till delivery. Maternal serum samples of 25OH vitD were collected at baseline, and delivery. Neonatal vitD status was assessed in cord blood or in neonatal serum samples within 48 hours of birth.
Obstetric outcomes included (gestational hypertension, gestational diabetes and preterm labor); neonatal wellbeing included (small for gestational age, birth weight, length, head circumference, one and five minute apgar scores)
Results: of 207 gravidae enrolled, 193 completed the trial. Maternal age, vitD status and gestational age at enrollment were comparable between the two groups.
At delivery, maternal 25OHD was increased in Group B(18.3±11ng/dl versus 8.82±11.84ng/dl (p=.001) compared to GroupA (6.9±7.0ng/dl, versus 6.32±3.97ng/dl p=.06).
The obstetric outcomes were comparable between the two groups (p>0.05).
Neonatal 25OHD levels were significantly higher in Group B compared to Group A (19.22±12.19ng/dl versus 6.27±5.2ng/dl)
There was positive correlation between maternal and neonatal 25OHD levels (r=0.83, p=0.001). One and five minute apgar scores were significantly higher in
- Group B (7.10 ±0.66 vs 6.90±0.50, p=0.026); and
- (8.53±0.68 vs 8.33±0.81, p=0.051) respectively.
Neonatal anthropometric parameters were comparable between the two groups (p>0.05).
Conclusion: Maternal vitD supplementation improved maternal and neonatal vitD status. Improved neonatal apgar scores, were observed in babies of mothers receiving antenatal vitD supplementation.
Note: Women in Pakistan have such low levels of vitamin D that 4,000 IU only achieved a 18 ng level. Also, without an initial loading dose it is doubtful if the vitamin D levels increased much for the remaining 16 weeks of pregnancy. Exepect that all measures would been greatly improved if mothers got to a level > 30 ng early (say week 1) of pregnancy.
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- Overview Pregnancy and vitamin D has the following summary
|IU||Cumulative Benefit||Blood level||Cofactors||Calcium||$*/month|
|200|| Better bones for mom|
with 600 mg of Calcium
|6 ng/ml increase||Not needed||No effect||$0.10|
|400|| Less Rickets (but not zero with 400 IU)|
3X less adolescent Schizophrenia
Fewer child seizures
|20-30 ng/ml||Not needed||No effect||$0.20|
|2000|| 2X More likely to get pregnant naturally/IVF |
2X Fewer dental problems with pregnancy
8X less diabetes
4X fewer C-sections (>37 ng)
4X less preeclampsia (40 ng vs 10 ng)
5X less child asthma
2X fewer language problems age 5
|42 ng/ml||Desirable||< 750 mg||$1|
|4000|| 2X fewer pregnancy complications |
2X fewer pre-term births
|49 ng/ml|| Should have |
|< 750 mg||$3|
|6000||Probable: larger benefits for above items|
Just enough D for breastfed infant
More maternal and infant weight
|< 750 mg||$4|