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
Vitamin D plays a vital role in many important physiologic functions, and its deficiency has been linked to both depression  and pain. An estimated 41 % of pregnant women in the United States have deficient vitamin D levels, with an additional 41% having insufficient levels. The American Congress of Obstetrics and Gynecology recommends vitamin D supplementation during pregnancy when deficiency is identified for maternal and fetal bone metabolism. 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.
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. 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.
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).
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. However, one hypothesis proposes that once ascending pain pathways are activated, simple vitamin D repletion may not be enough to silence those pathways. 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.
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Note: Only patients who requested and received an epidural were included.
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Healthy pregnancies need lots of vitamin D many more benefits besides reducing labor painProblem
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 TrialLess medicine for labor pain (12 vs 18 mg) if high vitamin D (44 vs 26 ng avg) Oct 2014
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