Gynecol Endocrinol. 2016 Mar 29:1-6. [Epub ahead of print]
Kamudoni P1, Poole C2, Davies SJ3.
1a Research Fellow, Centre for Socioeconomic Research, School of Pharmacy and Pharmaceutical Sciences, Cardiff University , Cardiff , UK .
2b Senior Lecturer, Department of Primary Care and Public Health, School of Medicine, Cardiff University , Cardiff , UK , and.
3c Consultant Endocrinologist, University Hospital of Wales , Cardiff , UK.
Pregnancy is associated with an increased risk of vitamin D deficiency beyond that of the general population. The aim of the current analysis was to synthesize the current evidence on the dose-outcome relationship of vitamin D/serum 25 hydroxyvitamin D (25-OHD) and complications during pregnancy. An additional aim was to estimate the economic burden attributable to inadequate levels of serum 25-OHD. Published literature on the effects of vitamin D supplementation/serum 25-OHD on pregnancy complications, including randomized control trials and non-interventional studies, was searched in bibliographic databases including Pubmed, Google Scholar, Scopus and EMBASE.
A positive and significant treatment effect was obtained for
- pre-eclampsia (OR = 0.75 95% CI 0.662-0.843),
- but not for preterm birth (OR = 0.783, 95% CI 0.49-1.251)
- or small for gestational age (OR = 0.76 95% CI 0.38-1.28).
Inadequate vitamin D accounted for 14.04% of risk for pre-eclampsia. It is estimated that addressing vitamin D inadequacy in pregnant women in England and Wales would reduce the number of cases of pre-eclampsia by 4126; and would result in a net saving of £18.6 million for the NHS in England and Wales. The current results suggest that based on current evidence a public health policy preventing vitamin D inadequacy in pregnant women is likely to have a positive impact on the NHS budget in England and Wales. This is contingent upon further evidence regarding the vitamin D dose-pregnancy outcome relationship becoming available.
- Failed to include costs included for education, distribution, etc.
- Dose sizes of the studies ranged from 200 IU/day to 4 doses of 120 000 IU
- 800 IU daily dose size recommended by study was determined by the maximum licensed in the UK, not the studies
800 IU is rarely enough to make a difference for anyone
- Cost of the vitamin D for pregnancy £27
- Study did not consider that a loading dose allows the pregnant woman to get the benefit of the vitamin D many months before the small daily dose
Supplementation with Vitamin D, etc, is extremely cost effective and also very beneficial to mom and infant
- Vitamin D 4,000 to 12,000 IU average daily - depending on weight, pre-existing conditions, distance from equator, etc.
probably given as 50,000 IU every 4-14 days
- Risk of preeclampsia might be cut in half if take an amount of Vitamin D – meta-analysis Sept 2017
- Vitamin D loading dose to get the benefits in days instead of months (range of 100,000 to 800,000 IU)
- Omega-3 - amount and dose frequency is TBD
Perhaps stop Omega-3 before birth to avoid excessive bleeding
- Magnesium - at least 100 milligrams in the form of Magnesium Chloride
- UK would save as least 636 million dollars annually by giving 800 IU vitamin D free to all seniors – June 2014
- Save 2 billion dollars annually in fractures if take Vitamin D and Calcium – Frost and Sullivan Sept 2013
- Vitamin D Webinar - cost of pre-term birth etc- Baggerly Nov 2013
- Routine monitoring of vitamin D during pregnancy is mandatory (Engl. and Port.) - May 2015
- Prenatal VITAMIN D is more important than other prenatal vitamins
- Ensure a healthy pregnancy and infant with as little as $20 of Vitamin D
- Preeclampsia reduced by Vitamin D (50,000 IU bi-weekly) and Calcium – Oct 2015
- Preeclampsia 2.7X more frequent if low vitamin D – meta-analysis Sept 2013
- Clinical trials for pregnancy with Vitamin D intervention – 51 as of Sept 2015
- More vitamin D needed during pregnancy – meta-analysis Oct 2014
- Vitamin D is being used to prevent premature births – Baggerly interview – Dec 2015
- Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015
- Pregnancy helped by single dose of 60,000 IU of Vitamin D – RCT March 2015
one of the references in the study
- Category Cost Savings with Vitamin D has
Healthy pregnancies need lots of vitamin D looks at the cost-effectiveness of vitamin D with pregnancyProblem
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 TrialVitamin D supplementation of all pregnant women (in UK) would be cost effective – just considering preeclampsia – March 2016
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