5,000 IU Vitamin D was not enough to reduce preeclampsia but did help future infant – RCT April 2014

Vitamin D Supplementation and the Effects on Glucose Metabolism During Pregnancy: A Randomized Controlled Trial

Diabetes Care April 23, 2014
Constance Yap1,2⇑, Ngai W. Cheung1,2, Jenny E. Gunton1,2,3, Neil Athayde4, Craig F. Munns5, Anna Duke1 and Mark McLean1,6
1Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
2Faculty of Medicine, Western Clinical School, University of Sydney
3Diabetes and Transcription Factors Group, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
4Obstetrics and Gynaecology, Westmead Hospital, Sydney, New South Wales, Australia
5Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
6School of Medicine, University of Western Sydney, Sydney, New South Wales, Australia
Corresponding author: Constance Yap, constanceyap@yahoo.com.

OBJECTIVE Vitamin D deficiency in pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM) and neonatal vitamin D deficiency. We conducted a double-blind, randomized controlled trial of low-dose (LD) versus high-dose (HD) vitamin D supplementation to investigate the effects of vitamin D supplementation on glucose metabolism during pregnancy.

RESEARCH DESIGN AND METHODS Women with plasma 25-hydroxyvitamin D (25OHD) levels <32 ng/mL before 20 weeks’ gestation were randomized to oral vitamin D3 at 5,000 IU daily (HD) (n = 89) or the recommended pregnancy dose of 400 IU daily (LD) (n = 90) until delivery. The primary end point was maternal glucose levels on oral glucose tolerance test (OGTT) at 26–28 weeks’ gestation. Secondary end points included neonatal 25OHD, obstetric and other neonatal outcomes, and maternal homeostasis model assessment of insulin resistance. Analysis was by intention to treat.

RESULTS There was no difference in maternal glucose levels on OGTT. Twelve LD women (13%) developed GDM versus seven (8%) HD women (P = 0·25). Neonatal cord 25OHD was higher in HD offspring (46 ± 11 vs. 29 ± 12 ng/mL, P < 0.001), and deficiency was more common in LD offspring (24 vs. 10%, P = 0.06). Post hoc analysis in LD women showed an inverse relationship between pretreatment 25OHD and both fasting and 2-h blood glucose level on OGTT (both P < 0·001). Baseline 25OHD remained an independent predictor after multiple regression analysis.

CONCLUSIONS HD vitamin D supplementation commencing at a mean of 14 weeks’ gestation does not improve glucose levels in pregnancy. However, in women with baseline levels <32 ng/mL, 5,000 IU per day was well tolerated and highly effective at preventing neonatal vitamin D deficiency.

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IU Cumulative Benefit Blood level CofactorsCalcium $*/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
Should have
< 750 mg $4
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