Low vitamin D in pregnancy and 2X worse language skills later – Feb 2012

Summary: <18 ng during pregnancy vs >28 ng resulted in 2X more language difficulties at ages 5/10

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Maternal Serum Vitamin D Levels During Pregnancy and Offspring Neurocognitive Development

Andrew J. O. Whitehouse, PhD, awhitehouse@ichr.uwa.edu.au
Barbara J. Holt, BSc,
Michael Serralha, BSc(Hons),
Patrick G. Holt, DSc,
Merci M. H. Kusel, MBBS, and
Prue H. Hart, PhD
Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Australia
Pediatrics Published online February 13, 2012

OBJECTIVE: To determine the association between maternal serum 25(OH)-vitamin D concentrations during a critical window of fetal neurodevelopment and behavioral, emotional, and language outcomes of offspring.

METHODS: Serum 25(OH)-vitamin D concentrations of 743 Caucasian women in Perth, Western Australia (32°S) were measured at 18 weeks pregnancy and grouped into quartiles.
Offspring behavior was measured with the Child Behavior Checklist at 2, 5, 8, 10, 14, and 17 years of age (n range = 412–652).
Receptive language was assessed with the Peabody Picture Vocabulary Test—Revised at ages 5 (n = 534) and 10 (n = 474) years.
Raw scores were converted to standardized scores, incorporating cutoffs for clinically significant levels of difficulty.

RESULTS: ?2 analyses revealed no significant associations between maternal 25(OH)-vitamin D serum quartiles and offspring behavioral/emotional problems at any age.
In contrast, there were significant linear trends between quartiles of maternal vitamin D levels and language impairment at 5 and 10 years of age.
Multivariate regression analyses, incorporating a range of confounding variables, found that the risk of women with vitamin D insufficiency (?46 nmol/L) during pregnancy having a child with clinically significant language difficulties was increased close to twofold compared with women with vitamin D levels >70 nmol/L.

CONCLUSIONS: Maternal vitamin D insufficiency during pregnancy is significantly associated with offspring language impairment.
Maternal vitamin D supplementation during pregnancy may reduce the risk of developmental language difficulties among their children.

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Kids' Language Skills Tied to Mom's Vitamin D

By Todd Neale, Senior Staff Writer, MedPage Today, Published: February 13, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points

  • Explain that pregnant women with low 25-hydroxyvitamin D levels may be more likely to have children who develop language difficulties.
  • Note that there was no relationship between maternal serum 25(OH)D levels and behavioral or emotional problems in the children.

Pregnant women with low 25-hydroxyvitamin D levels may be more likely to have children who develop language difficulties, an Australian study showed.

Children born to mothers with 25(OH)D levels less than 46 nmol/L in the second trimester were nearly twice as likely to have clinically significant language problems at ages 5 and 10 (OR 1.97, P<0.05), according to Andrew Whitehouse, PhD, of the University of Western Australia's Telethon Institute for Child Health Research in Subiaco, and colleagues.

There was no relationship, however, between maternal serum 25(OH)D levels and behavioral or emotional problems in the children, the researchers reported online in Pediatrics.

"The findings suggest that the trend over the past decade of a reduction in vitamin D levels among women of reproductive age has significant implications for offspring neurodevelopment and public health more generally," they wrote.

"Randomized controlled trials of vitamin D supplementation are required to verify these observational data that suggest that an adequate maternal vitamin D status during pregnancy is necessary for optimal language development in offspring."

A previous study identified an association between the timing of pregnancy and the risk of multiple sclerosis, with a greater risk in pregnancies that started in the winter or spring, when sunlight exposure and vitamin D levels are at their lowest.

That suggested that vitamin D insufficiency may be to blame for various adverse health outcomes, including possibly impaired neurocognitive development.

Whitehouse and colleagues explored the issue using data from the Western Australian Pregnancy Cohort (Raine) Study conducted in Perth. The current analysis included 743 white women who provided blood samples at 18 weeks of pregnancy, a key time for fetal neurodevelopment.

The researchers divided the women into quartiles according to their serum 25(OH)D levels:
46 nmol/L or less
47 to 59 nmol/L
60 to 71 nmol/L
72 nmol/L or more

Offspring behaviors were assessed at ages 2, 5, 8, 10, 14, and 17 using the Child Behavior Checklist.
There was no association between maternal serum 25(OH)D and behavioral outcomes at any age.

There was, however, an association between the lowest 25(OH)D levels (versus the highest) and a greater percentage of children with clinically significant impairments in receptive language, measured using the Peabody Picture Vocabulary Test-Revised at ages 5 and 10.

The authors used generalized estimating equations models to show the association between maternal 25(OH)D concentration at 18-weeks pregnancy and offspring language impairment during childhood. In a model that adjusted for maternal age at conception, family income, maternal smoking during pregnancy, offspring parity, and the season of maternal blood collection, they found the following:

  • 46 nmol/L or less: OR 1.97 (95% CI 1.00–3.93), P<0.05
  • 47 to 59 nmol/L: OR 1.35 (95% 0.71–2.57), P=0.36
  • 60 to 71 nmol/L: OR 1.44 (95% CI 0.74–2.80), P=0.28
  • 72 nmol/L or more: OR 1.00 (reference), no P-value

The relationship remained significant after adjustment for all the factors, "indicating that the association was primarily driven by maternal [25(OH)D] levels, rather than other seasonal factors," according to the researchers.

Although an observational study cannot prove a causal relationship, there is a biological connection between maternal vitamin D and the developing fetus.
Vitamin D has important functions during neurodevelopment, "including a signaling role in neuronal differentiation, a regulation role in the metabolism of neurotrophic factors and neurotoxins, and a protective role during brain inflammation," Whitehouse and colleagues wrote.

They added that vitamin D may also be involved indirectly in fetal brain growth.

The study was limited, they said, by sample attrition over time and the inclusion of only Caucasian participants.
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See also VitaminDWiki

IU Cumulative Benefit Blood level and notes Co-factors Calcium $*/year
400 + less infant rickets
+ 3X less adolescent Schizophrenia
+ fewer child seizures
<30 ng/ml Not needed No effect $3
2000 + More likely to get pregnant naturally or via IVF
+ 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 less language problems age 10
42 ng/ml Desirable < 750 mg $15
4000 + 2X fewer pregnancy complications
+ 2X fewer per-term births
49 ng/ml
Test Vitamin D
Must have < 750 mg $105
6000 + probable larger benefits for items listed above
+ Enough D for breastfed infant
+ Perhaps prevent 2nd autistic child
Test Vitamin D
clinical trials underway
Must have < 750 mg $120

There are many studies which have shown an association of autism to many factors:

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