Updated: Nov 21, 2019
By Dr. Kecia Gaither @KeciaGaitherMD - November 15, 2019
***Originally Posted in WholeFoodsMagazine.com***
Proper nutrition is key to the health of any individual, but perhaps most important to pregnant mothers. The health of women during pregnancy determines the future health of her child, and there is evidence that her health affects the next generation as well.
Unfortunately, today’s standard diet, and even one of whole foods, often does not provide all of the nutrients in the amounts necessary to support all aspects of health at a functional level. This is especially true for vitamin D—the sunshine vitamin—that is not easily found in the foods we eat, and must be obtained through supplements for most people.
Something Unique about Vitamin D and Pregnancy
Pregnancy presents a unique and exaggerated example of the body’s need for vitamin D. There’s something very unique concerning the metabolism of vitamin D that occurs only during pregnancy and at no other time in the human lifecycle. While the conversion of vitamin D is normally directly related to serum calcium levels, during pregnancy there is an uncoupling of vitamin D metabolism from calcium. If a pregnant woman has adequate levels (40-60 ng/ml or 100-150 nmol/L) of 25(OH) vitamin D, the precursor to active vitamin D, her body will convert twice the normal amount of active 1,25(OH) vitamin D by the end of the first trimester, and over three times the normal amount by birth, with her calcium levels remaining normal. This could potentially indicate a physiological need for greater availability of vitamin D during pregnancy more than any other time, and for reasons other than bone and calcium homeostasis.
80% or More of Pregnant Women are Vitamin D Deficient
Unfortunately, United States statistics reveal nearly 80% of pregnant women, and virtually 100% of African American women, have vitamin D levels below 40 ng/ml. This clinical finding potentially can preclude to a 30-50% increased risk of preterm birth and an increased risk of other perinatal morbidities including gestational diabetes, infections, preeclampsia, low birth rate and cesarean delivery.
The GrassrootsHealth Nutrient Research Institute panel of scientists recommends a vitamin D serum level of 40-60 ng/ml (100-150 nmol/L). Research published by GrassrootsHealth and others has shown that when these levels are achieved, there exists a potential 40-60 % reduction in preterm births. Other articles have shown such results as a 50% reduction in influenza rates in children, an 80% reduced risk of Type 1 diabetes and an 83% reduction in breast cancer risk. Keep in mind that, due to a large variation in the response each individual has to supplementation, testing the vitamin D serum level is essential. In other words, one cannot assume that supplementing with a certain recommended dose of vitamin D will get them to their target level; therefore it is important to test.
Research in Action at the Medical University of South Carolina (MUSC)
Due to the overwhelming evidence supporting vitamin D during pregnancy, specifically reaching a minimum vitamin D level of 40 ng/ml, GrassrootsHealth helped implement a first-of-its kind study for pregnant women at MUSC. The goal of the project was to help all prenatal patients to achieve a vitamin D serum level of at least 40 ng/ml, which has been demonstrated to be the threshold for benefit in previous randomized trials, as described above. This nutrient field trial included 1,064 pregnant women who, over a 16-month period, received vitamin D screening at their first prenatal appointment, supplementation and education about vitamin D, and re-testing to ensure a vitamin D level of 40 ng/ml had been achieved. Results found that those who achieved a vitamin D level of at least 40 ng/ml had a 60% lower risk of preterm birth compared to those with levels less than 20 ng/ml. For those women who had previously experienced a preterm birth (who are also at a higher risk for subsequent preterm birth), their chance of having a recurring preterm birth was reduced by 80%. During implementation there were no incidences of toxicity due to any vitamin D intake. An impressive result, especially considering the only intervention was vitamin D screening, supplementation and education. The MUSC project has run continuous analysis on the implementation of the protocol in practice since the original paper and continues to show consistent results.
Organic & Natural Health Win for Vitamin D Education On The Label
I serve on the scientific advisory council for Organic & Natural Health Association, a nonprofit trade association that advances research to redefine how health care is delivered, provides quality education to inform and empower conscious consumer choice, and advocates for meaningful public policy. They have worked collaboratively and in conjunction with GrassrootsHealth on this vitamin D consumer education campaign from a dual perspective. While GrassrootsHealth has focused on the research aspect of validating the importance of vitamin D testing and supplementation, Organic & Natural Health has made petitions to the Food and Drug Administration (FDA) to permit dietary supplements containing vitamin D to provide a health claim concerning the association between vitamin D and a preterm birth. The petition was based on numerous studies mentioned above showing an association between higher serum vitamin D levels in pregnant women and a reduced risk of preterm births. The FDA opted to reject the petition based on their decision that although vitamin D is a food source, serum levels of vitamin D are not considered food or components of food, therefore cannot be characterized as a substance to decrease the risk of preterm births. Their conclusion offers an interesting opportunity for manufacturers of vitamin D supplements to include language on their labels that supports healthy pregnancies and promotes full-term births as a structure/function claim instead.
Simply GOODFATS Vitamin D3 label is the first product to run with this and you’ll find on its label: “supports full-term birth” and “supports a healthy pregnancy” along with: “Pregnant women who have higher serum vitamin D levels have a decreased risk of preterm birth. Adding a vitamin D3 supplement to a healthy diet can help increase serum vitamin D levels. Your healthcare practitioner can measure serum vitamin D levels and determine appropriate dosage of vitamin D3 for you.” For retailers this is a huge win, because now you can point your customers directly to product labels to educate them about the benefits of vitamin D for pregnant women. Vitamin D is by far one of the most inexpensive solutions to reducing preterm births. If just 50% of preterm births could be prevented each year in the United States, hundreds of thousands of families would be spared this heartache and trauma. Retailers now have the opportunity to be part of the conversation by educating customers directly in the vitamin D aisle.