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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

Open-label trial: Vitamin D during pregnancy improves Apgar scores

New research published in the Journal of Clinical Endocrinology and Metabolism suggests that vitamin D supplementation during pregnancy may help improve Apgar scores in newborns.

There is much interest in vitamin D during pregnancy. Researchers are interested if low vitamin D levels during pregnancy increases risk of developing certain conditions during pregnancy, like preeclampsia, and certain complications, like needing a C-section. They’re also interested if low vitamin D levels during pregnancy increases risk of offspring developing a wide array of diseases, from cardiovascular diseases to autoimmune diseases to developmental disorders.

To date, we have lots of observational data showing that vitamin D deficiency is indeed linked to these diseases and complications. However, we’re still lacking good quantities of interventional data to see if vitamin D deficiency causes some of these diseases and complications.

In a new study, researchers from Dow University of Health Sciences in Karachi, Pakistan, conducted an interventional trial, to help shore up our lack of data in this realm.

The researchers enrolled 200 pregnant mothers into their study at the Civil Hospital in Karachi, Pakistan. The women were less than 20 weeks pregnant.

Half of the women were randomized to Group A, while the other half were randomized to Group B:

  • Starting at 20 weeks and through pregnancy, Group A received daily ferrous sulfate (200 mg) and calcium (600 mg).
  • Starting at 20 weeks and through pregnancy, Group B received daily ferrous sulfate (200 mg), calcium (600 mg) and vitamin D (4,000 IU).

The researchers wanted to know if there were differences in vitamin D levels, pregnancy outcomes and Apgar scores between the two groups. Apgar score is a scale that was developed in 1952 designed to assess the health of the newborn baby immediately after birth. Apgar is an acronym for appearance, pulse, grimace, activity and respiration, the five aspects the scale assesses. Apgar scores are typically given 1 and 5 minutes after birth.

The researchers tracked the women through pregnancy and delivery. After birth, what were the differences between mothers and babies in Group A vs Group B? Here’s what the researchers found:

  • Sixty-nine percent of the babies born in Group B (the vitamin D group) had vitamin D levels over 30 ng/ml at birth, while only 18% of the babies born in Group A (no vitamin D) had vitamin D levels over 30 ng/ml.
  • There was no difference in pregnancy outcomes between the two groups. Vitamin D supplementation in this trial had no impact on risk for preterm birth, gestational hypertension, preeclampsia, small for gestational age or delivery by C-section.
  • However, babies of mothers in Group B (the vitamin D group) had significantly better 1 minute and 5 minute Apgar scores compared to group A (P=.03 for 1-minute, .05 for 5-minute).

The researchers had mixed feelings about their findings:

“While on one hand, our data demonstrate tolerability of vitamin D in daily dose of 4,000 IU starting at 20 weeks gestation and continued until delivery, on the other hand, this study establishes inefficacy of the utilized regimen in impacting on maternal wellbeing. Other than improved Apgar scores observed in babies born to mothers who received vitamin D supplement, the remainder of neonatal parameters were unaffected by maternal supplementation.”

While this research shows an intriguing relationship between vitamin D supplementation during the latter half of pregnancy and improved Apgar scores, it’s also disappointing that the researchers didn’t find vitamin D to help with various conditions and complications. One possible limitation is that their study was too small to see effects beyond Apgar scores. It may also be crucial for pregnant women to supplement with vitamin D throughout pregnancy, not just during the latter half.

Continual and ongoing research should paint a clearer picture of how and in what ways adequate vitamin D supplementation during pregnancy can help with pregnancy and offspring outcomes.

Source

Hossain N et al. Obstetric and neonatal outcomes of maternal vitamin D supplementation: Results of an open label randomized controlled trial of antenatal vitamin D supplementation in Pakistani women. The Journal of Clinical Endocrinology and Metabolism, 2014.

  About: Brant Cebulla

Brant Cebulla was a staff member for the Vitamin D Council from May 2011 to April 2014. He has keen interests in nutrition and exercise.

4 Responses to Open-label trial: Vitamin D during pregnancy improves Apgar scores

  1. Rita and Misty says:

    Very nice article, Brant. Thank you for all your efforts, and I enjoy reading your work.

    To quote two sections from your above writings:

    “Sixty-nine percent of the babies born in Group B (the vitamin D group) had vitamin D levels over 30 ng/ml at birth, while only 18% of the babies born in Group A (no vitamin D) had vitamin D levels over 30 ng/ml.”

    “While this research shows an intriguing relationship between vitamin D supplementation during the latter half of pregnancy and improved Apgar scores, it’s also disappointing that the researchers didn’t find vitamin D to help with various conditions and complications.”

    My thoughts:

    Perhaps researchers might have find vitamin D to help with various pregnancy conditions and complications if the 25(OH)D level had been raised to 50 ng/ml to 80 ng/ml. Or, at least 60 ng/ml.

    I know I am repetitive..but I will keep on saying it until we at least reach consensus within the vitamin D community itself: We must establish optimal reference points for the 25(OH)D level.

    Looking to our current hunter/gatherer societies, this range appears to be 46 ng/ml to 104 ng/ml.

    Let’s catch a clue… 😉

  2. Brant Cebulla says:

    Rita, thanks for the comments.

    Mean levels of hunter-gatherer pregnant women, based on Luxwolda data, is 55.4 ng/ml with a standard deviation of 14 ng/ml. This means 68% of hunter gatherer pregnant women fall between 41.4 ng/ml and 69.4 ng/ml. So, it’s probably not necessary for study purposes to raise vitamin D levels beyond this range, if we want to test the theory that hunter gatherers have optimal vitamin D levels.

    There’s a good chance that in this population, 4,000 IU wasn’t quite enough. However, it’s a large enough dose where you’d hope to see some results. It could be that the combination of not quite high enough dose plus too small number of participants led to underwhelming results.

  3. Ian says:

    I think 20 weeks is too late. If the mother is deficient then where is the vitamin D going during the remainder weeks after dosing. How long does it take to raise the infants vitamin D levels in utero?
    Just measuring a level at birth is not telling us much. That level may have only been reached a few weeks before birth. Who knows!

    Difficult to achieve in a study but supplementation must be given at the start of pregnancy, or before then we might see more results

  4. Rita and Misty says:

    Ian–I think you raise an excellent point in that supplementation is much better if commenced at the start of pregnancy. Personally, I think a woman should correct for deficiency prior to considering pregnancy–but of course that would be in a perfect world (I am Pollyanna).

    Brant, if the vitamin D community would agree upon optimal 25(OH)D level as 40 ng/ml to 70 ng/ml I would be happy–not thrilled–but happy. From my own experience, my good health returned upon my level being raised to 74 ng/ml. I think that the VDC’s recommendation of 50 ng/ml–80 ng/ml is on target…but I would take 40 ng/ml to 70 ng/ml as a step in the right direction.

    By the way, I think it would be better to focus on blood levels rather than on daily dosage.

    Again, Brant, thanks for all your good work. I consider this website and forum to be invaluable–a true gift.