Vitamin D is a very important vitamin for the baby's mother and baby. Mothers need to ensure their vitamin D levels are normal during pregnancy and while breastfeeding.
But first, what actually is vitamin D? It is a vitamin that is formed mainly in the skin and then altered in the body to a more active component. Most importantly, it is needed in every cell for the body to function properly!
Also known as the sunshine vitamin, 90% of vitamin D is made from sunlight exposure directly onto the skin. Women who do not get enough sun are observed to have low levels of vitamin D. The darker your skin, the more sun exposure one needs! So mothers need to expose themselves to sun to prevent getting low levels of Vitamin D or take a vitamin D supplementation.
Apart from that, a normal level of vitamin D is needed to absorb calcium from food. Calcium, which is vital for building strong bones, strong teeth and is important for the nervous system. Adequate levels are important for the immune system to work properly.
A recent study found that 1,500 to 2000IU of vitamin D daily had the greatest benefits in preventing preterm labour/births and infections. (1)
What happens if you don't?
Vitamin D deficiency is common during pregnancy. A newborn baby's vitamin D level is the same as its mother. If the mother has a low vitamin D level during pregnancy, then her baby too will be born with a low vitamin D level. There will be very little vitamin D contain in breast milk, so if the baby is vitamin D deficient, they will remain deficient while being breastfed. Because Vitamin D deficiency symptoms are generally less obvious, one might think they have sufficient amounts until getting a blood test!
Low levels of Vitamin D in children and adults have also been linked to the development of many illnesses.
Inadequate vitamin D can lead to abnormal bone growth, fractures or rickets in newborns! Because the bones don't form normally, the child can be short and the legs bowed. At times, when the calcium level in the blood is very low, it will lead to the child having seizures(fits). If you think this is 'kind of' rare, check out Dr Rangan Chatterjee's story on how his son had seizure because of being deficient in this simple vitamin. (2)
Vitamin D from food consumption alone is not enough!
Only 10% of food contain vitamin D naturally, so a lot are fortified with this vitamin. All milk are vitamin D fortified. The best way to really ensure adequate vitamin D is through supplementation.
1. Dawodu A, Akinbi H. Vitamin D nutrition in pregnancy: current opinion. International Journal of Women’s Health. 2013;5:333-343. doi:10.2147/IJWH.S34032.
I am back, after a long break. I have been extremely busy with sorting out other things in my life AND being part of a 12-week fitness challenge. Life has definitely not been easy. And...I am back to my obsession about Vitamin D. Found this particular study to be quite interesting. A longitudinal study published in Lancet in 2006 found that maternal Vitamin D status was associated with reduced whole-body and lumbar-spine bone-mineral content (BMC) in children that persists to age 9 years (1).
The study followed 198 children born in 1991-1992 in UK up to 9 years of age and results show that maternal vitamin D status during pregnancy and placental calcium transfer, as indicated by concentrations of umbilical-venous calcium, are significantly correlated with bone-mineral accrual at 9 years of age. The researchers also postulated that maternal vitamin D insufficiency during pregnancy leads to an impairment of placental calcium transport. It is known that the fetus accumulates about 30 g of calcium from the mother in utero, and 80% of this transfer occurs in the last trimester of pregnancy.
Furthermore, your baby's weight at 1 year predicts bone mass at later age (2). So do you all mothers-to-be out there understand the importance of Vitamin D in pregnancy?
1: Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet. 2006 Jan 7;367(9504):36-43. Erratum in: Lancet. 2006 May 6;367(9521):1486.
2. Cooper C, Cawley M, Bhalla A, et al. Childhood growth, physical activity, and peak bone mass in women. J Bone Miner Res 1995; 10: 940–47
Attended a very interesting health meeting today and it was brought to my attention that Havard School of Public Health (HSPH) updated the Food Pyramid in 2008 based on the best available scientific evidence about the links between diet and health. According to HSPB this new Food Pyramid fixes the fundamental flaws in the original US Department of Agriculture (USDA) Pyramid and offers sound information to help people make better choices about what to eat.
HSPB has also kindly listed the top 5 tips to be healthy:
1. Start with exercise : A healthy diet is built on a base of regular exercise
2. Focus on food, not grams: Don't worry about specific servings or grams of food. It is important to note that everybody is different with different sizes, pre-existing conditions, family history etc. so there shouldn't be a set amount of serving.
3. Go with plants: Eating a plant base diet is the healthiest. Aim for lots of greens and healthy fats like olive oil and canola oil
4. Cut way back on American staples: Cut down on red meat, sugary drinks, potatoes and salty snacks.
5. Take a multivitamin: Taking a multivitamin can be a good nutrition insurance policy as it can fill in nutrient holes that may affect even the most careful eaters. Choose one multivitamin and top it up with Vitamin D. There is growing evidence Vitamin D lowers the risk of Colon and Breast Cancer.
For more info you can check out HSPB's handout here
I think this Food Pyramid is more in line with current average person's activity and nutritional requirements. Back in the days, my parents had lots of daily exercises working in the farm hence there was no need to put this in the pyramid. What do you think about current living trends?
I don't know why this hasn't been mentioned in ANY midwife visits, routine immunisations, parents groups, playgroups etc that I have been to since the birth of my daughter few months ago. With my recent obsession with Vitamin D and it so happened today that I stumbled upon a CDC recommendation that infants should have 400IU of Vitamin D supplement a day! Moreover, this recommendation was given by American Academy of Paediatrics in their 2008 report which states ' It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth.' This is another clear example of how millions of good research and recommendations never make it to the public.
It is however quite obvious you are not going to expose your precious babies under the sun for extended period of time just to get adequate amount of Vitamin D for the prevention of infant rickets. Not to mention the risk of skin cancer and wrinkling of skin increase with sunlight exposure.
According to the CDC website, 'Human milk typically contains a vitamin D concentration of 25 IU per liter or less' and I don't believe any baby under 6 months can go through 2 liters of breastmilk a day (equivalent to only 50IU of Vitamin D). So mothers, knowing how Vitamin D is essential for our human body (and many more benefits are currently being researched), do not deprive your babies of Vitamin D supplementation if you choose to exclusively breastfeed. If you are like me, lucky enough to have been supplementing formula with breastmilk, your babies will get Vitamin D from the formula.
Bottom line, breastmilk does not contain everything your baby needs. It is important to always be aware and educate yourself.
Yesterday a colleague of mine came to me and told me that his wife is 6 months pregnant and has a Vitamin D level of 15nmol/L and he continued by saying that the doctor suggested her to take 2 Vitamin D tablets a day from now on. I was literally in shock, with a Vitamin D level of 15nmol/L which is categorised as severe Vitamin D deficiency during pregnancy is rather serious and if the treating doctor had paid attention to any recent clinical guidelines, the dosage suggested would have been more than just 2 Vitamin D tablets (2000IU of Vitamin D supplementation).
Have a look at the clinical guidelines for Vitamin D deficiency above which is taken from King Edward Memorial Women's Hospital in Perth, WA, Australia. They actually recommend taking 5000IU of Vitamin D plus calcium for 6 weeks if Vitamin D level is below 50nmol/L. It makes me wonder how can a treating doctor be so out of date with the current treatment plan and why didn't he/she highlight the importance of maintaining optimum Vitamin D level in pregnancy?
Interestingly, my colleague's wife has actually been taking a certain brand of Vitamin D supplementation ever since she found out that she was pregnant. All I have to say is maybe that brand is pretty low quality. If you would like to know further details, please email me.
Effects of low maternal Vitamin D includes:
- Low serum calcium in newborns, with or without convulsions
- Defective tooth enamel
- Lower birth rates and higher risk of small for gestational age
- Lower newborn bone mineral
- Affects fetal femoral bone development
- Greater risk for multiple sclerosis, cancer, insulin dependent diabetes mellitus, and schizophrenia in later life
Population that should be screened for Vitamin D deficiency:
- Dark skin population
- Have limited exposure to sunlight (tend to be indoors/ protected from sun when outdoors)
- Pre-pregnancy BMI > 40
I cannot stress enough the importance of Vitamin D and how common it is to find a person who is deficient in Vitamin D these days due to the risks of developing skin cancers with extreme sun exposures. In fact, a few of my close friends who are taking multivitamins think that there is enough Vitamin D supplementation in it! To be honest most multivitamins consist of minute amount of Vitamin D and it is not enough for good Vitamin D level maintenance.
The take home note, each and every pregnant woman should know their Vitamin D levels and understand the importance of maintaining the level throughout pregnancy.
Interestingly I just came back from a health talk today and the focus was on research translation and it brings back the memories of me attending the 2014 - 3rd annual NHMRC Research Translation Faculty Symposium – "Achieving better health outcomes for Australians living with chronic conditions through more effective research translation". It is very true that although a lot of money has been spent on research and there are abundance of quality and interesting research work being done, the public and the health professionals doesn't necessarily know about it. Just think even if you only learn about 1 research per day, wouldn't that add more value to your life?
I was browsing through one of the hottest topic in research now which is Vitamin D because if you know me personally, the latest project I worked on was on Vitamin D and Type 2 Diabetes. Matter of fact, Vitamin D is also linked to depression!
Depression affects 350 million people worldwide and it is the leading cause of disability. At its worst, depression can lead to suicide and over 800 000 people die due to suicide every year with suicide being the second leading cause of death in 15-29year olds according to WHO. On the other hand Vitamin D deficiency is now a global public health problem affecting a billion people worldwide and studies have found that one third of Australians are Vitamin D deficient. Knowledge on Vitamin D has grown exponentially in recent years with 95% of our current knowledge published in the last 15 years. Interestingly, vitamin D has also been known to be associated with breast cancer fatality rate as shown in my other post.
A longitudinal study found that low vitamin D levels are associated with depressive symptoms, especially in persons with a history of depression (1). Researchers suggested that it might be important to check Vitamin D levels in diagnosed depression cases.
In a randomised double blind controlled trial of 20,000 or 40,000 IU vitamin D per week versus placebo for 1 year on 441 subjects (159 men and 282 women, aged 21-70 years), subjects with serum 25(OH)D levels < 40 nmol L(-1) scored significantly higher (more depressive traits) than those with serum 25(OH)D levels > or = 40 nmol L(-1) on the Beck's Depression Inventory (BDI). In the two groups given vitamin D, but not in the placebo group, there was a significant improvement in BDI scores after 1 year.
Some studies might argue about Vitamin D's controversial theory in aiding depression but overall, being deficient in a vital vitamin for the body is never a good thing so it is very important to make sure your Vitamin D levels are in the normal range to start with.
1: Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center longitudinal study. Mayo Clin Proc. 2011 Nov;86(11):1050-5. doi: 10.4065/mcp.2011.0208. PubMed PMID: 22033249; PubMed Central PMCID: PMC3202994.
2. Jorde R, Sneve M, Figenschau Y, Svartberg J, Waterloo K. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind trial. J Intern Med. 2008 Dec;264(6):599-609. doi:10.1111/j.1365-2796.2008.02008.x. Epub 2008 Sep 10. PubMed PMID: 18793245.
Breast cancer is the most common cancer in women worldwide with nearly 1.7 million diagnosed in 2012 according to World Cancer Research Fund International. A meta-analysis published in 2014 concluded that higher serum 25(OH)D concentrations (Vitamin D) were associated with lower fatality rates in patients with breast cancer. Patients with the highest concentration of 25(OH)D had approximately half the fatality rate compared to those with the lowest concentration (1)
In studies of cancer cells and of tumors in mice, vitamin D has been found to have several activities that might slow or prevent the development of cancer, including promoting cellular differentiation, decreasing cancer cell growth, stimulating cell death (apoptosis), and reducing tumor blood vessel formation (angiogenesis) (2)(3)
Another study conducted by Prof. Garland in 2011, which found that a 50 ng/ml level of 25-hydroxyvitamin D in the blood (a level that can be reached with an intake of 4,000 international units (IU) of vitamin D a day) reduces breast cancer risk by 50% (4). Although Prof. Garland says further research is needed to confirms the team's findings, he believes there is no reason why people should not increase their vitamin D intake now, after confirming with their health care provider that it is safe to do so.
1: Mohr SB, Gorham ED, Kim J, Hofflich H, Garland CF. Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer Res. 2014 Mar;34(3):1163-6. PubMed PMID: 24596354.
2: Thorne J, Campbell MJ. The vitamin D receptor in cancer.
Proc Nutr Soc. 2008 May;67(2):115-27. doi: 10.1017/S0029665108006964. Review. PubMed PMID: 18412986.
3. Deeb KK, Trump DL, Johnson CS. Vitamin D signalling pathways in cancer: potential for anticancer therapeutics.
Nat Rev Cancer. 2007 Sep;7(9):684-700. Review. PubMed PMID: 17721433.
4. Mohr SB, Gorham ED, Alcaraz JE, Kane CJ, Macera CA, Parsons JK, Wingard DL,Garland CF. Serum 25-hydroxyvitamin D and prevention of breast cancer: pooled analysis.
Anticancer Res. 2011 Sep;31(9):2939-48. Erratum in: Anticancer Res. 2011 Oct;31(10):3637. PubMed PMID: 21868542.
This is my first blog post and I would like to highlight that even though I am a doctor, I have never ever tested my Vitamin D levels until the day I took part in a medical research 4 years ago. It was then that the PhD student told me that my levels were <10ng/mL and I was put on Vitamin D supplementation since then.
Recent study shows that 31 percent of the Australian population are Vitamin D deficient (<50nmol/L) and people of non-European origin were 4-5 times more likely to be deficient (1). What is more interesting from this study is that people who are obese and physically inactive are twice more likely to be Vitamin D deficient. So if you think you fall into the 'high risk' category you should really get it checked with your GP.
So you might think, what is the big deal with being Vitamin D deficient? Well, studies have shown that low levels of vitamin D can contribute to a number of serious, potentially life-threatening, conditions such as softened bones; diseases that cause progressive muscle weakness leading to an increased risk of falls, osteoporosis, cardiovascular disease, certain types of cancer (particularly of colon, breast and prostate gland) (2) and type 2 diabetes.
And in case you are thinking what is with all this mixed messages about getting skin cancer (ie, sun protection) and risk of Vitamin D deficiency, have a read on this article. As for me, I have been on Vitamin D supplement since 4 years ago so I definitely agree with Alice in the article. At the end of the day, prevention is better than cure.
1: Daly RM, Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Sikaris KA, Zimmet PZ,, Ebeling PR, Shaw JE.
Prevalence of vitamin D deficiency and its determinants in Australian adults aged 25 years and older: a national, population-based study.
Clin Endocrinol (Oxf). 2012 Jul;77(1):26-35.
2. Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseases. Eur J Clin Invest. 2005 May;35(5):290-304.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research