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Medical Forum / General / General / June 2007Low vitamin D levels increase rates of preeclampsia
I've some mixed emotions on this piece of research. As the research resulted in comparing the frankly deficient to the decidely insufficient. When reading the following remember the latest research has shown 25 OH vitamin serum level of around 75 to 80 nmol/L (30 to 32 ng/dL) is the BOTTEM end of the optimal range. For those used to thinking in ng/dL multiple the numbers in the abstract by 0.4 to convert nmol/L to ng/dL. Nor should we surprised in the light of these findings that blacks (in higher latitudes apparently) are more prone preeclampsia than lighter skin groups. --------------------------------------------------- Also be aware the full article is available without a fee by way of a link on PUBMED to the journal. +++++++++++++++++++++++++++++++++++++++ J Clin Endocrinol Metab. 2007 May 29; [Epub ahead of print] Maternal vitamin D deficiency increases the risk of preeclampsia. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.; Magee-Womens Research Institute, Pittsburgh, Pennsylvania.; Vitamin D Laboratory, Section of Endocrinology, Nutrition and Diabetes, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. Context: Vitamin D has direct influence on molecular pathways proposed to be important in the pathogenesis of preeclampsia, yet the vitamin D-preeclampsia relation has not been studied. Objectives: We aimed to assess the effect of maternal 25-hydroxyvitamin D [25(OH)D] concentration on the risk of preeclampsia and to assess the vitamin D status of newborns of preeclamptic mothers. Design: Nested case-control study of pregnant women followed from <16 weeks gestation to delivery (1997-2001). Setting: Prenatal clinics and private practices. Patients: Nulliparous pregnant women with singleton pregnancies who developed preeclampsia (n=55) or did not develop preeclampsia (n=219). Women's banked sera was newly measured for 25(OH)D. Main Outcome Measure: Preeclampsia (new-onset gestational hypertension and proteinuria for the first time after 20 weeks gestation). Our hypotheses were formulated before data collection. Results: Adjusted serum 25(OH)D concentrations in early pregnancy were lower in women who subsequently developed preeclampsia compared with controls (geometric mean (95% CI): 45.4 (38.6, 53.4) nmol/l versus 53.1 (47.1, 59.9), p<0.01). There was a monotonic dose-response relation between serum 25(OH)D concentrations at <22 weeks and risk of preeclampsia. After confounder adjustment, a 50-nmol/l decline in 25(OH)D concentration doubled the risk of preeclampsia (adjusted OR (95% CI): 2.4 (1.1, 5.4)). Newborns of preeclamptic mothers were twice as likely as control newborns to have 25(OH)D <37.5 nmol/l (adjusted OR (95% CI): 2.2 (1.2, 4.1)). Conclusions: Maternal vitamin D deficiency may be an independent risk factor for preeclampsia. Vitamin D supplementation in early pregnancy should be explored for preventing preeclampsia and promoting neonatal well-being. PMID: 17535985 [Pubmed - as supplied by publisher] On 22 Jun, 09:26, betaine_...@yahoo.com wrote: > I've some mixed emotions on this piece of research. > As the research resulted in comparing the frankly [quoted text clipped - 5 lines] > ng/dL multiple the numbers in the abstract > by 0.4 to convert nmol/L to ng/dL. Those wondering what the lowest level is at which all the bodies systems can operate freely without restriction from lack of Vitamin d the answer is in this paper. Circulating Vitamin D3 and 25-hydroxyvitamin D in Humans: An Important Tool to Define Adequate Nutritional Vitamin D Status http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17218096 To achieve this 100nmol/L level remember it takes one 400iu Vitamin D3 supplement daily to raise status by between 8-12nmol/L On Jun 22, 5:56 am, "swabyma...@googlemail.com" <swabyma...@googlemail.com> wrote: > To achieve this 100nmol/L level remember it takes one 400iu Vitamin D3 > supplement daily to raise status by between 8-12nmol/L Where on earth do you get that from? One should not need as much as 5000 IU per day to reach optimal levels. I went from almost 0 nmol/L to about 115 nmol/L taking less than 2000 IU per day. I was around 200 lbs at the time too. > On Jun 22, 5:56 am, "swabyma...@googlemail.com" > [quoted text clipped - 6 lines] > to about 115 nmol/L taking less than 2000 IU per day. I was around 200 > lbs at the time too. It would depend on your input from sunlight. Those living above Lat 37 don't have the benefit of UVB generated Vit D from October to March http://www.ajcn.org/cgi/content/full/85/3/649 The urgent need to recommend an intake of vitamin D that is effective was my source for the 400iu to raise 8-12nmol/l comment. The rest is basic maths. Bear in mind NO OBSERVABLE ADVERSE EVENTS occur under 10,000iu/d Risk assessment for vitamin D http://www.ajcn.org/cgi/content/full/85/1/6 So in order to be on the safe side, the side which enjoys a 77% lower cancer incidence and 70% lower cold/flu occurance and lower stroke risk, you better err on the side of caution and that means optimal status of 125nmol/L. this also may be a helpful link for readers of this topic. http://www.cmaj.ca/cgi/content/full/174/9/1287 Nutritional vitamin D status during pregnancy: reasons for concern On Jun 23, 4:39 am, "swabyma...@googlemail.com" <swabyma...@googlemail.com> wrote: > > On Jun 22, 5:56 am, "swabyma...@googlemail.com" > [quoted text clipped - 21 lines] > this also may be a helpful link for readers of this topic.http://www.cmaj.ca/cgi/content/full/174/9/1287 > Nutritional vitamin D status during pregnancy: reasons for concern Well this does not quite jive with me. I went from almost zero to 115 in less than 8 weeks in February. I live well above the 37th and obviously at 2 nmol/L I was not getting any sun. According to your math I should have gone from 2 to 40 in those 8 weeks. Your equation seems to be off by about 300%. Once again, I got no sun...just took between 1200 and 1600 IUs a day on average over 8 weeks. In one month I was alrady at 54 nmol/L. Third test after 8 weeks like I said I was at 115 nmol/L. So this leads me to believe that taking between 5000 IU and 10000 IU a day might even be harmful for some people. You maybe one of the exceptions. On the other hand, your supplement may contain more vitamin D than listed on the label. I can assure you that some fortified foods vary wildly as to their added vitamin content. And I left wondering how good your kidneys are. Perhaps the kidneys are a bottleneck in vitamin D metabolism due to reduced function? Are you on any meds? > On Jun 23, 4:39 am, "swabyma...@googlemail.com" > <swabyma...@googlemail.com> wrote: [quoted text clipped - 34 lines] > at 115 nmol/L. So this leads me to believe that taking between 5000 IU > and 10000 IU a day might even be harmful for some people. On Jun 24, 2:57 am, betaine_...@yahoo.com wrote: > You maybe one of the exceptions. > On the other hand, your supplement may [quoted text clipped - 4 lines] > in vitamin D metabolism due to reduced function? > Are you on any meds? My supplement was dry 400 IU "Nature's Way" from Walgreens and then a couple weeks later was TwinLabs 400 IU Allergy Caps Dry Vitamin D for the rest of my 8 week dosage period. The measured levels rose from 2 nmol/L to 50 nmol/L and finally 115 nmol/L quite evenly. Due to my previous 2nmol/L and my total avoidance of fortified foods I doubt thats where the excess came from. I did chug down quite a bit of Cod Liver oil, but that is supposed to be quite accurately controlled as well as far as D3 levels go so its a puzzle to me. I am not on any meds at all but every now and then after I binge eat on junk food I suffer from swollen feet(perhaps kidney or diabetes related) but even if my kidneys themselves are out of order in some way it doesn't mean all functions are compromised such as 25[OHD3]-- >1,25[OHD3] conversion does it? I did get a battery of tests done on all three test occasions and my Kidney Panel(BUN etc) and Liver panel came out "normal" almost always. Only LDL cholesterol was high and my blood's coagulation ability was a bit borderline(I started chugging down Vitamin K1 to try and take care of that). I don't know what to think. Perhaps me being chronically and acutely deficient for years and perhaps decades my Kidneys' or Liver's ability to deal with Vitamin D just "went to sleep" and has not fully woken up yet...or I might have developed the ability(like nocturnal mammals) to make 1,25[OHD3] directly out of cholesterol without needing UVB rays as a catalyst. Well anyway since the last couple of weeks I have been chugging down 2400 IU of D3 each day and in another month or two I will get another battery of tests done. Its sad that so few places give reliable 1,25[OHD3] tests because that would have been nice too since it measures true hormone levels, not the precursor. > On Jun 23, 4:39 am, "swabyma...@googlemail.com" > [quoted text clipped - 37 lines] > > - Show quoted text - You have to understand that on average most people only utitlise about a quarter of the Vitamin D they make from sunshine. It appears that your body is more economical, more efficient at dealing with Vitamin D3 than the majority of the population. There clearly is a difference as most people with dark skins have a lower Vitamin d status than those with white skins because they need five to ten times the exposure to make the same amount, However although they are overrepresented in those conditions which thrive in low Vitamin d scenarios they seem to cope better than might be expected so the figures aren't quite as bad as one might expect. Another variable that we haven't discussed is the accuracy of the test used, Many read higher than they should and some labs are better at doing the tests than others. http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343&e=6950&& is a conference for medics. I think it was Glenville Jones session that was discussing testing but I may be wrong. On Jun 24, 5:42 am, "swabyma...@googlemail.com" <swabyma...@googlemail.com> wrote: > > - Show quoted text - > [quoted text clipped - 13 lines] > is a conference for medics. I think it was Glenville Jones session > that was discussing testing but I may be wrong. Ok that does make some sense. My body may have been starved of Vitamin D for so many years that it just got used to operating on next to no D. I am somewhat lactose intolerant and stick to yogurt(unfortified) and kefir(not consumed daily or even weekly even though it is fortifed) and "eat healthy" meaning not eating D fortified cereals and bread(ouch). Well add all that together and there is practically zero Vitamin D in my diet considering I did not used to take multivitamins either(I do now religiously). Living in the northern US and being somewhat dark skinned would block out even more Vitamin D especially by February when I got tested. Perhaps its similar to a calorie starved person who eats so little he becomes emaciated and when you put him on a regular 2000 calorie diet it takes months for some flesh to grow back because the body just doesn't know what to do with the nutrients for a while. I may also have developed the ability over the years and decades(like nocturnal mammals) to make 1,25[OHD3] directly out of cholesterol without needing UVB rays as a catalyst. I might also be on the verge of kidney failure as betaine postulated which would mean my kidneys cannot handle all the D thrown at them. Only thing to suggest chronic renal failure is occasional swollen feet and random bouts of thirst that have to be quenched accompanied by slightly excessive urination on some days. But judging by my kidney panel tests all seems to be fine. The last couple of weeks I have been taking 2400 IU of D3 per day and in a few more weeks I will get another bunch of tests to see how things look. Sadly its very hard and expensive to get an accurate 1,25[OHD] test so thats one that I will continue to skip. On Jun 27, 9:44 pm, Ice Man <iceman458...@yahoo.com> ........snip........ > Sadly its very hard and expensive to get an accurate > 1,25[OHD] test so thats one that I will continue to skip.- Hide quoted text - > > - Show quoted text - The test you need is a 25-hydroxyvitamin D test (25(OH)D test) This is the test that measures the amount of calcidiol circulating in the blood. The most accurate measure of the amount of vitamin D in the body. One of the sessions here http://app2.capitalreach.com/esp1204/servlet/tc?cn=asbmr&c=10169&s=20343&e=6950&& Discussed testing Vitamin D status. I think it was Glenville Jones but as I've almost run out of my broadband monthly entitlement I'll have to wait to 1st July to check. On Jun 28, 2:58 am, "swabyma...@googlemail.com" <swabyma...@googlemail.com> wrote: > On Jun 27, 9:44 pm, Ice Man <iceman458...@yahoo.com> > ........snip........> Sadly its very hard and expensive to get an accurate [quoted text clipped - 11 lines] > I think it was Glenville Jones but as I've almost run out of my > broadband monthly entitlement I'll have to wait to 1st July to check. I have not looked at those video sessions yet but I can tell you something I myself found out about Vitamin D. Firstly Calcidiol is just an indication of nutritional intake of Vitamin D3. As far as I know it is basically just an inert substance. The really potent beast however is Calcitriol or 1,25[OHD3]. Calcitriol is the active hormone, Calcidol is just the raw material. In nocturnal mammals(and I suspect some if not most humans) the body has the ability to manufacture Calcidol directly from cholesterol without the use of UVB rays. Anyway thats going off on a tangent. As far as the 25[OHD] test that you were mentioning I have had that taken 3 times because it is a very common and reliable test. Another very important test is the 1,25[OHD] test which measures the ACTIVE level of the vitamin D hormone. It is the level of 1,25[OHD] and not the level of 25[OHD] which really establishes if you are acutely or chronically deficient or not, the 25[OHD] levels just establish how much Vitamin D is present in your diet. So I was saying it would have been nice if I had both the 25[OHD] and 1,25[OHD] levels to analyze together to see which were out of optimum range. The result's not that surprising. The VDR is an input into regulatory T-cells and it's been demonstrated in other papers that hypofunctional Tregs increase the risk of preeclampsia - in other words, the condition is a type of autoimmune rejection. Treg transplants in mice cure the condition. Women having sex without condoms a year before conception have the lowest risk. Each sex act is an "innoculation." The cervix picks up the father's DNA and trains the mother's immune system over time to build a tolerance to it so the baby won't be rejected. Since the cervix has special immunoprivilege for this purpose, it's particularly vulnerable to HPV infection and cancerous mutations. (The vagina is also adapted to pick up various hormones in ejaculate like testosterone; women using condoms are more likely to be depressed because they're blocking T transfer.) I'm willing to bet that other inputs/outputs on Tregs can affect preeclampsia risk. In general, risk should go up with COX-2 inhibitors (NSAIDs can also affect formation of sexual identity/response in the fetus), TGF-beta inhibitors (curcumin, ellagic acid, silymarin), mTOR activators (arginine, leucine - although effects from fasting are generally dangerous and might override any mTOR input into Tregs), caffeine maybe (through NEP and VIP effects), theophylline maybe (HDAC activation). Risk should drop with TNF-alpha inhibitors, mTOR inhibition (see above), carnitine, butyrate (and other HDAC inhibitors), PGE2, androgens, estrogens, maybe DHEA and definitely helminths and probiotics. Of course, some of these benefits may be counterbalanced by birth defects (HDAC inhibitors, for example, are problematic). Androgens and estrogens also have complex effects on non-Treg T-cells so they may be a wash. I haven't checked the literature. Similarly, pre-existing autoimmune conditions like M.S. can go into remission during pregnancy - possibly from the boost in Treg numbers, although other factors have been cited. I would expect any condition marking a deficiency in Tregs would indicate a raised risk (e.g., allergies, rheumatism, history of type I diabetes).
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