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Tuesday
Dec232008

Vitamin D & Cesarean Risk

Awhile ago, I began a dialogue regarding the seemingly important role of Vitamin D in a pregnant woman's diet and the lasting effects that impact her life as well as that of her newborn, including during the breastfeeding experience.

This week, a very small study looked at Vitamin D deficiency and the rate of cesareans in women who were deficient. It found that women who are deficient of Vitamin D are four times more likely to have a cesarean than women with normal levels.

In the study, the researchers said they felt women needed more Vitamin D than is routinely recommended, from 400 IUs to 1400 IUs a day. There are no standard guidelines for how much Vitamin D supplementation folks should take, but, as I said in the Vitamin D post, many experts believe we are being told to take far, far less than we should be ingesting.

I encourage you all to read as much as you can about the role fish oil, calcium and Vitamin D play in unison to bring women to a healthy labor and birth - the uterus working beautifully, on-time and producing a healthy baby that nurses great and maintains its own health as well as the mother retaining hers.

I really believe we know so, so little about Vitamin D - and, of course, with my foot being broken, Calcium, Vitamin D and fish oil are a crucial part of my diet. It seems it should be for all of us!

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Reader Comments (12)

Ethel... thanks for the heads-up... I saw the Google Alert right before your comment, so was defintely on my way to saying something on it. You nudged me faster! Thanks lots!

December 25, 2008 | Registered CommenterNavelgazing Midwife

Sure thing! It kind of reinforces my gut hunches anyway, now I need to spread the word with the gals around me - living where we do means a lot of vitamin D deficiency during the fall and winter. One small step to saving the world.... :P

December 25, 2008 | Unregistered CommenterEthel

Hi Barbara,

I've had muscle twitches in my hands and face for over a year, finally went to the doc and had my Vit D checked. It's vastly below the lowest 'accepted' threshold, AND I'm nursing too. My MIL works for an HMO as a lab manager of several clinics and one of the inservices someone did simultaneously with my situation was about Vit D and how low people in our area (WA) seem to be. Everyone got tested voluntarily and all but two people were deficient!

This reminds me I need to be taking my supplements... Thanks!

December 25, 2008 | Unregistered CommenterKristina

That's really interesting. I'd love to know more, but what are the chances of anyone throwing a lot of money at a study about the role of Vit.D and labor? Hmm. I guess it's not out of the question.

Mushrooms are a Vitamin D rich food, in case there were any pregnant ladies who could add that to their diet. ^__^ I'm addicted to portabellas, myself.

Hope your foot is better,
Leslie (birth advocate)

December 25, 2008 | Unregistered CommenterLady Leslie

What is the RDA for pregnant/nursing women, and how much of that can come from sun exposure? When I was pregnant with my daughter, I was outside a lot even in winter (NJ) because at the time I owned horses and spent quite a bit of time mucking stalls, filling water troughs and training my young horse. I don't think it takes a lot of time to synthesize Vit D from the sun, but I think I read somewhere that Vit D deficiency has gone up as use of sunscreen has increased.

December 28, 2008 | Unregistered CommenterJennifer B

There IS no RDA for Vitamin D because there isn't enough information (for the gov't) to establish an RDA. Therefore, there are Adequate Intake recommendations and there is no distinction for pregnant or nursing mothers. For women 19-50 years old, the AI is 200 IUs a day. Most specialists believe this is easily 10 times OR MORE too little to keep women healthy.

I choose to take 10,000 IU a day. I encourage my clients to take at least 1000 IUs a day, but believe they need at least 5000 IUs. I wanted to begin testing my clients, but the test is flippin' expensive! Barring testing, it is assumed that women are deficient because 65%-75% of Americans are thought to be deficient.

I encourage you to read the previous Vitamin D article I wrote - it will answer a lot of questions people have ("Can't you overdose from Vitamin D supplementation?"), including how much sun is vital to health, get.

The short version is: for white people, 20-30 min per day -in the summer- and 40-50 min per day in the winter. Above the middle of the United States, there aren't enough UVB rays, the ones necessary to make the Vitamin D. Plus, even though you worked with horses during the day, did you have your hands, arms and face with no sunscreen? The more nekkid the body, the better it can make Vitamin D from the sun. Some experts say hands, arms, face, chest and back, but most speak about the front of the body. If you were wearing long sleeves and gloves, you weren't getting enough.

Hope this helps!

December 28, 2008 | Registered CommenterNavelgazing Midwife

I recently spoke with a physician who made me a believer in vitamin d. He reminds of the movie "my Big Fat Greek Wedding" where the father thought Windex would take care of anything... This doctor's answer to any kind of ailment is to take vitamin d.... I have been taking 10,000 IU for about 3 months. Now I am noticing more charley horses and muscle cramps. I spoke with the doc again and he says vitamin d increases calcium and magnesium absorption. Calcium is readily available in our diets and magnesium not so much, so what can happen is you can get a calcium/magnesium imbalance. Too much calcium can cause muscle contraction/cramping and magnesium relaxes muscles.
His recommendation is take magnesium 200 mg twice a day. Any kind of magnesium except mag oxide. The body only absorbs about 4% of mag oxide. There are many different types of magnesium supplements but mag oxide is what is in most vitamins. One side effect of mag supplementation is loose stools. I actually got some magnesium citrate which is in the laxative isle at Walgreen's. After 3 days I haven't had any more charley horses. This doctor is an older family practitioner who used to deliver babies. He said that modern obstetrics has not been successful in finding preventive/cures/treatment for preeclampsia and preterm labor/birth since he stopped birthing babies 15 years ago. But both of these conditions respond to mag sulfate....Magnesium is nature's calcium channel blocker. It will be interesting to see where this may lead.
I really enjoyed reading your vitamin d research! Thank you!

December 28, 2008 | Unregistered CommenterSylvia

Oddly enough sun expose is no longer adequate. I think it is from all types of atmospheric changes that pollution caused. I know because I'm outdoors in the sun everyday, and I was recently told I have a vitamin D deficiency.

I do not wear sunblock or a hat. I live in NYC and walk in central park, outside in the sunshine for two hours everyday, seems as if outdoor sun exposure is not working anymore!

December 29, 2008 | Unregistered CommenterDewi

Were the results of this very small study statistically significant? And if so, were they clinically significant? Just wondering....

December 29, 2008 | Unregistered CommenterYehudit

It doesn't say in the article, it was with under 250 women, so I suspect not either one.

I pulled it out because of my own un-scientific hunch that Vitamin D is going to play as much a role in the health of pregnant and nursing women as folic acid does. Again, just a hunch.

December 29, 2008 | Registered CommenterNavelgazing Midwife

To flesh out your hunches, you might be interested to read the NICE antenatal care guidelines. The full guidelines can be downloaded here -> http://www.nice.org.uk/Guidance/CG62/Guidance/pdf/English

The section on vitamin D in pregnancy is pages 86-92, and reviews the research to date (the guidelines were published in 2008).

The NICE recommendations are as follows:

Recommendations on vitamin D supplementation

All women should be informed at the booking appointment about the importance for their own and their baby’s health of maintaining adequate vitamin D stores during pregnancy and whilst breastfeeding. In order to achieve this, women may choose to take 10 micrograms of vitamin D per day, as found in the Healthy Start multivitamin supplement [this is free to women on low incomes in the UK]. Particular care should be taken to enquire as to whether women at greatest risk are following advice to take this daily supplement. These include:
• women of South Asian, African, Caribbean or Middle Eastern family origin
• women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors
• women who eat a diet particularly low in vitamin D, such as women who consume no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal
• women with a pre-pregnancy body mass index above 30 kg/m².

Research recommendation
There is a need for research into the effectiveness of routine vitamin D supplementation for pregnant and breastfeeding women.

Why this is important

Although there is some evidence of benefit from vitamin D supplementation for pregnant women at risk of vitamin D deficiency, there is less evidence in the case of pregnant women currently regarded as being at low risk of deficiency. It is possible that there will be health gains resulting from vitamin D supplementation, but further evidence is required.

December 29, 2008 | Unregistered CommenterYehudit

No good evidence, and there probably never will be, but I've seen scuttlebutt that high dose fish oil may contribute to post-dates pregnancy. I'm four months post-Caesarean after going to 41w5d with minimal cervical changes (two days on Cervidil got me from not quite 1 cm to just over 1 cm before the amped up contractions started causing fetal heart rate abnormalities). I'd been taking the recommended dose of an algae-derived DHA/EPA supplement (I do eat meat, including fish, but there aren't enough fish in the sea for all of us to get all of our required long-chain omega-3's). I'm still taking it now, but next pregnancy, I'm discontinuing that stuff at 37 weeks and letting the kid suck the DHA out of my brain for a while instead.

December 31, 2008 | Unregistered CommenterJudy

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