Video: Nutrition for a Healthy Pregnancy Part 2 with Dr. Gregory Ward
Dr. Gregory Ward explores nutrition research that points to the benefits of docosahexaenoic acid (DHA) omega-3.
By: Elizabeth Somer, MA, RD
February 20, 2017
What if every pregnant woman – and every woman even considering pregnancy – could stack the deck in favor of her unborn child never having a neurological disorder? That may be possible, according to a recent study published in the scientific journal, Neurology, which found that babies born with adequate blood levels of vitamin D had a low risk of developing multiple sclerosis (MS). MS is a debilitating disease that can affect the brain, spinal cord and optic nerves found in the eyes.[1]
In this study, blood samples taken at birth were compared to MS risk later in life. Newborns with levels of vitamin D less than 30 nmol/L were considered deficient in the vitamin, while babies born with levels higher than or equal to 50 nmol/L were considered adequate. Results showed that babies born with vitamin D blood levels in the deficient range were at the highest risk, while those born with levels in the adequate to optimal range had a 47 percent reduced risk of developing MS as adults. As vitamin D levels increased, risk decreased.[2]
This is not the first study to find that vitamin D is critical for protecting the developing baby from later risk of MS. Other studies also have found that low vitamin D levels in women during pregnancy result in up to a two-fold increased risk for MS in their children.[3,4] At first, researchers looked at MS risk based on when a baby was born, since early studies had found people who developed MS were most likely born in early Spring after extended low winter levels of sunshine. The body manufactures vitamin D when skin is exposed frequently to sunshine – no sunshine, no vitamin D.[5] It became increasingly clear that vitamin D deficiency was the connecting link between lack of sunshine exposure and MS.[6,7,8,9,10,11]
For years vitamin D was thought only to improve bone health. Now it is clear that the vitamin’s role in maintaining health is considerably more widespread, including a role in helping regulate nervous system development and function. It makes sense that a deficiency of vitamin D would affect MS risk, since MS is a chronic inflammatory disease of the central nervous system. Low vitamin D means a baby’s developing nerves and brain may not have this important building block. Less than perfect tissue may develop as a result. Other neurological conditions that might have a link to poor vitamin D status include memory loss, autism and schizophrenia.[12,13,14,15,16,17] There also is preliminary evidence that other pregnancy problems might be associated with poor vitamin D intake, including spontaneous abortion, preterm birth, preeclampsia and small-for-gestational-age birth.[18,19,20,21,22,23,24,25,26]
This link between diet and disease would not be newsworthy if vitamin D deficiency was rare. The opposite is true. Suboptimal vitamin D status is very common throughout the world, averaging a third to half of all healthy people, and topping out at 100 percent of subjects in some studies.[27,28,29,30] Almost 70 percent of postpartum women and their babies are low in vitamin D.[31,32,33,34,35,36,37]
Why is vitamin D deficiency so prevalent? Sun exposure has traditionally been the way people obtained vitamin D, but today we are inside more and when outside, we cut our risk for skin cancer by using sunscreen, which prevents UV light from reaching the skin.[38] In addition, there are few dietary sources of the vitamin, other than egg yolk, liver, and fortified milk or orange juice. Even then, it is near impossible to meet the adult requirement of at least 600IUs a day from food alone. For example, a cup of milk supplies 100IUs. Who drinks six glasses of milk every day? To add insult to injury, there is evidence this recommended intake is inadequate to achieve optimal vitamin D status for many women.[39]
Supplements are a must. Pregnant and breastfeeding women who take supplements containing vitamin D are the ones most likely to maintain optimal blood levels and give birth to babies with the same.[40,41,42 The researchers of this recent study showing vitamin D lowers MS risk conclude that, “…the high prevalence of [low vitamin D status] among pregnant women and the fact that increasing maternal vitamin D levels is likely to reduce the mother’s risk of MS as well as her offspring’s provides a rationale for universal vitamin D supplementation in pregnancy.”[43]
1. Nielsen N, Munger K, Koch-Henriksen, et at: Neonatal vitamin D status and risk of multiple sclerosis. Neurology 2016; November 30th.
2. Nielsen N, Munger K, Koch-Henriksen, et at: Neonatal vitamin D status and risk of multiple sclerosis. Neurology 2016; November 30th.
3. Munger K, Aivo J, Hongell K, et al: Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish Maternity Cohort. JAMA Neurology 2016; 73:515-519.
4. Mirzaei F, Michels K, Munger K, et al: Gestational vitamin D and the risk of multiple sclerosis in offspring. Annals of Neurology 2011;70:30-40.
5. Munger K, Aivo J, Hongell K, et al: Vitamin D status during pregnancy and risk of multiple sclerosis in offspring of women in the Finnish Maternity Cohort. JAMA Neurology 2016; 73:515-519.
6. Mirzaei F, Michels K, Munger K, et al: Gestational vitamin D and the risk of multiple sclerosis in offspring. Annals of Neurology 2011;70:30-40.
7. Dobson R, Giovannoni G, Ramagopalan S: The month of birth effect in multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry 2013;84:427-432.
8. Grytten N, Torkildsen A, Aarseth J, et al: Month of birth as a latitude-dependent risk factor for multiple sclerosis in Norway. Multiple Sclerosis 2013;19:1028-1034.
9. Torkildsen O, Grytten N, Aarseth J, et al: Month of birth as a risk factor for multiple sclerosis. Acta Neurologica Scandinavica Supplementum 2012; (195):58-62.
10. Becker J, Callegaro D, Lana-Peixoto M, et al: Season of birth as a risk factor for multiple sclerosis in Brazil. Journal of Neurological Sciences 2013;329:6-10.
11. Sotirchos E, Bhargava P, Eckstein C, et al: Safety and immunologic effect of high- vs low-dose cholecalciferol in multiple sclerosis. Neurology 2015;December 30th.
12. Schlogl M, Holick M: Vitamin D and neurocognitive function. Clinical Interventions in Aging 2014;9:559-568.
13. Wrzosek M, Kukaszkiewicz J, Wrzosek M, et al: Vitamin D and the central nervous system. Pharmacology Report 2013;65:271-278.
14. Hossein-Nezhad A, Holick M: Vitamin D for health: A global perspective. Mayo Clinic Proceedings 2013; 88:720-755.
15. Pet M, Brouwer-Brolsma E: The impact of maternal vitamin D status on offspring brain development and function. Advances in Nutrition 2016;7:665-678.
16. Chen J, Xin K, Wei J, et al: Lower maternal serum 25(OH)D I first trimester associated with higher autism risk in Chinese offspring. Journal of Psychosomatic Research 2016;89:98-101.
17. Bischoff-Ferrari H: Optimal serum 25-hydroxyvitamin D levels for multiple health outcomes. Advances in Experimental Medicine and Biology 2008;624:55-71.
18. Kiely M, Zhang J, Kinsella M, et al: Vitamin D status is associated with uteroplacental dysfunction indicated by pre-eclampsia and small for gestational age birth in a large prospective pregnancy cohort in Ireland with low vitamin D status. American Journal of Clinical Nutrition 2016;104:354-361.
19. Hou W, Yan X, Bai C, et al: Decreased serum vitamin D levels in early spontaneous pregnancy loss. European Journal of Clinical Nutrition 2016;70:1004-1008.
20. Qin L, Lu F, Yang S, et al: Does maternal vitamin D deficiency increase the risk of preterm birth. Nutrients 2016;May 20th :8(5)
21. Agarwal S, Kovilam O, Agrawal D: Vitamin D and its impact on maternal-fetal outcomes in pregnancy. Critical Reviews in Food Science and Nutrition 2016;August 24th.
22. Karras S, Fakhoury H, Muscogiuri G, et al: Maternal vitamin D levels during pregnancy and neonatal health. Therapeutic Advances in Musculoskeletal Disease 2016;8:124-135.
23. Gould J, Anderson A, Yelland L, et al: Association of cord blood vitamin D with early childhood growth and neurodevelopment. Journal of Paediatrics and Child Health 2016;August 27th.
24. Yayla C, Kurek M, Turan I, et al: Association between maternal circulating 25 hydroxyvitamin D concentration and placental volume in the first trimester. Journal of Maternal and Fetal Neonatal Medicine 2016;December 6th:1-22.
25. Baca K, Simhan H, Platt R, et al: Low maternal 25-hydroxyvitamin D concentration increases the risk of severe and mild preeclampsia. Annals of Epidemiology 2016; 26:853-857.
26. Miliku K, Vinkhuyzen A, Blanken L, et al: Maternal vitamin D concentrations during pregnancy, fetal growth patterns, and risks of adverse birth outcomes. American Journal of Clinical Nutrition 2016;103:1514-1522.
27. Holick M: High prevalence of vitamin D inadequacy and implications for health. Mayo Clinical Proceedings 2006;81:353-373.
28. Lee J, O’Keefe J, Bell D, et al: Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? Journal of the American College of Cardiology 2008;52:1949-1956.
29. Dong Y, Pollock N, Stallmann-Jorgensen I, et al: Low 25-hydroxyvitamin D levels in adolescents. Pediatrics 2010;125:1104-1111.
30. Marshall I, Mehta R, Ayers C, et al: Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome. BMC Pediatrics 2016;16 (1):208.
31. Holick M: High prevalence of vitamin D inadequacy and implications for health. Mayo Clinical Proceedings 2006;81:353-373.
32. Holick M: Sunlight, UV-radiation, vitamin D and skin cancer. Advances in Experimental Medicine and Biology 2008;624:1-15.
33. Lee J, O’Keefe J, Bell D, et al: Vitamin D deficiency an important, common, and easily treatable cardiovascular risk factor? Journal of the American College of Cardiology 2008;52:1949-1956.
34. Dong Y, Pollock N, Stallmann-Jorgensen I, et al: Low 25-hydroxyvitamin D levels in adolescents. Pediatrics 2010;125:1104-1111.
35. Marshall I, Mehta R, Ayers C, et al: Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome. BMC Pediatrics 2016;16 (1):208.
36. Vinkhuyzen A, Eyles D, Burne T, et al: Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods. Journal of Steroid Biochemistry Molecular Biology 2015;September 15th.
37. Saraf R, Morton S, Camargo C, et al: Global summary of maternal and newborn vitamin D status. Maternal and Child Nutrition 2016;12:647-668.
38. Naeem Z: Vitamin D deficiency: An ignored epidemic. International Journal of Health Sciences 2010;January:4(1):V-VI.
39. Aghajafari F, Field C, Kaplan B, et al: The current recommended vitamin D intake guideline for diet and supplements during pregnancy is not adequate to achieve vitamin D sufficiency for most pregnant women. PLoS One 2016;11:e0157262.
40. Thiele D, Ralph J, El-Masri M, et al: Vitamin D3 supplementation during pregnancy and lactation improves vitamin D status of the mother-infant dyad. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2016; November 10th.
41. Salameh K, Al-Janahi N, Reedy A, et al: Prevalence and risk factors for low vitamin D status among breastfeeding mother-infant dyads in an environment with abundant sunshine. International Journal of Women’s Health 2016;8:529-535.
42. Merewood A, Mehta S, Grossman X, et al: Vitamin D status among 4-month-old infants in New England. Journal of Human Lactation 2012;28:159-166.
43. Nielsen N, Munger K, Koch-Henriksen, et at: Neonatal vitamin D status and risk of multiple sclerosis. Neurology 2016; November 30th.
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