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Pregnant women should consume more vitamin D

admin — Wed, 23 Nov 2011 12:00:24 +0000

Pregnant women could, and should, consume more vitamin D than experts currently recommend, according to a new study.

"Pregnant women need to take at least 1,000iu of vitamin D a day," says Dr Bruce Hollis

Current guidelines for daily vitamin D intake during pregnancy range from 200 international units (IU) per day to 400iu. For decades, doctors have worried that too much vitamin D during pregnancy could harm the mother and baby but growing research is proving pregnant women require more and not less sun.

The vast majority of our knowledge of the impact and importance of vitamin D has come from research within the last decade. Vitamin D is not only essential during pregnancy, research now states that supplementing with 1,000iu daily or more may actually reduce the risk of complications (1). A baby is born with around 50-60% of the Mother’s vitamin D levels (2). If the Mother is deficient then so will the baby. It has been proven that babies born in Spring have a higher propensity for illness than those born in Autumn, the reason being the Mother’s exposure, or lack of it, to sunlight.

A well referenced study looked at women in their second trimester and beyond. In the study, 500 women who were at least 12 weeks pregnant took either 400iu, 1,000iu, or 4,000iu of vitamin D per day. The women who took 1,000iu and 4,000iu were least likely to go into labour early, give birth prematurely, or develop infections.

“Pregnant women need to take at least 1,000iu of vitamin D a day,” says Dr Bruce Hollis, Director of paediatric nutritional sciences at the Medical University of South Carolina and one of the authors of the study. “The ideal would be 4,000iu. In the higher dosage groups we didn’t see a single adverse effect. It was absolutely safe, and we saw a lot of improved outcomes. The risk of preterm labour was vastly decreased and so was the risk of other complications of pregnancy.”

Taking supplements is the only practical way to consume that much vitamin D as to rely on food as a way of ensuring our daily amount is simply not feasible for our modern diets and lifestyles. A glass of milk delivers around 5iu, two eggs will give you 40iu and a portion of cheese around 50iu. Wild salmon is a good source providing around 500iu within a decent portion. However if the salmon is from a farmed source that quantity reduces dramatically to around 100iu!

Exposure to direct and unprotected sunlight is the most effective way of achieving our required levels but this is proving difficult as our modern lives keep us inside for longer periods of time. Add to this the fact that the UK is one of the cloudiest countries in the industrialised world. What we fail to remember is that our bodies only begin to store vitamin D at a blood level of 40ng/ml. The average blood level in Britain during Summer months is only 32ng/ml with Winter averaging on 19ng/ml! (4, 5)

“There are no risks,” Hollis adds, “as the conventional wisdom about the dangers of too much vitamin D was manufactured and based on flawed data”. “There was never any real harm, just misconceptions.”

Michael F. Holick, M.D., a professor of medicine, physiology, and biophysics at the Boston University School of Medicine, has maintained for years that getting too little vitamin D is worse than getting too much. Although doctors have been taught that vitamin D is toxic in large amounts, he says, vitamin D intoxication is extremely rare and easy to treat. The levels of vitamin D recommended in the study are sensible, Holick says. Previous research suggests that pregnant women who get too little vitamin D are more likely to develop high blood pressure and muscle cramping, he says. “Giving 4,000 IU a day to pregnant women not only doesn’t cause toxicity, but may improve birth outcomes,” Holick says. “The risks of vitamin D during pregnancy are overblown and the benefits are understated.” (5)

Prompted by the recent flood of research on vitamin D deficiency, the Institute of Medicine, an independent organization that advises the U.S. Government on health matters, is now considering whether to raise its guidelines for vitamin D intake, including those for pregnant women (currently 200iu per day) and the maximum safe daily dose (currently at 2,000iu). The new guidelines are expected to be announced in 2012/13.

Written by Andrew Thomas from BetterYou

References
1, 5: Randomized comparison of the effects of the vitamin D3 adequate intake verus 100mcg (4,000iu) per day on biochemical responses and the wellbeing of patients. R Vieth, S Kimball, A Hu, PG Walfish. July 2004.

2: Sunlight Robbery – Health benefits of sunlight are denied by current public health policy in the UK. Oliver Gillie. A report presented at The House of Commons, November 2005.

3: Assessment of dietary vitamin D requirements during pregnancy and lactation. BW Hollis, CL Wagner, Medical University of South Carolina, American Journal of Clinical Nutrition, May 2004.

4: Zittermann, A., Scheld, K., and Stehle, P., Seasonal variations in vitamin D status and calcium absorption influence bone turnover in young women. European Journal of Clinical Nutrition, 1998. 52: p501-506.

5: Sunlight Robbery. Oliver Gillie, Health Research Forum, 2004.

Iron Supplementation During Pregnancy Could Prevent Complications

admin — Wed, 16 Nov 2011 09:00:07 +0000

Anaemia occurs when haemoglobin levels fall below the lower safe limits. This is often more common in pregnancy due to the higher demands that the growing foetus puts on the body. The leading cause of anaemia is iron-deficiency which generally results in symptoms such as weakness, fatigue and light-headedness. This happens because iron is a compulsory mineral for transporting oxygen around the body through the blood to tissues as well as being used for enzymes that produce energy. Therefore if the body is deficient, these essential processes will decline and the symptoms will become apparent in the sufferer.

Iron supplementation during pregnancy could prevent anaemia induced pregnancy complications and newborn abnormalities.

Eating foods containing iron can help this deficit. Eating the following foods can help to increase your iron uptake: Sun dried tomatoes, sunflower seeds, dried apricots, foods from the bean family, tofu, raisins, whole wheat bread and of course, spinach in addition to meats including chicken, turkey and beef.

Females’ iron stores are often already limited due to their monthly menstrual blood losses (which in rare cases may also be present in pregnancy) and, during pregnancy, the body attempts to compensate for the increases in blood quantity caused by the growth of the unborn child. Therefore although the overall nutritional needs of the mother increase significantly in pregnancy, iron needs can surpass other nutrient requirements during this time. The average pregnant woman needs approximately twice as much iron as she would normally require (about 30mg a day) (1), and it is when this need is not met that pregnancy induced iron-deficiency anaemia occurs.

A recently published study (2) investigated the efficacy of iron supplementation in anaemic pregnant women based on incidences of pregnancy complications and birth outcomes. The authors did this by comparing incidences of problems in pregnancy and the outcome of the birth with iron deficiency and iron supplementation in those who gave birth to malformed newborns or healthy babies. The study published in the journal Nutrition in 2011, used medically recorded data from the population based Hungarian Case Control Surveillance System of Congenital Abnormalities, which is a set of information about birthing outcomes. Of the 22,843 cases with abnormalities, a significant 16% had mothers with anaemia.

Early diagnosed anaemic pregnant women who were not supplemented with iron had shorter delivery ages and significantly higher premature births, however this was not found in those who had been supplemented with iron. The authors found a 0.4 week shorter mean gestational age in anaemic women without iron supplementation than those with iron supplementation and preterm births were also lower with iron treatment. The incidence of complications in pregnancy was higher for anaemic mothers, and iron treatment was also found to reduce severe nausea and vomiting. The authors also found that the improvements in complications and birthing outcomes were greater in those that had supplemented with both iron and folic acid together.

Based on these findings, if you are pregnant or are planning on becoming pregnant, you may want to consider supplementing your diet with both iron and folic acid. However, you must always consult your GP or Health Practitioner before embarking on any new supplement regimen.

Written by Lauren Foster

References

(1) Miller, R.S. (2011) Nutritional needs during pregnancy. Nursing Made Incredibly Easy, 9, 5, 21–24.

(2) Banhidy,F., Acs, N, Puho, E.H., Czaizel, A.E. (2011) Iron Deficiency Anaemia: Pregnancy Outcomes With or Without Supplementation. Nutrition, 27, 1, 65-72.

The sunshine vitamin: Vitamin D and healthy immunity

admin — Tue, 19 Jul 2011 12:00:02 +0000

New research supports the link between vitamin D and a healthy immune system. The recent study of almost 7,000 adults in the UK has confirmed a link between Vitamin D levels and the risk of infection (1).

New research supports the link between vitamin D and a healthy immune system. (5)

Natural sunshine can provide our bodies with up to 10,000iu vitamin D each day. This ‘sunshine vitamin’ helps to boost the body’s defences by increasing levels of ‘anti-microbial peptides’. Working like natural antibiotics, these peptides mount an attack against unwanted infections.

During the winter months, infections such as colds, flu and chest infections are common. It is believed that this increased risk of infection is due in part to the lower levels of vitamin D that we receive in the colder months.

There is however increasing concern over vitamin D levels throughout the year. After all, most of us are careful to protect our skin from the sun during the summer months, a sensible measure to help prevent burning, premature skin ageing and to protect against skin cancer.
The study, conducted by researchers from University College London, looked at the relationship between Vitamin D levels and infection. Higher levels of vitamin D were linked with lower risk of infection.

For each 10nmol/l (4ng/ml) increase in vitamin D, the risk of infection dropped by 7 per cent. The researchers discovered a further link between higher vitamin D levels and better lung function.

While this particular study was epidemiological in nature, it will be interesting to see how future controlled trials will further our understanding. After all, vitamin D not only supports the immune system and bone health. More recently, deficiency has been linked with cardiovascular disease, impaired glucose tolerance, poor muscle development and certain types of cancer (2). The Department of Health now recommends that certain groups in the UK population should take daily vitamin D supplements (3). These groups are:

• all children aged six months to five years old
• all pregnant and breastfeeding women
• all people aged 65 and over
• people who are not exposed to much sun, such as those who are confined indoors for long periods

BioCare’s BioMulsion D provides 2000iu vitamin D in just two drops

• people with darker skins such as people of African-Caribbean and South Asian origin

While vitamin D can be obtained in the diet through oily fish such as salmon and sardines, it is generally believed that supplementation is the most viable way of ensuring adequate intake. A recent European policy document concludes that “only vitamin D supplements or vitamin D enriched food products are truly viable options for optimising the vitamin D status” (4).

Bolstering your vitamin D levels can be as simple as spending some time outdoors every day, while ensuring that you eat vitamin D enriched foods such as breakfast cereals, milk, margarine and soy drinks. Those who would like to take an easily absorbed supplement might consider an emulsified liquid vitamin D such as Biocare’s BioMulsion D which provides 2000iu vitamin D in just two drops.

Written by Nadia Mason

References:

1. Berry DJ, et al. Vitamin D status has a linear association with seasonal infections and lung function in British adults. British Journal of Nutrition. Available on CJO June 2011 doi:10.1017/S0007114511001991

2. Vieth R, Bischoff-Ferrari H, Boucher BJ, Dawson-Hughes B, Garland CF, Heaney RP, Holick MF, Hollis BW, Lamberg-Allardt C, McGrath JJ, Norman AW, Scragg R, Whiting SJ, Willett WC, Zittermann A. The urgent need to recommend an intake of vitamin D that is effective. Am J Clin Nutr 2007;85:649–50.

3. NHS Choices. “Vitamins and Minerals – Vitamin D”. Web article. Visited on 30th June 2011.

4. The Standing Committee of European Doctors. Vitamin D Nutritional Policy in Europe. March 2010. Visited on 30th June 2011.

5. Image Ccourtesy of digitalart.

Study links folic acid supplementation and DNA changes in newborn babies

AniKowal — Mon, 24 Jan 2011 05:00:13 +0000

A new groundbreaking study (1) conducted by a UK team of research scientists has linked changes in the DNA of newborn babies, folic acid supplementation during pregnancy and birth weight. This study was conducted at Keele and Nottingham Universities together with doctors at University Hospital of North Staffordshire and Derby Children’s Hospital and was funded by the World Cancer Research Fund (WCRF).

I have previously written about the importance of folic acid during pregnancy for the prevention of neural tube defects, low birth weight and congenital heart defects. This new study (1) showed that the levels of a critical metabolite of folic acid, homocysteine, in the blood of newborn babies is linked to modifications of their DNA (DNA methylation) in key genes and that such modifications might be used to predict birth weight (2).

To recap on homocysteine: homocysteine is produced when the amino acid (the building blocks of protein) methionine is broken down in the body. Normal levels of homocysteine are important to help build and maintain body tissues, however elevated concentrations in the blood can be harmful and have been associated with an increased risk of heart disease and other disorders. At normal levels homocystein can be converted in the body into a harmless substance called cystanthionine. The conversion of homocysteine into this harmless substance depends upon various B vitamins (B6, B12 and folic acid). Having good levels of these B vitamins appears to be a very good way of preventing high homocysteine levels and low levels of B vitamins have been associated with raised homocysteine levels.

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects such as spina bifida. It also protects against low birth weight, which has numerous short- and long-term consequences. It has been suggested that folic acid, though its metabolism to chemicals such as homocysteine, might secure these clinical effects via DNA methylation (2). In this study the researchers examined the relationship between folic acid supplementation and its metabolites on DNA methylation in human blood from the umbilical cord, using a state-of-the-art ‘microarray’ techniques which simultaneously examines methylation at 27,578 sites in the DNA.

In a press release, Professor Farrell, lead study scientist said: “It has been known for many years that folic acid supplementation is essential for women during pregnancy to reduce the risk of neural tube defects and low birth weight delivery. However, we had little idea as to how this worked. This study is the first to suggest that methylation of particular genes in the baby’s DNA may be the key to unlocking the secret of the action of folic acid”. “Now we have identified which genes might be the link between folic acid and birth weight, we have opened the door to research that may allow doctors to predict the likelihood of low birth weight with greater certainty. Furthermore, it sheds light on the underlying causes of low birth weight and offers the potential to intervene earlier to prevent poor pregnancy outcomes such as premature delivery and pregnancy loss.”

The work being done by this group of scientists illustrates the potential of DNA methylation ‘microarray’ technology to identify a new generation of clinical markers that will have a major impact, not only on the development of new therapeutic agents, but also on the way we manage a wide range of medical scenarios (1,2)

Supplementation with folic acid during pregnancy is known to reduce the risk of neural tube defects and low birth weight. Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age. The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant. At this early stage of pregnancy this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida.

If you are planning pregnancy or a woman of childbearing age who could fall pregnant it is certainly worth taking a multi-nutrient supplement which contains folic acid. Specific supplements are available for pregnant women and those planning pregnancy and it is always a good idea to check with your doctor or midwife before starting supplementation. Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.

(1) Fryer AA et al. 2011. Quantitative, high-resolution epigenetic profiling of CpG loci identifies associations with cord blood plasma homocysteine and birth weight in humans. Epigenetics. 6(1). [Epub ahead of print]

(2)Press release. Keele University. Posted 2^nd December 2010. Folic acid supplementation in pregnancy, DNA methylation and birth weight in newborn babies. http://www.keele.ac.uk/pressreleases/2010/title,34358,en.php

Written by Ani Kowal

High intakes of vegetables and fruits before pregnancy shown to reduce the risk of babies being born undernourished

AniKowal — Wed, 17 Nov 2010 05:00:40 +0000

A new study (1) has found that eating a healthy diet, rich in vegetables and fruits, before and during pregnancy is associated with a reduced risk for babies being born “small for gestational age” or undernourished. The time before pregnancy, and during pregnancy, is a time where eating healthily is crucial. Making healthful food choices can impact both mother and baby.

The study (1) included women involved in the SCOPE “Screening for Pregnancy Endpoints” study. This study comprises a large database of women from New Zealand, Australia, Manchester, London and Cork and aims to develop screening tests for pre-eclampsia, ‘small for gestational age’ infants and spontaneous preterm births.

In this particular part of the research study (1) the scientists looked at mothers who had infants that were small for gestational age. They divided the women into those who had normal blood pressure and those who had high blood pressure in late pregnancy. 3513 women were involved, various measurements were taken of the foetus and information was collected about the mother including her own birthweight, her gynaecological history, socio-economic status, smoking history, alcohol consumption and diet.

Scientists discovered that a woman’s diet prior to becoming pregnant had a strong impact on the risk of babies being born ‘small for gestational age’ in women with normal blood pressure. Specifically it was found that women who consumed a high intake of green leafy vegetables (defined as three or more portions of vegetables a day) were found to have a 50% reduction in ‘small for gestational age’ babies. Women consuming low amounts of fruit (defined as less than one portion a week) had a 50% increase in ‘small for gestational age’ babies (1,2). It was also found that women who had a high intake of oily fish (at least 3 servings per week) had a 60% reduction in ‘small for gestational age’ babies.

Cigarette smoking at 15 weeks which was associated with a 30-60% increase in risk of small for gestational age babies for every five cigarettes smoked per day.

Professor Lesley McCowan, one of the study authors, said in a press release (2) “These findings emphasise the influence of pre-pregnancy diet on the baby’s growth and are important as a number of the identified risk factors are amenable to public health interventions.” It is thought that the nutrients found in vegetables and fruits, and the omega 3 fats found in oily fish, could be protective to the pregnant mother and her developing foetus. However, this study is only an association study so it could be that women who consume a healthy diet also leady generally healthier lifestyles.

Professor McCowan also stated (2) “SGA [small for gestational age] infants are more likely to be stillborn, to have complications in the newborn period and in later life. Less than one third of these at-risk babies are identified before birth in current antenatal practice. Improved identification of these vulnerable infants, by screening early in pregnancy, therefore has the potential to reduce stillbirths and complications in the newborn period”. “In the SCOPE study, our findings show that the risk factors for the majority group of SGA infants with mothers with normal blood pressure included: low fruit intake (less than weekly) in the three months before pregnancy, cigarette smoking, increasing maternal age, daily vigorous (high intensity) exercise, being a tertiary student, and the pregnant woman being born with a low birthweight herself. Eating green leafy vegetables three or more times daily in the three months before pregnancy reduced the risk by 50% as did having a Rhesus negative blood group. Risk factors for SGA infants in mothers with high blood pressure included conception by in vitro fertilisation and previous early pregnancy loss”.

Professor Philip Steer editor of the journal in which the study is being published said (2)”The importance of taking up and maintaining a healthy lifestyle before and during pregnancy has repeatedly been shown, however we live in an era of fast and convenience foods which are attractive but bad for our health if eaten too often and to the exclusion of healthier options. This study emphasises the importance of good diet and nutrition. Unfortunately, many people find it difficult to resist the temptations of ‘junk’ food”. He added “If more women can be persuaded to have a better diet during pregnancy, using the motivation of optimising their baby’s health, then as they are commonly in charge of the family diet, we could improve the health of the whole population. The take-home message is: Fewer take-aways, more fresh fruit and vegetables.”

The important message is that women can make a difference to the outcome of their pregnancies. Being motivated enough to change diet and lifestyle habits can really impact the health of mother and child. Changes need not be drastic, working to include more vegetables and fruits into the daily diet and aiming to perhaps walk an extra 20minutes a day can have a positive influence on health. These foundations can gradually be built upon. Maintaining these healthful lifestyles long-term is important so realistic goals need to be set.

(1)McCowan L et al. 2010. Risk factors for small-for-gestational-age infants by customised birthweight centiles: data from an international prospective cohort study. BJOG. Article first published online: 6 OCT 2010 | DOI: 10.1111/j.1471-0528.2010.02737.x

(2)Press release. 06/10/10. Fresh Fruits And Vegetables Consumed For Three Months Before Pregnancy Reduce Chances Of Baby Being Born Undernourished. http://www.bjog.org/details/news/858729/Fresh_fruits_and_vegetables_consumed_in_the_three_months_before_pregnancy_reduce.html

Written by Ani Kowal

Low vitamin D levels linked to preeclampsia

AniKowal — Mon, 06 Sep 2010 05:00:36 +0000

New evidence (1) suggests that vitamin D may be important in preeclampsia. Preeclampsia is a serious condition also known as: pregnancy-induced hypertension (PIH); proteinuric gestational hypertension; and toxaemia of pregnancy. It is a form of high blood pressure (hypertension) that develops in conjunction with water retention (oedema) and/or excess protein in the urine (proteinuria).

Around 3% of all pregnant women suffer from preeclampsia each year and this condition is the principal cause of maternal death in the UK. Around 10 mothers and 1000 babies die each year as a result of the effects of preeclampsia and the condition is also the most common reason for elective (often early) delivery. Usually preeclampsia occurs between the 20th week of Pregnancy and the end of the first week postpartum. The earlier it presents in pregnancy the more threatening it can become

Previously I have written about how a healthy diet and certain vitamins and minerals, including vitamin D, may be linked to prevention of preeclampsia. I have also written about vitamin D and pregnancy

This research (1) investigated blood plasma levels of vitamin D at the time of diagnosis of early-onset severe preeclampsia. The study involved 50 women with early-onset severe preeclampsia and 100 healthy women who acted as ‘control’ comparison subjects. The results showed that women with early-onset severe preeclampsia had decreased total blood plasma vitamin D levels when compared to the healthy control subjects. The difference in vitamin D levels remained statistically significant even after the researchers controlled for potential confounding subjects. Vitamin D levels were an average of 18ng/mL in the women with preeclampsia compared to 32ng/ML in the control group of women.

This study shows a potential association between low levels of vitamin D and an increased risk of preeclampsia, however the study does not prove that low levels of vitamin D cause preeclampsia. The authors of the study conclude that “Further study is needed to understand the impact of vitamin D deficiency on pregnancy outcomes”. The findings add to the recent research, accumulated over the last 3 years, which has highlighted the importance of vitamin D for health

The study did not investigate why vitamin D might act to prevent preeclampsia or why low levels were associated with the condition. The link could exist for a number of reasons. Vitamin D acts as a hormone in the body and there is some indication from laboratory studies that it could affect the placenta. Further research would be needed to investigate the links between vitamin D and preeclampsia risk.

There is debate over what constitutes an adequate level of vitamin D in the blood. But many experts say that at least 40 ng/mL is needed for overall health. It is also not known what daily intake of vitamin D is needed to achieve optimal blood levels. As mentioned in previous posts many experts advocate a minimum of 2000iu Vitamin D daily but as yet there are no official recommendations. Most individuals in the UK are probably not getting enough vitamin D, if you are concerned please check with your medical doctor prior to taking a vitamin D supplement.

(1) Robinson CJ et al. 2010. Plasma 25-hydroxyvitamin D levels in early-onset severe preeclampsia. Presented at the 30th Annual Meeting of the Society for Maternal-Fetal Medicine, Chicago,IL, Feb. 1-6, 2010. American Journal of Obstetrics & Gynecology.203. doi:10.1016/j.ajog.2010.06.036

Written by Ani Kowal

Probiotics in pregnancy may reduce the risk of eczema in children

AniKowal — Mon, 16 Aug 2010 05:00:53 +0000

Previous evidence has suggested that probiotics (‘friendly’ gut bacteria) given to pregnant women at risk of having children with atopic dermatitis (a type of eczema), and then their infants, seems to reduce the incidence of eczema in the children. A recently published study in the British Journal of Dermatology (1) took place to examine whether probiotic supplements given to non-select pregnant women (not just those at risk of having a child with eczema) could prevent eczema in the child’s first two years.

In the study (1) women received a probiotic milk or placebo (milk which did not contain probiotics) from 36 weeks of pregnancy to three months postnatally during breastfeeding (all the mothers breastfed their children). The probiotic milk contained the probiotic strains Lactobacillus rhamnosus GG, Lactobacillus acidophilus La-5 and Bifidobacterium animalis subsp. lactis Bb-12. Children with an itchy rash for more than four weeks were assessed for eczema. After two years of age, all the children were assessed for various conditions such as atopic dermatitis, asthma and allergic rhinoconjunctivitis. The results showed that children of the women who drank the probiotic milk during and after their pregnancy had a 40% reduced incidence of eczema.

“The results showed that probiotic bacteria reduced the incidence of eczema in children up to age two years by 40 percent. And the kids in ‘probiotics group’ who did have eczema, had less severe cases,” explains Christian Kvikne Dotterud, a student in the Medical Student Research Programme at the Department of Community Medicine at NTNU (2).

The study was conducted by researchers at the Norwegian University of Science and Technology (NTNU), Norwegian University of Science and Technology, it is part of a larger research project at the university called the Prevention of Allergy Among Children in Trondheim, or PACT, an ongoing population-based intervention study in Norway focused on childhood allergy (2).

One of the study researchers said (2) “Our study is the first to show that certain probiotic bacteria given to the mother during pregnancy and breast-feeding prevents eczema,”. Previous studies have shown that probiotics taken by pregnant mothers and then by their children may prevent eczema, but this is the first study to show a preventative effect when the mother alone consumed the probiotics. It is thought that the probiotic bacteria, taken by the mothers, affects the composition of breast milk in a positive way.

The researchers of this study used a variety of strains of probiotics. In the press release they say “There is reason to believe that it is beneficial for your health to consume a variety of bacterial strains with documented efficacy, rather than unilateral influence of only one bacterial strain”. One of the strains of bacteria used in the probiotic milk drink was LGG ®, (Lactobacillus rhamnosus GG) which is currently the probiotic bacteria that are most extensively studied and researched in terms of human health in the world. It has been shown that LGG ® contributes to good gut function and a stronger defense against unwanted bacteria and viruses in the stomach. At present there are more than 500 published articles on LGG ® in international journals and more than 30 doctoral theses have been completed on LGG’s ® effect on health. More than 40 countries in different parts of the world market products with LGG ® (2). The probiotic milk also a contained a strain of Bifidobacteria, which have also been used in numerous research studies.

Evidence is continually accumulating for the use of probiotics (and prebiotics) for health. It is important to talk to your doctor or midwife before beginning any supplement regimen during pregnancy or when breastfeeding.

(1) C. K. Dotterud CK et al. 2010. Probiotics in pregnant women to prevent allergic disease: a randomised, double-blind trial. British Journal of Dermatology E-Pub prior to print. 10.1111/j.1365-2133.2010.09889.x

(2)Press release. Norwegian University of Science and Technology. http://www.ntnu.edu/probiotic-use-in-pregnancy

Written by Ani Kowal

Another study links sunshine, vitamin D and multiple sclerosis risk

AniKowal — Mon, 28 Jun 2010 05:00:38 +0000

In February I wrote about low vitamin D levels and the risk of relapse in multiple sclerosis patients, I also mentioned a study which linked season of birth to risk for the development of multiple sclerosis. A study recently published in the British Medical Journal (1) indicates that sunlight exposure, possibly linking to vitamin D, during pregnancy might impact the risk of multiple sclerosis in the child.

Multiple sclerosis is the most common disabling neurological condition affecting young adults. Around 100,000 people in the UK have multiple sclerosis. For more information about the condition please visit the MS society website. The MS Society is the UK’s largest charity for people affected by multiple sclerosis. Multiple sclerosis is the result of damage to myelin, a protective sheath surrounding nerve fibres of the central nervous system. When myelin is damaged, this interferes with messages between the brain and other parts of the body. Multiple sclerosis, often called MS, is categorised as a type of autoimmune disorder where the body’s own defence system breaks down the protective myelin around nerve fibres.

This recent Australian study (1) found that children whose mothers had low sunlight exposure during their first three months of pregnancy might have a higher risk of developing multiple sclerosis later in life. The authors of the study postulate that the risk is linked to low vitamin D levels which have previously been linked to a higher risk of MS development. It is thought that low vitamin D, due to lack of sunlight exposure, might be having an effect on the developing foetus’s immune system or central nervous system and hence increasing the risk of it developing MS later in life. There was about a 30% higher risk of multiple sclerosis in those who were born in the early summer months when their mothers would have had lower sunlight exposure during early pregnancy (the first trimester).

“Higher exposure to ultraviolet radiation (sunlight), higher vitaminD intake, and also higher serum vitamin D concentrationsseemto be associated with a reduced risk of onset of multiple sclerosis.This evidence comes from various studiesand indicates that age of operation for such a protective effectmight include both childhood and early adulthood. Pregnancy is a vulnerable time for vitamin D deficiency becauseof increased physiological needs and reduced maternal outdooractivity. Although human evidence pertaining to foetal development hasbeen difficult to obtain, the body of related evidence to datehas led some to recommend antenatal supplementation with vitaminD to prevent multiple sclerosis” (1).

Vitamin D may be particularly important for the development of the foetus’s central nervous system. The authors write (1) “Vitamin D supplementation for the prevention of multiple sclerosis might also need to be considered during in utero development“. The findings are supported by previous studies which also found more cases of MS among people whose mothers probably had little exposure to sunlight in their first trimester of pregnancy. The researchers of this study conclude “Region of birth and low maternal exposure to ultravioletradiation in the first trimester are independently associatedwith subsequent risk of multiple sclerosis in offspring in Australia” (1).

The study is important and interesting but ultimately it is only an association study and does not directly examine vitamin D status of foetus or mother. Further work is necessary to look deeper at the associations and the potential for vitamin D supplementation in pregnancy and beyond. The authors of this study (1) do write about the potential use of vitamin D supplementation in pregnancy, childhood and adolescence as a means of preventing auto-immune diseases including multiple sclerosis and I look forward to seeing further work in this area.

Vitamin D has been heavily researched over the last 3 years and exciting results have been found with regards many conditions from cancer to heart disease, for more information please visit my past posts on Vitamin D. Recently I also wrote about a group of researchers who recommend vitamin D supplementation in pregnancy, to read this piece pleace click here. What is known, as mentioned in my previous posts, is that many people in the UK do not get enough vitamin D and have insufficient/deficient blood levels. There is no current consensus about the amount of daily vitamin D intake necessary to maintain blood levels at around 40-50nmol/l (which is currently seen as optimal by many medical practitioners). There is some suggestion that most adult (age 18 and over) individuals in the UK would require a supplement of around 2000iu vitamin D daily. Higher doses (up to 5000iu daily) may well be useful but I would not recommend such a regimen unless under the supervision of a medical doctor who can monitor blood levels regularly. Pregnant women should not take any nutritional supplements without checking with their GP and/or midwife first.

(1) Judith Staples J et al. 2010. Low maternal exposure to ultraviolet radiation in pregnancy, month of birth, and risk of multiple sclerosis in offspring: longitudinal analysis. BMJ. 340:c1640 doi:10.1136/bmj.c1640

Written by Ani Kowal

A group of researchers recommend vitamin D supplementation in pregnancy

AniKowal — Mon, 07 Jun 2010 05:00:10 +0000

A press release published on the website of the American Academy of Pediatrics (1) details a randomised controlled study (2,3) presented at the Pediatric Academic Societies annual meeting in Canada which found that “Taking vitamin D supplements during pregnancy is not only safe for mother and baby, but also can prevent preterm labor/births and infections” (1)

There was concern 50-60 years ago that vitamin D could cause birth defects in unborn children but the authors of the current research (2,3) emphasise that vitamin D is crucial for maternal and infant health. Vitamin D can impact bone health and immune health amongst other things. Readers of this blog will be aware that over the last two years plentiful research has been published about the health benefits of vitamin D and also worrying evidence that many of us are not getting enough of this vitamin for optimal health. The press release (1) talks about the recent studies which indicate that vitamin D deficiency during pregnancy is a serious public health issue. The lead author, Dr Wagner, the study says (1) “Diet doesn’t provide enough vitamin D, and we don’t go in the sun as much as we need”

In order to investigate vitamin D in pregnancy the researchers looked to determine the optimal dose of vitamin D supplements for pregnant women (2,3). Almost 500 pregnant women were involved in the study, they were between 12-16 weeks into their pregnancy and were split into three groups. One group received 500iu of vitamin D daily until delivery, the second group received 2,000iu daily and the third group received 4,000iu vitamin D daily until the time of delivery. All of the women were regularly evaluated to ensure there were no adverse effects. Dr Wagner stated (1)“No adverse events related to vitamin D dosing were found in any of the three arms of the study”. “VitD supplementation of 4,000 IU vitD/day for pregnant women was safe and effective in achieving vitD sufficiency. We recommend this daily regimen for all pregnant women”(2).

The researchers were also keen to investigate the effects of vitamin D supplementation on pregnancy complications such as preeclampsia, gestational diabetes, infections, preterm labour and birth. The researchers write (3) that establishing what the optimal vitamin D requirements of pregnant women are is vital in preventing vitamin D deficiency and the health problems associated with that. The objective of the study was to evaluate the effectiveness of vitamin D supplementation in decreasing pregnancy risks. Dr Wagner was happy to report (1) “The spectacular part of the study was it showed women replete in vitamin D had lower rates of preterm labor and preterm birth, and lower rates of infection,” The greatest positive effects were seen among women taking 4,000 IU of vitamin D per day and the researchers recommend this daily regimen for all pregnant women in their reports (2,3).

As mentioned in my previous posts on vitamin D there has, frustratingly, been no consensus over what the best does of vitamin D supplement is and what level of vitamin D in the blood is considered optimal for health. Many researchers suggest that a vitamin D blood level of around 45ng/mL is considered optimal. In this research (3) the scientists used a benchmark of 40ng/mL as being sufficient to protect against pregnancy complications and suggest that 4,000iu daily vitamin D supplement is necessary to obtain those blood levels.

Although these researchers are keen to recommend 4000 IU/day of vitamin D for all pregnant women it is vital that women NEVER self-prescribe supplements during pregnancy or when planning pregnancy. If you are pregnant or planning to become pregnant please visit your GP or speak to your midwife about vitamin D supplementation. A simple blood test can determine the level of vitamin D in your blood. If this is below 40ng/mL you can talk to your doctor about vitamin D supplementation to increase your levels of this important nutrient.

(1)Press release. American Academy of pediatrics. http://www.aap.org/advocacy/releases/PAS2010/pregnant.htm. For release: Saturday, May 1, 2010. RESEARCHERS RECOMMEND PREGNANT WOMEN TAKE 4,000 IU VITAMIN D A DAY

(2) Wagner CL et al. [2630.7] Vitamin D Supplementation during Pregnancy Part I NICHD/CTSA Randomized Clinical Trial (RCT): Safety Considerations Sunday, May 2, 2010. http://www.abstracts2view.com/pas/view.php?nu=PAS10L1_2450&terms Platform Session: CTSA Supported Pediatric Clinical Translational Research (1:00 PM – 3:00 PM)

(3)Wagner CL et al. Saturday, May 1, 2010. [1665.6] Vitamin D Supplementation during Pregnancy Part 2 NICHD/CTSA Randomized Clinical Trial (RCT): Outcomes http://www.abstracts2view.com/pas/view.php?nu=PAS10L1_2481&terms Platform Session: Neonatal Fetal Nutrition & Metabolism I (2:45 PM – 4:45 PM)

Written by Ani Kowal

Another benefit of folic acid during early pregnancy

admin — Wed, 13 Jan 2010 18:40:51 +0000

Folic acid is gaining quite a lot of attention, in 2009 I mentioned it with regards the prevention of birth defects, prevention of premature births, low birth weights and also ADHD. Recently a study (1) has also found that folic acid use pre-pregnancy and in early pregnancy is associated with a reduced risk of congenital heart defects (heart abnormality present from birth) in newborns.

The study scientists(1) looked at over 600 mothers who had delivered infants with heart defects (but without any genetic or related abnormalities). These were compared to a ‘control’ group. Folic acid use was associated with a reduced risk of congenital heart disease in infants “Use of periconceptional folic acid supplements (of at least 400micrograms a day) was related to approximately 20% reduction in the prevalence of any CHD. Given the relatively high prevalence of CHD worldwide, our findings are important for public health” (1)

The authors note that the findings could be very significant since heart related birth defects can be quite common occurring in up to 2 newborns in every 100 worldwide. When results were further broken down to look at specific heart defects it was found that women taking folic acid supplements had almost a 40% lower risk of having a child with a heart defect involving the septum, a part of the heart which separates one side of the heart from the other, compared to that of the general population (1). This is a preliminary study but certainly deserves attention. Further research would be necessary before any firm conclusions could be drawn

Folic acid supplements have long been recommended for all pregnant women, women planning on becoming pregnant and also women of childbearing age. The reason for this recommendation is that folic acid is crucial for optimal foetal development very early in pregnancy, at a time when many women do not realise they are even pregnant. At this early stage this nutrient of the B-vitamin group is known to prevent neural tube (brain and spinal cord) birth defects such as spina bifida.

Foods particularly rich in folate include leafy vegetables such as spinach, asparagus, turnip greens, lettuces, dried or fresh beans and peas, fortified cereal products, sunflower seeds, yeast extract, liver and liver products.

(1) van Beynum IM et al. 2009. Protective effect of periconceptional folic acid supplements on the risk of congenital heart defects: a registry-based case-control study in the northern Netherlands. Eur Heart J. [Epub ahead of print]
Written by Ani kowal