Pharmacokinetics of High-Dose Weekly Oral Vitamin D3 Supplementation during the Third Trimester of Pregnancy in Dhaka, Bangladesh
Nutrients 2013, 5(3), 788-810; doi:10.3390/nu5030788
Daniel E. Roth 1,†,daniel.roth@sickkids.ca , Abdullah Al Mahmud 2 , Rubhana Raqib 2 , Evana Akhtar 2 , Robert E. Black 1 and Abdullah H. Baqui 1,2
1 Department of International Health, The Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
2 International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), GPO Box 128, Dhaka 1000, Bangladesh † Present Address: Division of Paediatric Medicine, The Hospital for Sick Children and University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
(This article belongs to the Special Issue Vitamin D and Human Health)
Vitamin D response
NH = not pregnant (much higher response to 35,000) solid line
PH = pregnant, higher dose (35,000 IU weekly)
PL = Pregnant and low (14,000 IU weekly)_ _ _ _ _ _ _ _
Note: Much faster response than most studies - perhaps because of weekly instead of daily dosing?
A pharmacokinetic study was conducted to assess the biochemical dose-response and tolerability of high-dose prenatal vitamin D3 supplementation in Dhaka, Bangladesh (23°N). Pregnant women at 27–30 weeks gestation (n = 28) were randomized to
- 70,000 IU once + 35,000 IU/week vitamin D3 (group PH: pregnant, higher dose) or
- 14,000 IU/week vitamin D3 (PL: pregnant, lower dose) until delivery.
A group of non-pregnant women (n = 16) was similarly administered 70,000 IU once + 35,000 IU/week for 10 weeks (NH: non-pregnant, higher-dose).
Rise (∆) in serum 25-hydroxyvitamin D concentration ([25(OH)D]) above baseline was the primary pharmacokinetic outcome.
Baseline mean [25(OH)D] were similar in PH and PL (35 nmol/L vs. 31 nmol/L, p = 0.34).
A dose-response effect was observed: ∆[25(OH)D] at modeled steady-state was 19 nmol/L (95% CI, 1 to 37) higher in PH vs. PL (p = 0.044). ∆[25(OH)D] at modeled steady-state was lower in PH versus NH but the difference was not significant (−15 nmol/L, 95% CI −34 to 5; p = 0.13). In PH, 100% attained [25(OH)D] ≥ 50 nmol/L and 90% attained [25(OH)D] ≥ 80 nmol/L; in PL, 89% attained [25(OH)D] ≥ 50 nmol/L but 56% attained [25(OH)D] ≥ 80 nmol/L. Cord [25(OH)D] (n = 23) was slightly higher in PH versus PL (117 nmol/L vs. 98 nmol/L; p = 0.07).
Vitamin D3 was well tolerated; there were no supplement-related serious adverse clinical events or hypercalcemia.
In summary, a regimen of an initial dose of 70,000 IU and 35,000 IU/week vitamin D3 in the third trimester of pregnancy was non-hypercalcemic and attained [25(OH)D] ≥ 80 nmol/L in virtually all mothers and newborns. Further research is required to establish the safety of high-dose vitamin D3 in pregnancy and to determine if supplement-induced [25(OH)D] elevations lead to maternal-infant health benefits.
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4. Discussion
This study demonstrated the biochemical dose response to third-trimester high-dose weekly antenatal vitamin D3 supplementation. Among Bangladeshi women with a mean [25(OH)D] of 33 nmol/L, 70,000 IU followed by 35,000 IU/week of vitamin D3 until delivery yielded an average [25(OH)D] that was about 20 nmol/L higher than an antenatal dose of 14,000 IU/week (the IOM vitamin D upper limit at the time the study was conducted). Similar to our conclusions from analyses of single-dose vitamin D3 pharmacokinetics in the same study setting (and involving an overlapping group of participants) [13], we found that the minor differences between pregnant vs. non-pregnant participants receiving the same dose were within the margins of error given the small sample size. However, based on the present analysis, we could not exclude the possibility of a slightly diminished 25(OH)D response to a weekly dose of vitamin D during the third trimester of pregnancy.
To our knowledge, the 35,000 IU/week regimen used in this study is the highest vitamin D3 maintenance dose studied in pregnancy under controlled conditions. Devlin et al. (1986) reported that a daily dose of 1000 IU vitamin D3 administered to 15 French women during the third trimester modestly raised mean maternal serum [25(OH)D] from 55 nmol/L to 65 nmol/L [20]. The largest published study of vitamin D3 supplementation in pregnancy was conducted by Bruce Hollis and colleagues in South Carolina, in which 502 pregnant women at 12 to 16 weeks gestation were randomized to 400 IU/day, 2000 IU/day, or 4000 IU/day vitamin D3 [21]. This population was more vitamin D-replete at baseline (mean [25(OH)D] = 60 nmol/L) compared to the present study. Based on data from the 350 participants (70%) followed until delivery, the 2000 IU/day and 4000 IU/day regimens raised [25(OH)D] to means of 105 nmol/L (rise of 47 nmol/L) and 119 nmol/L (rise of 60 nmol/L), respectively, at one month before delivery [21]. The A[25(OH)D] in the 2000 IU/day group in the Hollis study was similar to the response we observed in the 14,000 IU/day group (equivalent regimen) in the present study, substantiating the consistency of vitamin D3 dose-response modeling across diverse populations of pregnant women. In a separate trial in South Carolina, Wagner et al. reported comparatively less robust responses to 2000 IU/day and 4000 IU/day during pregnancy, which may have been attributable to non-adherence to the supplementation regimen [22].
The lower dose produced a more efficient 25(OH)D response per mcg of vitamin D3 when compared to the high-dose regimen: 0.73 vs. 0.46 nmol/L/mcg/day in the empiric estimates, and 0.90 versus 0.49 nmol/L/mcg/day based on the pharmacokinetic model. These estimates, as well as those from the non-pregnant cohort that received the higher-dose regimen (0.61 nmol/L/mcg/day based on 10th-week data, and 0.63 nmol/L/mcg/day based on the parametric model), were similar to the values conventionally cited for non-pregnant adults: ~0.70 nmol/L/mcg/day [23,24]. However, analyses by Barger-Lux et al. (1998) [25] and Aloia et al. (2008) [24], as well the recent IOM report (2010) [1], have demonstrated that the A[25(OH)D] per mcg is a curvilinear inverse function of vitamin D intake at doses <50 mcg/day, but nearly proportional to intake at >50 mcg/day [24], which may explain the greater observed efficiency of the lower dose.
A unique aspect of this study was the measurement of biochemical parameters between weekly doses at the end of the supplementation period. These data showed an absence of inter-dose perturbations in calcium homeostasis that might have otherwise been missed by sampling serum only at the time of the "trough" [25(OH)D] (i.e., immediately preceding administration of a weekly dose). Although the study may have been too small to detect minor inter-dose fluctuations in [25(OH)D], the data supported the appropriateness of administering weekly doses of 35,000 IU instead of daily administration of 5000 IU.
In pregnant participants, the higher-dose vitamin D regimen had a significant suppressive effect on maternal PTH secretion, relative to the lower dose, as indicated by the change in average PTH concentrations from baseline to delivery, similar to previous observations by Wagner et al. in South Carolina [22]. However, since the role of PTH as a vitamin D status biomarker during pregnancy is unclear [26], the clinical significance of the apparent dose-response effect of vitamin D on PTH requires further study.
Both the higher and lower vitamin D3 regimens administered to pregnant women attained fetal [25(OH)D] > 50 nmol/L. Therefore, in this small sample, we did not observe a clear benefit of the higher-dose over the lower-dose regimen with respect to neonatal vitamin D status. In a related study at the same study site, we observed a mean cord [25(OH)D] of 50 nmol/L (range of 29 to 80 nmol/L) in a group of neonates born to women who had received a single vitamin D3 dose of 70,000 IU at 30 weeks gestation [13], and previous studies in South Asia have found cord serum [25(OH)D] ranging from 17 to 59 nmol/L [27-30].
Appreciable increases in serum calcium in the higher-dose relative to the lower-dose group highlighted a dose-dependent effect of vitamin D3 supplementation on calcium homeostasis. We previously reported that mean serum calcium concentrations rose slightly but significantly during the first week after administration of a single 70,000 IU dose of vitamin D3 in both pregnant and non-pregnant participant groups [13]. However, in the present analyses of weekly-dose vitamin D3, a significant increase in serum [Ca] from baseline was only observed in pregnant women who received the higher dose. Pregnancy is associated with an elevation in the maternal serum concentration of the active vitamin D metabolite, 1,25-dihydroxyvitamin D (1,25(OH)2D) [31,32], which appears to be primarily attributable to classic renal 1a-hydroxylation of 25(OH)D [33]. However, placental trophoblasts and decidual cells [34] are capable of extra-renal 1a-hydroxylation which could theoretically predispose the pregnant woman to exaggerated physiological responses to increases in [25(OH)D] [9]. Similar to the participants who received only a single dose of 70,000 IU [13], maternal serum calcium values in the weekly-dose participants were all below the threshold for defining hypercalcemia used by the IOM in setting the 1997 dietary reference intakes (DRIs) for vitamin D (2.75 mmol/L) [35] and in the revised DRIs in 2010 (2.63 mmol/L) [1]. Cord blood calcium concentrations were also within reference limits, and [25(OH)D] were well below the range that has been associated with toxicity in adults [36] and older children [37]. Pregnancy and newborn clinical outcomes were within the expected range for the study population, but we were unable to draw conclusions from this study regarding clinical effects of vitamin D. Nonetheless, this study together with the recent findings of Hollis and Wagner and colleagues in South Carolina [21,22] demonstrate that vitamin D3 doses during pregnancy up to 25% above the current IOM UL of 4000 IU/day do not induce hypercalcemia, and have not led to any observed short-term clinical adverse effects.
There were several important limitations of this study. First, precision of estimates of pharmacokinetic parameters and between-group comparisons, as well as the generalizability of inferences regarding maternal-fetal safety of high-dose vitamin D supplementation, were limited by the small number of participants, stringent inclusion/exclusion criteria, and enrolment of pregnant and non-pregnant participants at one clinic site. Moreover, the lower-dose pregnancy group had less frequent blood sampling (a cost-savings measure given the relative lack of safety concerns for this group) and only 9 of 14 enrolled women contributed endpoint samples during the 10th week of supplementation. The supplementation period may not have been long enough to ensure that all participants reached a steady-state [25(OH)D]. Conclusions based on comparisons between pregnant and non-pregnant women were tempered by the differences in baseline characteristics, including season of enrolment and the relatively higher socioeconomic status of the non-pregnant participants. In addition, there were too few participants to consider modifiers of A[25(OH)D]. Most importantly, the present results do not yet provide sufficient evidence that the regimens studied are beneficial or safe for use in clinical or public health practice; rather, they serve to inform application of these dose regimens in future research studies.
5. Conclusions
This detailed analysis of the response to high-dose weekly vitamin D3 administered during the third-trimester of pregnancy demonstrated a dose-responsiveness to oral vitamin D3 in Bangladeshi women that echoed observations in other settings, and was generally in accordance with established pharmacokinetic characteristics of vitamin D3. Nonetheless, increases in the mean calcium concentration (within the normal range) and suppression of PTH secretion among pregnant women receiving the higher-dose regimen (70,000 IU initial dose followed by weekly doses of 35,000 IU) highlighted the physiological impact of the intervention and the need to cautiously address potential pregnancy-specific sensitivities to vitamin D supplementation.
Prior to undertaking large trials to test the effects of prenatal micronutrient interventions on pregnancy and birth outcomes, preliminary dose-finding and safety studies are essential, particularly when the intervention is a fat-soluble vitamin at a dose above the conventional upper limit of tolerability (i.e., 4000 IU/day for vitamin D, as established by the Institute of Medicine [1]). The most direct application of the present observations is to guide the design of future trials of vitamin D3 (at doses up to 35,000 IU per week) aimed at confirming safety and establishing the health benefits of antenatal vitamin D supplementation in South Asia, where many potentially vitamin D-responsive outcomes (e.g., infant growth and infectious disease morbidity) are major public health priorities. Following from our preliminary pharmacokinetic studies, we have conducted a placebo-controlled trial of 35,000 IU/ week during the third trimester (n = 160), with follow-up of infants to monitor growth to one year of age (NCT01126528). Future trials in Dhaka will address the dose-dependency of the effects of prenatal vitamin D supplementation on infant growth and morbidity.
See also VitaminDWiki
Overview Pregnancy and vitamin D has the following summary
IU | Cumulative Benefit | Blood level | Cofactors | Calcium | $*/month |
200 | Better bones for mom with 600 mg of Calcium | 6 ng/ml increase | Not needed | No effect | $0.10 |
400 | Less Rickets (but not zero with 400 IU) 3X less adolescent Schizophrenia Fewer child seizures | 20-30 ng/ml | Not needed | No effect | $0.20 |
2000 | 2X More likely to get pregnant naturally/IVF 2X Fewer dental problems with pregnancy 8X less diabetes 4X fewer C-sections (>37 ng) 4X less preeclampsia (40 ng vs 10 ng) 5X less child asthma 2X fewer language problems age 5 | 42 ng/ml | Desirable | < 750 mg | $1 |
4000 | 2X fewer pregnancy complications 2X fewer pre-term births | 49 ng/ml | Should have cofactors | < 750 mg | $3 |
6000 | Probable: larger benefits for above items Just enough D for breastfed infant More maternal and infant weight | Should have cofactors | < 750 mg | $4 |
Pregnancy category starts with
- see also
- Overview Pregnancy and vitamin D
- Number of articles in both categories of Pregnancy and:Dark Skin
30 ; Depression 21 ; Diabetes 44 ; Obesity 17 ; Hypertension 44 ; Breathing 35 ; Omega-3 44 ; Vitamin D Receptor 24 Click here for details - All items in category Infant/Child
854 items - Pregnancy needs at least 40 ng of vitamin D, achieved by at least 4,000 IU – Hollis Aug 2017
- 38+ papers with Breastfed etc, in the title
- Call to action – more Vitamin D for pregnancies, loading doses are OK – Holick Aug 2019
- 53+ preeclampsia studies
- 94+ studies with PRETERM in the title
- Fertility problem (PCOS) reduced by vitamin D, etc: many studies 15+
- 94+ Gestational Diabetes
- Caesarean birth much more likely if low Vitamin D - many studies 15+ studies
- Post-partum depression and low Vitamin D - many studies 15+ studies
- Stillbirth reduced by Vitamin D, Zinc, Omega-3 - several studies 5+ studies
- Search VitaminDWiki for "Assisted reproduction" 33 items as of Aug 2022
- Fertility and Sperm category listing has
142 items along with related searches - (Stunting OR “low birth weight” OR LBW) 1180 items as of June 2020
- Less labor pain if higher level of vitamin D – August 2021
- Healthy pregnancies need lots of vitamin D
- Ensure a healthy pregnancy and baby - take Vitamin D before conception
Healthy pregnancies need lots of vitamin D has the following summary
Most were taking 2,000 to 7,000 IU daily for >50% of pregnancy
Click on hyperlinks for detailsProblemVit. D
ReducesEvidence 0. Chance of not conceiving 3.4 times Observe 1. Miscarriage 2.5 times Observe 2. Pre-eclampsia 3.6 times RCT 3. Gestational Diabetes 3 times RCT 4. Good 2nd trimester sleep quality 3.5 times Observe 5. Premature birth 2 times RCT 6. C-section - unplanned 1.6 times Observe Stillbirth - OMEGA-3 4 times RCT - Omega-3 7. Depression AFTER pregnancy 1.4 times RCT 8. Small for Gestational Age 1.6 times meta-analysis 9. Infant height, weight, head size
within normal limitsRCT 10. Childhood Wheezing 1.3 times RCT 11. Additional child is Autistic 4 times Intervention 12.Young adult Multiple Sclerosis 1.9 times Observe 13. Preeclampsia in young adult 3.5 times RCT 14. Good motor skills @ age 3 1.4 times Observe 15. Childhood Mite allergy 5 times RCT 16. Childhood Respiratory Tract visits 2.5 times RCT RCT = Randomized Controlled Trial
The articles in Pregnancy AND Intervention are here:
- 3X reduction in preemie Bronchopulmonary Dysplasia if add tiny amount of Vitamin D – meta-analysis June 2024
- 4,000 IU of daily Vitamin D during pregnancy is good (Mongolia this time) – RCT Oct 2023
- Resulting childhood Asthma cut in half if 4,400 IU Vitamin D daily while pregnant - RCT April 2023
- 6,400 IU of Vitamin D is safe and effective during breastfeeding – RCT Dec, 2020
- Vitamin D during pregnancy – single 200,000 IU similar to daily 5,000 IU – April 2020
- Massive improvement in vaginal microbiome during pregnancy with Vitamin D – March 2019
- Autism risk reduced 2X by prenatal vitamins (Vitamin D or Folic) – Feb 2019
- Fetal bones helped a bit by 1,000 IU of vitamin D – RCT Feb 2019
- Adding 1,000 IU vitamin D while pregnant did not help much (no surprise) – RCT Jan 2019
- Pregnancies helped a lot by Vitamin D (injection then 50,000 IU monthly) – RCT May 2018
- 430 genes changed when 3,800 IU Vitamin D added in late second trimester – RCT May 2018
- 300,000 IU of Vitamin D is not enough during pregnancy – RCT May 2018
- Preeclampsia risk reduced 7X by 4,000 IU of Vitamin D daily – RCT March 2018
- Risk of infant Asthma cut in half if mother supplemented Vitamin D to get more than 30 ng – RCT Oct 2017
- Gestational diabetes 30 percent less likely if consumed more than 400 IU of vitamin D daily – Oct 2017
- Monthly 120,000 IU Vitamin D plus daily Calcium was great during pregnancies – RCT Sept 2017
- Preterm birth rate reduced by vitamin D – 78 percent if non-white, 39 percent if white – July 2017
- 1,000 IU of Vitamin D while pregnant helped a little bit (4,000 IU helps a lot) – RCT Dec 2016
- Preeclampsia recurrence reduced 2 X by 50,000 IU of vitamin D every two weeks – RCT July 2017
- Only a select group of women will get a modest benefit from 800 IU of vitamin D – Jan 2017
- Reduction of infant asthma may require good vitamin D when lung development starts (4 weeks) – March 2017
- Gestational diabetes treated by Vitamin D plus Omega-3 – RCT Feb 2017
- 3,800 IU Vitamin D during pregnancy did not help much – RCT Jan 2017
- 50,000 IU of vitamin D for 8 weeks of pregnancy raised most above 30 nanograms - RCT Jan 2017
- Gestational Diabetes reduce 3 times by 5,000 IU of Vitamin D – RCT Jan 2016
- Preeclampsia risk reduced by higher levels of vitamin D (VDAART 4,400 IU) - RCT Nov 2016
- Gestational Diabetes treated with 50,000 IU every two weeks – RCT Sept 2016
- Perinatal depression decreased 40 percent with just a few weeks of 2,000 IU of vitamin D – RCT Aug 2016
- Pregnancy – adding 35,000 IU Vitamin D weekly was nice, but not enough – RCT April 2016
- Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015
- Autism rate in siblings reduced 4X by vitamin D: 5,000 IU during pregnancy, 1,000 IU to infants – Feb 2016
- Preterm birth rate reduced 57 percent by Vitamin D – Nov 2015
- Pregnancy supplemented with 2,000 IU vitamin D got most infants to more than 12 nanograms – Aug 2015
- Preeclampsia reduced by Vitamin D (50,000 IU bi-weekly) and Calcium – Oct 2015
- Clinical trials for pregnancy with Vitamin D intervention – 51 as of Sept 2015
- No multiple sclerosis relapses during pregnancy if 50,000 IU of Vitamin D weekly – RCT April 2015
- Wheezing reduced 35 percent if vitamin D added during pregnancy – April 2015
- 4,000 IU raised vitamin D levels during pregnancy – July 2014
- Pregnant mothers in Quatar needed more than weekly 50,000 IU Vitamin D – Nov 2013
- Gestational diabetes – Vitamin D and Calcium provided huge benefits – RCT March 2015
- Pregnancy helped by single dose of 60,000 IU of Vitamin D – RCT March 2015
- Gestational diabetes reduced by just two 50,000 IU doses of vitamin D – RCT Nov 2014
- Improved births with 2,000 IU vitamin D during pregnancy in India - RCT Feb 2015
- 50,000 IU of Vitamin D every 2 weeks reduced gestational diabetes – RCT Feb 2015
- Infant much healthier if Gestational Diabetic mother got 2 doses of vitamin D – RCT Nov 2014
- 2000 IU vitamin D during pregnancy and 800 IU to infant resulted in less use of antibiotics – RCT April 2014
- Gestational Diabetes reduced with 50,000 IU of vitamin D every 3 weeks and daily Calcium – RCT June 2014
- Gestational Diabetes reduced 40 percent by 5,000 IU of vitamin D – RCT April 2014
- 5,000 IU Vitamin D was not enough to reduce preeclampsia but did help future infant – RCT April 2014
- Breast milk resulted in 20 ng of vitamin D for infant if mother had taken 5,000 IU daily – RCT Dec 2013
The articles in Pregnancy AND Meta-analysis are here:
- Pregnancy and offspring health - umbrella of 250,000 pregnancies - meta-analysis May 2024
- Vitamin D reduces: pre-eclampia 1.6 X, postpartum dep. 3.6 X, autism 1.5X etc. - meta-analysis March 2024
- Vitamin D supplementation decreased the risk of preeclampsia by 39% – meta-analysis Feb 2024
- Yet another reason to take Vitamin D while pregnant – fight COVID - meta-analysis May 2023
- Vitamin D during pregnancy increased child’s bone mineral density – meta-analysis April 2023
- Preeclampsia reduced by 33 percent if high vitamin D – meta-analysis Feb 2023
- Maternal pregnancy problems if Vitamin D is less than 40 ng – meta-analysis Oct 2022
- Worse COVID during 3Q pregnancy if 2.5 ng lower Vitamin D – meta-analysis Sept 2022
- Miscarriage 1.6 X more likely if low vitamin D – meta-analysis May 2022
- Recurrent Miscarriage 4X more likely if low vitamin D – meta-analysis June 2022
- Pregnancy problems (LBW, PTB, SGA) associated with low vitamin D, 42nd meta-analysis – March 2022
- Low Vitamin D associated with preeclampsia - meta-analysis Feb 2022
- Low Vitamin D associated with pre-eclampsia -40th meta-analysis – Feb 2022
- Small vitamin D doses while pregnant do not decrease infant allergies – meta-analysis Feb 2022
- Anemia 1.6 X more likely during pregnancy if low Vitamin D – meta-analysis Dec 2021
- Vitamin D reduces preeclampsia, gestational diabetes and hypertension - 38th meta-analysis Dec 2021
- Need at least 6,000 IU daily while breastfeeding to eliminate Vitamin D deficiency – meta-analysis Oct 2021
- Gestational diabetes risk reduced 1.5X by Vitamin D – meta-analysis March 2021
- Gestational Diabetes – increased risk if poor Vitamin D Receptor – 2 Meta-Analyses 2021
- Small vitamin D doses given during pregnancy do not reduce childhood asthma – meta-analysis Dec 2020
- Multiple Sclerosis 40 percent more likely if mother had low vitamin D – meta-analysis Jan 2020
- Pregnancies helped by Vitamin D (insulin and birth weight in this case) – meta-analysis Oct 2019
- Preeclampsia 2.7 X less likely if 50,000 IU of Vitamin D every 2 weeks – meta-analysis Sept 2019
- Autism risk increased 30 percent by Cesareans (both low vitamin D) – meta-analysis Sept 2019
- Vitamin D treats Gestational Diabetes, decreases hospitalization and newborn complications – meta-analysis March 2019
- Birth size and weight increased by Vitamin D – meta-analysis Feb 2019
- Pregnancies helped by Vitamin D in many ways – 27th meta-analysis Jan 2019
- Vitamin D supplementation reduced SGA, fetal mortality, infant mortality – JAMA Meta – May 2018
- Gestational Diabetes 39 percent more likely if insufficient Vitamin D – Meta-analysis March 2018
- Preeclampsia reduced 2X by Vitamin D, by 5X if also add Calcium – meta-analysis Oct 2017
- Preeclampsia risk reduced 60 percent if supplement with Vitamin D (they ignored dose size) – meta-analysis Sept 2017
- Small for gestational age is 1.6 X more likely if mother was vitamin D deficient – meta-analysis Aug 2017
- Miscarriage 2 times more likely if low vitamin D – meta-analysis May 2017
- Fewer than half of pregnancies will get even 20 ng of vitamin D with 800 IU daily dose – meta-analysis May 2017
- Low Vitamin D results in adverse pregnancy and birth outcomes – Wagner meta-analysis March 2017
- Bacterial vaginosis in pregnancy increased prematurity risk by 60 percent - meta-analysis 1999
- Preterm birth rate reduced by 43 percent with adequate Vitamin D supplementation – meta-analysis Feb 2017
- Vitamin D during pregnancy reduces risk of childhood asthma by 13 percent – meta-analysis Dec 2016
- Vitamin D helps during pregnancy – meta-analysis Feb 2016
- Preterm birth 30 percent more likely if low vitamin D – meta-analysis May 2016
- Preterm birth extended by 2 weeks with Omega-3 – Meta-analysis Nov 2015
- Gestational Diabetes Mellitus 1.5X more likely if low vitamin D – meta-analysis Oct 2015
- Infant wheezing 40 percent less likely if mother supplemented with vitamin D, vitamin E, or Zinc – meta-analysis Aug 2015
- Birth weight and length increased with high levels of vitamin D – meta-analysis March 2015
- Pregnancy and Vitamin D – meta-analysis April 2015
- More vitamin D needed during pregnancy – meta-analysis Oct 2014
- Preeclampsia rate cut in half by high level of vitamin D – meta-analysis March 2014
- Preeclampsia 2.7X more frequent if low vitamin D – meta-analysis Sept 2013
- 2X more preeclampsia when vitamin D less than 30 ng, etc. - meta-analysis March 2013
- 2X more likely to have preeclampsia if less than 20 ng of vitamin D – Meta-analysis Jan 2013
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