Emergency Caesarean 2X more likely if less than 12 ng of Vitamin D – Aug 2020

Late Pregnancy Vitamin D Deficiency is Associated with Doubled Odds of Birth Asphyxia and Emergency Caesarean Section: A Prospective Cohort Study

Maternal and Child Health Journal (2020)
Hanna Augustin, Sinead Mulcahy, Inez Schoenmakers, Maria Bullarbo, Anna Glantz, Anna Winkvist & Linnea Bärebring

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Caesarean birth much more likely if low Vitamin D - many studies

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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 36; 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
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Problem	Vit. D Reduces	Evidence
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 limits		RCT
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

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Objectives
The aim of this prospective cohort study was to investigate the associations between maternal vitamin D status in late pregnancy and emergency caesarean section (EMCS) and birth asphyxia, in a population based sample of women in Sweden.

Methods
Pregnant women were recruited at the antenatal care in Sweden and 1832 women were included after exclusion of miscarriages, terminated pregnancies and missing data on vitamin D status. Mode of delivery was retrieved from medical records. EMCS was defined as caesarean section after onset of labour. Birth asphyxia was defined as either 5 min Apgar score < 7 or arterial umbilical cord pH < 7.1. Serum was sampled in the third trimester of pregnancy (T3) and 25-hydroxyvitamin D (25OHD) was analysed by liquid chromatography tandem mass spectrometry. Vitamin D deficiency was defined as 25OHD < 30 nmol/L, and associations were studied using logistic regression analysis and expressed as adjusted odds ratios (AOR).

Results
In total, 141 (7.7%) women had an EMCS and 58 (3.2%) children were born with birth asphyxia. Vitamin D deficiency was only associated with higher odds of EMCS in women without epidural anaesthesia (AOR = 2.01, p = 0.044). Vitamin D deficiency was also associated with higher odds of birth asphyxia (AOR = 2.22, p = 0.044).

Conclusions for Practice
In this Swedish prospective population-based cohort study, vitamin D deficiency in late pregnancy was associated with doubled odds of birth asphyxia and with EMCS in deliveries not aided by epidural anaesthesia. Prevention of vitamin D deficiency among pregnant women may reduce the incidence of EMCS and birth asphyxia. The mechanism behind the findings require further investigation.

Significance
What is already known on this subject?
Poor maternal vitamin D status is suggested as a risk factor of delivery by caesarean section and birth asphyxia. However, studies are few and the data are contradictory.

What this study adds
In this population-based cohort study, maternal vitamin D deficiency doubled the odds of delivering a baby with birth asphyxia and of delivery by emergency caesarean section in women without epidural anaesthesia. The interaction between vitamin D deficiency and epidural anaesthesia might explain disparate results in previous studies, and should be considered in future studies.