Vitamin D Demonstrates 60% Lower Preterm Births in First Large Population Study

GrassrootsHealth helped implement a first-of-its kind study for pregnant women. The goal was to help pregnant women achieve a vitamin D serum level of at least 40 ng/ml (100 nmol/L) — which has been demonstrated to be the threshold for benefit in previous randomized trials.

The study, Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center, was published in PLOS ONE by GrassrootsHealth, the implementation leaders.

This population study included over 1,000 pregnant women at the Medical University of South Carolina. Results found that women who achieved a 25-hydroxyvitamin D serum level of greater than or equal to 40 ng/ml (100 nmol/L) had a 60% lower risk of preterm birth compared to those with levels less than 20 ng/ml (50 nmol/L), p=0.0001.

Two randomized controlled trials with vitamin D and pregnancy outcomes and an associated post-hoc analysis by researchers at the Medical University of South Carolina (MUSC) showed a 59% lower risk of preterm births with 25-hydroxyvitamin D levels of greater than or equal to 40 ng/ml (100 nmol/L) compared to women with concentrations less than 20 ng/ml (the current sufficient level recommended by the Institute of Medicine). This new population study of all pregnant women at the medical center, using the implementation services of GrassrootsHealth and their Protect our Children NOW! program, has confirmed that results can be replicated in a much larger population.

There were ethnic disparities within the results, but they were most apparent when the results singled out the women who had at least two vitamin D tests during their pregnancy, with the assumption being that the second test helps the mother zero in on how to achieve the desired vitamin D level. The overall percentage of women with two tests during the study period was 16%. Those with a follow-up test of greater than or equal to 40 ng/ml only had a 6% preterm rate, a full 60% lower rate than the normal population (p value of 0.006). For non-white women only, there was an 18% preterm rate at the start of the study and a 78% lower rate of preterm birth if the women achieved the 40 ng/ml by the 2nd test. Non-white women with two tests reduced their preterm birth rate to 4%! (p value of 0.01.)

“These findings are another powerful example of the importance of the environment in our human health,” said Roger B. Newman, MD, Dir. OB/Gyn, Medical University of South Carolina. “Our evolution away from sun exposure over the last hundred years has resulted in widespread Vitamin D deficiency which contributes to multiple health consequences including higher and racially disparate preterm birth rates.”

The protocol followed at the medical center was to test vitamin D levels at the first prenatal visit, then, if levels were below 40 ng/ml, to provide supplementation and retest at 24-28 weeks gestation and again at delivery. Overall, 90% had initial levels lower than 40 ng/ml, and 97% of black women had initial levels lower than 40 ng/ml. Testing early in pregnancy is important for the doctors and researchers to be able to track the effect of supplementation. Also, based on other research published by GrassrootsHealth, the response to vitamin D supplementation varies by a factor of six, so there is no one supplement amount perfect for all pregnant women. Follow up testing of vitamin D levels during pregnancy is essential.

Key to the success of this project was the provision of already developed project protocols, measures of performance, and implementation methods for the health care providers, the administrative functions and the patients. In addition, since compliance by both staff and patients is essential, there are reminder systems and predefined questions for decision making to enhance quality performance. The data requirements and analytical structures are also in place to help minimize problems with internal systems. With over 1,000 preterm births/day happening in the United States alone, this methodology can be used to help significantly reduce the preterm birth rate at any hospital in only 2 years, not the standard 15+ years.

The next phase of the project at MUSC will be to include further attention to follow-up testing and patient supplementation and further analyze the around other comorbidities of pregnancy, from the use of the progesterone drug 17p to other basic interventions such as magnesium.

There is definitely a sense of urgency to get pregnant women’s vitamin D levels above 40 ng/ml. The GrassrootsHealth Protect our Children NOW! implementation program has been developed to quickly meet that need.

About GrassrootsHealth 
GrassrootsHealth is a nonprofit public health promotion organization dedicated to moving public health messages regarding vitamin D from science into practice. GrassrootsHealth provides a comprehensive set of implementation tools/analytics to help organizations implement population projects in a short time frame vs. the usual 15-20 years. GrassrootsHealth has a panel of 48 senior vitamin D researchers from around the world contributing to its operations. GrassrootsHealth runs the D*action population intervention program to solve the vitamin D deficiency epidemic worldwide as well as a breast cancer prevention project, a new omega-3 project, and Protect our Children NOW! – a population intervention program for pregnancy.