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Director's Letter
Carole Baggerly
Director, GrassrootsHealth
WE CAN'T KEEP WAITING, IT'S
DESTROYING
PEOPLE'S LIVES!
We need each and every one of you that knows something about vitamin D to help us move forward with the message that we absolutely MUST have a serum level of 40 ng/ml or above. It is demonstrably safe, it's what the African tribes had, it's been demonstrated in many randomized trials, specifically the ones we use by Hollis & Wagner regarding pre-term births.
Please note on this very chart, that the weeks of gestation (left vertical bar) keeps increasing until the serum level reaches about 40 ng/ml. How can anyone possibly say that 20 ng/ml is 'enough'?! (There was just an
article out this week that indicated that very erroneous statement. More to come on this very shortly.)
Preterm birth is the March of Dimes' #1 issue... yet, we see no activity by them to address the easiest thing they could do--get mothers' vitamin D serum levels to 40 ng/ml. How can we get them to use their considerable resources to address this? We are open to your suggestions.
We are making progress with hospital groups, yes, hospital groups, that know they must solve the vitamin D deficiency epidemic (those less than 40 ng/ml) right now. They are indeed taking action. Along with the Medical University of South Carolina (MUSC), we are adding Palmetto Hospital in Columbia, South Carolina, and a new hospital (name to come) in Montana. Hospitals KNOW this needs to be done.
Please use some of the resources on the side panel to take to your friends, your local institutions, the WORLD to help get people to take action this very day... and, applaud all the great organizations like those mentioned above that are already doing so.
It's always up to US to make change.
Enjoy! It's our day.
Carole Baggerly
Director, GrassrootsHealth
A Public Health Promotion & Research Organization
Moving Research into Practice
NOW!
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World Prematurity Day was first started on November 17, 2008 by the European Foundation for the Care of Newborn Infants (EFCNI) at a meeting of European Parents' Organizations. Since that time, the March of Dimes has declared November to be Prematurity Awareness Month.
The March of Dimes was founded in 1938 as the National Foundation for Infantile Paralysis by Franklin Delano Roosevelt to combat polio. With its mission complete, in 1958, it began to turn to other health issues of the nation - focusing on birth defects, arthritis and viruses. In 1976 it became the March of Dimes and then in 2005 it officially changed its mission to preventing preterm birth.
According to the March of Dimes, approximately 15 million babies around the world will be born prematurely each year, and 1 million will die. In addition, it costs about $4,000 to deliver a healthy baby and about $54,000 to deliver a premature baby. The March of Dimes also conducts research and puts out a prematurity report card for every region in the country. Their 2016 report announced an upswing in premature birth in the US for the first time in 8 years and an overall 'C' rating (9.6 %) for the US.
Why preterm birth?
Doctors have realized that preterm birth (before 37 weeks gestation) and low birth weight (under 5.5 lbs) are associated with increased risk of health problems for the baby, including respiratory problems, feeding difficulties, jaundice, delayed brain development, increase of cerebral palsy, risk of ADHS and autism, as well as an increased risk of infant death.
Was it always this bad?
A summary report from the American Academy of Pediatrics proceedings in 1935 reported that in 1930 in Chicago, all infant deaths were reported to be about 5% of births. They surmised that these deaths mostly came from premature infants and started a new program to single out and better care for and track premature babies. In this same report a doctor in Brooklyn reported a 6% premature birth rate (NY rate is currently 8.7%, IL is 10.2%).
This paper reported data from the National Center for Health Statistics (NCHS) that showed low birth weight accounted for 6.8% of births in the US in 1980.
In 1990 the premature birth rate in the US was 10.6%, as illustrated in this chart of NCHS data. After the 90s the premature rate for the country went up to about 13%, and has slowly come down over the past ten years... this year at 9.6%.
What about Vitamin D levels?
The National Health and Nutrition Examination Survey (NHANES) 2005-2006 reported that 90% of Mexican-American adolescent females had vitamin D levels below 20 ng/ml; 20% were below 15 ng/ml. For African-American adolescents, the corresponding figures were 99% below 30 ng/ml and 58% below 15 ng/ml.
The chart below shows vitamin D serum levels in US women of childbearing age (18-45 years), by race/ethnicity, based on data from NHANES 2005-2006. 93% of the population had levels BELOW the 40 ng/ml recommended for a healthy pregnancy.
What can you do?
If you are pregnant, research has shown (see paper review below) that testing vitamin D levels immediately (optimally before conception) and maintaining vitamin D levels above 40 ng/ml (100 nmol/L) throughout the entire pregnancy will lower the chances of
- Preterm birth
- Hypertension disorders
- Gestational diabetes
- Bacterial vaginosis
- Depression and post-partum depression
- Impaired muscle strength
In addition, there are benefits for the baby of
- Normal birth weight
- Reduction of common colds
- Reduction of ear infections
- Reduction of respiratory illnesses and asthma
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Medical University of South Carolina Leads the Way
Starting last year, September 2015, the Medical University of South Carolina, under the direction of Dr. Roger Newman, has implemented GrassrootsHealth's Protect our Children
NOW! Campaign.
Every mother that comes to one of their clinics for treatment, thousands of mothers per year, has a 25(OH)D test during their first prenatal visit (typically 12-14 weeks gestation). After reviewing the results, their OB may recommend supplementation to increase vitamin D levels, usually starting with 5000 IU vitamin D / day (their average entry vitamin D level is 20 ng/ml or below). Vitamins are free to patients under the program, thanks to the sponsorship of
Bio-Tech Pharmacal, Inc. The OBs continue to monitor blood levels to ensure > 40 ng/ml throughout the pregnancy, typically testing again at 24-28 weeks and again at 34 - 36 weeks.
Note: Before the project began, 80% of all their patients and 100% of their
African American patients were below 40 ng/ml.
Education of all of their OBs, over 20 doctors and health care providers, has occurred through
free online continuing medical education (CME) courses provided by GrassrootsHealth. Educating and bringing the whole staff at MUSC up to speed was an important part of the project, so that all of the staff could buy into the new standard of care.
Educational materials are also provided for the mothers to help them understand the importance of taking their supplements. An onsite project manager assists in the education and follow through of all aspects of the program with staff and patients.
Data should be available to GrassrootsHealth by the end of 2016, for their 14 months of implementation - over 3,000 births. The data will be analyzed, and results will be published and taken to public health officials. The goal of this program is to halt vitamin D deficiency in its tracks and help women at MUSC and beyond have safer pregnancies.
Not only did MUSC house the groundbreaking researchers - Drs. Carol Wagner and Bruce Hollis - but they also had support and funding from
Select Health of South Carolina. Beyond providing for the health of their clients, insurers could see significant savings with a potential for 50% reduction of preterm birth as the March of Dimes estimates an added cost of $50,000 for preterm care.
If you want to compute the potential savings for your region,
- Determine the number of births in your county or state
- Find the % preterm birth for that region from the March of Dimes report card
- Calculate the number of children that are born early every year (multiply your answers for #1 x #2)
- Divide that number by 2
- Multiply by $50,000
That is the cost savings of implementing a Protect our Children
NOW! program in your area. In addition, with education of mothers - this should continue throughout their life - giving better health outcomes for those children's lives.
Let's change the health of the world by starting with the next generation!
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Comparing preterm birth rates of two pregnancy cohorts
Post-hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates
Carol L. Wagner, et al.
Medical University of South Carolina
The Journal of Steroid Biochemistry and Molecular Biology
January 2016
Read Paper
 Lead author, Carol L. Wagner, MD, is a professor of medicine, neonatologist, associate director of the Neonatal-Perinatal Fellowship Program and the Clinical and Translational Research Center at the Medical University of South Carolina, and the principal investigator of the Protect Our Children NOW! campaign by GrassrootsHealth.
What does this paper report?
Two vitamin D pregnancy supplementation trials were run by Dr. Wagner at MUSC: The NICHD (n=346) and Thrasher Research Fund (TRF, n=163) studies. The findings suggest increased dosages of supplemental vitamin D were associated with improved health outcomes of both mother and newborn, including risk of preterm birth (<37 weeks gestation). The key finding reported in this analysis was done by the results achieved with a given serum level.
This post-hoc analysis highlights the relationship between 25(OH)D concentration and preterm birth rates in the NICHD and TRF studies (n=509) with comparison to Charleston County, South Carolina March of Dimes (CC-MOD, n=14,609) published rates of preterm birth.
What did this paper find?
As you can see from the graph below, a 46% lower preterm birth rate was observed among women with vitamin D levels ≥40 ng/mL compared to the CC-MOD (March of Dimes) reference group. It is also interesting to note that the findings were more robust in Hispanic and Black women. This is believed to be due in large part to the change in vitamin D level. Black women entering the studies had an average vitamin D level of 16 ng/mL, and increased to an average of 30 ng/mL. Hispanics started with an average vitamin D level of 24 ng/mL and increased to an average of 38 ng/mL. (White women started with an average of 30 ng/mL, thus leaving less room for improvement).
Another key finding is that there was a steady increase of gestation time (how long the baby stayed in the womb) correlating to the rise of 25(OH)D, reaching a plateau around 40 ng/mL. This adds evidence to the effort to change the standard of practice for all OBs - with a goal of getting all pregnant women to at least 40 ng/mL.
Conclusion
In this post-hoc analysis, women who achieved a 25(OH)D serum concentration ≥40 ng/mL were observed to have a 59% lower risk of preterm birth compared to those who had concentrations of ≤20 ng/mL. These findings suggest the importance of raising 25(OH)D levels substantially above 20 ng/mL, the level currently considered sufficient by the Institute of Medicine (IOM).
Read Paper
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We've Won an Award!
The American College of Nutrition has awarded us with the Humanitarian Award in recognition of our dedication to moving public health messages regarding vitamin D from science into practice.
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Carole accepting the award from Michael Stroka, Executive Director, ACN
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"We have been aware of the vitamin D deficiency state in the vast majority of our Caucasian patients and almost all our Black patients for far too long. Now the evidence has accumulated of the high price we pay in terms of prematurity and other obstetrical complications from our failure to systemically address these deficiencies in maternal vitamin D levels. It is time to change, to get ahead of the curve."
Roger B. Newman, MD
Director & Professor, Obstetrics & Gynecology
Vice Chairman for Academic Affairs & Research
Medical University of South Carolina
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November is Prematurity Awareness Month
The United States has one of the highest rates of preterm birth of any industrialized country.
Premature birth is the leading cause of newborn death.
Let's work together with the March of Dimes to spread the word about how vitamin D sufficiency can reduce the risk of preterm birth by almost 50%! In a very short time!
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Early pregnancy vitamin D status and risk of preeclampsia
Hooman Mirzakhani et al.
Brigham and Women's Hospital
The Journal of Clinical Investigation
November 14, 2016
Total elimination of preeclampsia for women who have reached 40 ng/ml (100 nmol/L) by conception.
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| Top Pregnancy & Vitamin D Research |
Vitamin D Supplementation During Pregnancy: Double-Blind, Randomized Clinical Trial of Safety and Effectiveness
Bruce W. Hollis et al.
Journal of Bone and Mineral Research
October 2011
Read Paper
German Translation of the Abstract
Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery
Carol L. Wagner et al.
Journal of Steroid Biochemistry & Molecular Biology
April 2015
Read Paper
Post-Hoc analysis of vitamin D status and reduced risk of preterm birth in two vitamin D pregnancy cohorts compared with South Carolina March of Dimes 2009-2011 rates
Carol L. Wagner et al.
Journal of Steroid Biochemistry & Molecular Biology
January 2016
Read Paper
High-Dose Vitamin D3 Supplementation in a Cohort of Breastfeeding Mothers and Their Infants: A 6-Month Follow-Up Pilot Study
Carol L. Wagner et al.
Breastfeeding Medicine
July 2006
Read Paper
Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial
Bruce W. Hollis et al.
Pediatrics
October 2015
Read Paper
Maternal 25-Hydroxyvitamin D and Preterm Birth in Twin Gestations
Lisa M. Bodnar et al.
Obstetrics & Gynecology
July 2013
Read Paper
Does Maternal Vitamin D Deficiency Increase the Risk of Preterm Birth: A Meta-Analysis of Observational Studies
Lu-Lu Qin et al.
Nutrients
May 2016
Read Paper
Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years
Augusto A. Litonjua et al.
JAMA
January 26, 2016
Read Paper
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17 photos of adorable kids who were born prematurely, now holding their own baby pictures.
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