American Journal of Clinical Nutrition 2011;94:906–12.

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Supplement use related to decreased premature births, especially in underweight and healthy-weight women

Background  More than a half million babies in the United States—1 in every 8—are born premature each year. Although many risk factors for this serious pregnancy outcome cannot be easily altered (eg, problems with the uterus or cervix, carrying twins or triplets), some choices that women make do affect their risk. These choices include smoking, use of illicit drugs, and alcohol consumption. Poor maternal nutritional status can also increase a woman’s risk. Surprisingly, although use of dietary multivitamin/multimineral supplements is commonly advised to women who are planning to conceive or are already pregnant, little is known about their impact on risks of premature birth and other adverse pregnancy outcomes, such as low birth weight. To help fill this research gap, Danish and US scientists analyzed data from a very large cohort of women to test their hypothesis that dietary supplementation would provide some protection from delivering premature or small infants. The results of their study are published in the September 2011 issue of The American Journal of Clinical Nutrition.

Study Design  Data reflecting dietary supplement use and pregnancy outcome for 35,897 women were drawn from the Danish National Birth Cohort. Dietary supplement use was recorded from 4 wk before (preconception) to 8 wk after (postconception) the women’s last menstrual period. Although the exact composition of dietary supplements was not ascertained, products typically consumed during this period of the lifecycle contain a mixture of essential vitamins and minerals, including folic acid and iron. In this study, preterm birth was defined as delivering a baby before 37 wk of pregnancy. Small for gestational age (a subcategory of low birth weight) was defined as a birth weight in the lowest 3% of what is considered healthy for a particular gestational age. In analyzing their data, the researchers statistically controlled for a host of potentially confounding variables such as maternal age, smoking, parity, and marital status.

Results  Most women (61%) reported supplement use during the pre- and/or postconceptional periods. Regular use of supplements was related to 16% lower risk of premature birth in underweight and healthy-weight, but not overweight, women. Supplement use was associated with a 17% reduction in small-for-gestational-age births, regardless of maternal weight status.

Conclusions  Although they acknowledge limitations to their study (such as its racial homogeneity and lack of precise characterization of the supplements taken), the researchers concluded, “Regular multivitamin use around the time of conception is associated with reductions in risk of preterm births in nonoverweight women and decreased risk of low-birth-weight infants independent of maternal body weight.”

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We all know that the presence of vitamin D in our bodies is important for a variety of reasons notably for the absorption and utilization of calcium & phosphorus by the intestinal tract, to enable normal mineralization of the bone, reduce cancer risk and may play a role in the prevention or treatment of type 1 and type 2 diabetes, hypertension and multiple sclerosis.

The question here is what is the best source of vitamin D?

Science seems to be divided on the answer to this question especially in the area of supplementation. There are some scientists who believe that our diets are deficient in vitamin D and that supplementation is necessary. Others say that the recommended dosages for adequate vitamin D supplementation are inadequate (Michael Holick, M.D., and a group of other nutrition experts writing in the American Journal of Clinical Nutrition (March, 2007, 85(3);649-650.) Still others claim that vitamin D supplementation suppresses the immune system (Trevor Marshall, Ph.D., professor at Australia’s Murdoch University School of Biological Medicine and Biotechnology).

In the absence of a clear scientific conclusion where should we turn for the answer to the question at hand? Personally, when I am conflicted, having no clear choice I always chose to err on the side of safety and turn to the body’s built in mechanisms. The body produces vitamin D naturally when the skin is exposed to ultraviolet rays. In my opinion this is the most natural method of assuring that vitamin D is present in the body. Many studies show that most people meet their vitamin D needs through exposure to sunlight. The factors that affect UV radiation exposure and research to date on the amount of sun exposure needed to maintain adequate vitamin D levels make it difficult to provide general guidelines. It has been suggested by some vitamin D researchers, for example, that approximately 5-30 minutes of sun exposure between 10 AM and 3 PM at least twice a week to the face, arms, legs, or back without sunscreen usually lead to sufficient vitamin D synthesis and that the moderate use of commercial tanning beds that emit 2-6% UVB radiation is also effective. Individuals with limited sun exposure need to include good sources of vitamin D in their diet (milk or fish) or take a supplement.

It is important to note that vitamin D obtained from sun exposure, food, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. The first occurs in the liver and converts vitamin D to 25-hydroxyvitamin D [25(OH)D], also known as calcidiol. The second occurs primarily in the kidney and forms the physiologically active 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as clairol. For people who suffer from some kind of dysfunction of the liver or kidney further supplementation may be necessary for the body to hydroxylate the vitimin. If you do suffer from inadequate liver or kidney function and desire to optimize the way your body uses vitamin D you should consult your physician.

Conclusion: Until there is a clear consensus on weather vitamin D supplementation is beneficial or harmful I suggest letting your body produce it’s own vitamin D from sunlight as it was designed to do.

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