Trusted Information for Healthy Pregnancies
12 weeks
High-dose vitamin D safe during pregnancy
May 3rd
Taking high doses of vitamin D during pregnancy is safe and appears to reduce the risk of preterm birth and infections, say the authors of a study that compared different amounts of supplementation in expectant mothers.
But their recommendation that pregnant women should take 4,000 international units of vitamin D daily -- at least 10 times the standard recommended amount -- is sure to generate controversy.
"When we first proposed the study in 2002, it was heresy to even think about giving more than 400 international units a day of vitamin D," co-principal investigator Dr. Carol Wagner said from Vancouver, where the two-part study is being presented at an international pediatrics meeting.
"Diet doesn't provide enough vitamin D, and we don't go in the sun as much as we need (to)," said Wagner, adding that her research team set out to determine the optimal dose of vitamin D supplements for pregnant women that would promote health without doing harm.
The researchers enrolled 494 pregnant women at 12 to 16 weeks' gestation in the study and assigned them to three groups: one group received 400 IUs of vitamin D a day until delivery; the second got 2,000 IUs; and the third 4,000 IUs. The women were tested monthly to ensure they were not suffering any negative effects.
Neither the women nor the researchers knew what dose of vitamin D they were receiving in the study, a "blinded," randomized controlled trial whose methodology is considered the gold standard of medical science.
"What we found was that 2,000 was better than 400, and 4,000 was the best, without any adverse events that were associated with vitamin D," said Wagner. "And then ... we found fewer infections in the 4,000 group and fewer preterm labors and-or preterm birth deliveries in the 4,000 group compared to the 400 group."
Analysis of the data also showed that the women taking 4,000 units of vitamin D had half the rate of pregnancy-related disorders, such as gestational diabetes and preeclampsia, compared to expectant mothers taking 400 units.
However, Wagner conceded that the notion of pregnant women taking a daily dose of 4,000 IUs of vitamin D will likely stir some debate, especially within the medical community. The current recommended daily dose is 200 to 400 IUs daily.
Dr. Gideon Koren, head of the Motherisk Program at Toronto's Hospital for Sick Children, said the study is too small to provide such a definitive recommendation and to "declare therapeutic superiority" of 4,000 units of vitamin D.
"I think for now women should be sure that they get the recommended dose. I don't know that this study by itself should send women to buy 4,000. No, no way. I don't think this is sufficient."
"The study's important to show that it doesn't cause side-effects, but I think to tell women that they need 4,000 - to go from 400 to 4,000 - is huge."
However, Dr. Reinhold Vieth, head of the Bone and Mineral Laboratory at Mount Sinai Hospital in Toronto, has long argued that recommended daily amounts (RDAs) for vitamin D are outdated and woefully inadequate.
Vieth, who has conducted numerous studies on vitamin D in different patient populations, said the Canadian Pediatric Society has been advocating 2,000 units during pregnancy since 2007.
"The next step, 4,000, well, I bet you they'll come up with that in a couple of years, because this (the Wagner-group study) has to get published first," he said, adding that he agrees that pregnant women should be taking that level of vitamin D daily.
Dr. Robert Gagnon, a spokesman for the Society of Obstetricians and Gynecologists of Canada (SOGC), said the study was well-designed and its findings are important.
The Montreal specialist said SOGC is in the process of reviewing the medical literature before deciding on its official recommendation for expectant mothers.
"We need to see all the details of the study before we come to the recommendation," he said. "To say (pregnant women) should take 4,000, I think it's a little premature for that."
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Pregnant women develop emotion-reading superpowers
Dec 14th
Raging hormones during pregnancy prompt mood swings, but may also lead to a heightened ability to recognize threatening or aggressive faces. This may have evolved because it makes future mothers hyper-vigilant, yet it could also make them more vulnerable to anxiety.
Previous studies have suggested that a woman's ability to correctly identify fearful or disgusted facial expressions varies according to her stage of the menstrual cycle, with perception heightened on days associated with high levels of the hormone progesterone. Since levels of progesterone and other hormones rise dramatically in late pregnancy, Rebecca Pearson and her colleagues at the University of Bristol in the UK investigated whether the ability to read faces varies during pregnancy.
They asked 76 pregnant women to assign one of six emotions to 60 computer-generated faces before the 14th week of pregnancy, and again after the 34th week. Faces expressing happiness and surprise tended to be correctly assigned at both stages of pregnancy, but for faces expressing fear, anger and disgust, the accuracy rates were higher in late pregnancy.
This may increase the chance that the woman will spot potential threats to her and her fetus, and prime her to be hyper-vigilant once she becomes a mother. But it could have a downside. Pearson points out that people with clinical anxiety are also better at identifying negative emotions in faces. Pregnant women aren't clinically anxious, but "they might interpret negative or emotional things around them in a slightly more sensitive way", she says.
The finding builds on a recent study by Ben Jones of the University of Aberdeen in the UK who found that pregnant women - and women in stages of the menstrual cycle where progesterone levels spike - are better at identifying faces showing signs of sickness. "It's preventing them from becoming sick by interacting with people who are ill," he says.
The next step will be to examine whether pregnant women and new mothers are also more sensitive to emotional cues in babies' faces, Jones says.
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FDA Updates Warning for Pregnant Women on Antiepileptic Drugs
Dec 4th
The FDA has issued a statement reminding patients and doctors that valproate sodium, valproic acid, and divalproex products increase the risk of birth defects in babies exposed to the chemicals during pregnancy.
The medications - used to treat epilepsy since 1978 and more recently for bipolar disorder and migraine - can cause neural tube defects, craniofacial defects, and cardiovascular malformations in unborn children during the first trimester. This is often before many women know they are pregnant, the FDA said in a statement.
Use of the products increases neural tube defects during the first 12 weeks of pregnancy from one in 1,500 to one in 20, on average, the FDA noted.
Babies born to women taking valproate for epilepsy are more than three times as likely to have birth defects as those born to women on a different therapy (10.7%, 95% CI 6.3% to 16.9% versus 2.9%, 95% CI 2.0% to 4.1%), according to data from the North American Antiepileptic Drug Pregnancy Registry.
The FDA cautioned women of childbearing potential to take valproate only if it is essential for managing a medical condition. Those taking the drug who are not planning pregnancy should use contraception, the agency said.
Women planning to become pregnant can reduce the risk of congenital neural tube defects by taking folic acid before and during the first trimester of pregnancy, the FDA noted.
The agency also noted a danger to pregnant mothers and their child if epilepsy or bipolar disorder is left untreated while the baby is developing. Likewise, it reminded doctors and patients of a major risk associated with ceasing valproate therapy suddenly.
The FDA recommended that women talk with healthcare professionals before stopping use of valproate products if they become pregnant.
It also recommended women who become pregnant while taking valproate or other antiepileptic drugs enroll in the North American Antiepileptic Drug Pregnancy Registry to help gather more information on the safety of the medications during pregnancy.
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