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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PregnancyWeekly.com

My story starts back in 2006.

I have a history of miscarriage. I had two early losses before giving birth to Noah, but for some reason had thought it would not happen again.

We decided to start trying for another baby in December 2005, and got pregnant right away. However, this pregnancy sadly ended in a miscarriage at the end of January, a very traumatic loss.

Since this was my third loss, despite not being consecutive, I talked my GP into referring me to the hospital for further testing. I had a ton of blood taken for various different tests, however by the time my appointment came along to see the consultant to discuss my results I was already pregnant again, after suffering a chemical pregnancy the cycle before, it turned out this time the baby was going to stick. I had about 8 scans as they monitored my pregnancy very closely this time.

However, things were not to go completely smoothly, as at 16 weeks I consented to having the triple test done for Downs/Edwards syndrome/Spina Bifida, something I regret doing as I feel very strongly against abortion apart from in extreme medical circumstances. This test came back with an elevated risk for Downs Syndrome, at 1 in 200. (The risk for my age, 29, should have been 1 in 1000.) Due to my loss history I refused an amniocentesis. The risk for losing my baby was double the actual risk of it having Downs and I could not accept those odds. So I opted for a detailed scan instead. The scan showed no soft markers for Downs and confirmed what we already suspected was true, that I was carrying another little boy.

At 34 weeks, I had another scan which also showed no markers for Downs. The consultant tried to talk me into an amnio at that stage, which I refused, as I could see little point. She said,

Do you know what risk you are taking?

I felt that was completely ridiculous, as whatever abnormalities my child might have had, we would just deal with whatever came up. I would love my child no matter what and strongly believe that we got given what we can handle and no greater than that. My gut told me though that my child was healthy and I clung onto this.

We started to plan the delivery, our local hospital had recently upgraded their birthing pool so that mothers could actually give birth in it rather than just laboring in it and then getting out before the birth itself. I fully intended on using this pool, especially after researching it and finding out that a warm bath is the second most effective form of pain relief after an epidural!

I had an epidural with Noah’s birth which had not taken properly (just down one side) and I had some horrible side effects (nausea and shaking). I was determined not to have one this time.

A good family friend of ours, Joana, is a midwife and had delivered Noah, we had her on call whenever I went into labor, although she would need some assistance as this would be her first waterbirth.

At 39 weeks, 4 days, I woke up to mild contractions, timed them as coming every 10 minutes.

As the day wore on though, they did not intensify, or get any closer together. By the time Gary got home from work I was getting very frustrated and at that point not even bothered if they stopped, I just wanted SOMETHING to happen or let me get some rest. At 9 p.m., I decided to try and get some sleep so went to bed. It was difficult as I was woken with every contraction, but I was determined I would need some sleep if I was going to have any energy to deal with labor.

Somehow I managed to get to sleep and the next thing I knew, it was 1 a.m. and I awoke having a very intense contraction. I lay there timing them again, and noticed they were coming about 3 minutes apart and lasting about 50 seconds each. I woke DH and we both got up, rang the in-laws. I got dressed and headed over to the hospital. I rang Joana on the way over.

At this point my contrax were 3 min apart, but every now and again I would have an extra one in between; they were painful but manageable. When we got there they had the pool all ready for me and they checked me before I hopped in. Joana was shocked to find I was already 9cm dilated – so I had already gone through most of labour at home!

I got into the tub and as soon as I hit the water I hit transition and started to lose it. Seconds after, I felt a huge pop and my waters broke. (Great timing!) I managed to focus on the contractions, which were getting really intense.

About 10 mins after I started to feel the urge to push, my body just took over – this part always freaks me out, how the body just does things with no input.

With my last labor, the pushing had been very, very difficult, as I was on my back wired up to machines after having an epidural, and it took over 2 hours to get him out.

This time though, I was able to get right into a good position and let gravity help me. Still, I was nervous. I also tore badly last time and was worried about it happening again.

In the end though I just realized the faster I get him out the sooner the pain is over and just pushed along with my body. I knew he was coming soon. I could feel the infamous “ring of fire”.

Joana called the other midwife in. They got me to squat right in the center of the pool as low as I could and as he came out, they told me not to touch his head, as it might stimulate him to breathe. His head popped out and very soon after the rest of his body.

When they told me the time was right I brought him up to the surface and laid him on my chest. I remember thinking how soft his skin was and what a big boy! He didn’t even cry and soon pinked right up nicely.

Seamus weighed on at 8lbs, 4oz, born at 4.50am (45 minutes after reaching the hospital) on the 24th February 2007. Perfectly healthy.

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PregnancyWeekly.com

Women who take folic acid supplements during the later months of pregnancy may be increasing their baby's risk of developing asthma, according to a newly released Australian study.

Found in its natural form in leafy green vegetables, legumes and some nuts, folic acid is commonly recommended to women trying to conceive to prevent neural defects in the first weeks of pregnancy.

But the Australian study found that women who continue to take folic acid late into pregnancy were 30 percent more likely to give birth to a child which would develop asthma.

"We see a substantial proportion of women taking these folate supplements throughout pregnancy, and it may be because people think it is entirely benign," said Michael Davies, associate professor at Adelaide University.

"Folate is incredibly important because of its role in preventing neural tube defects (like spina bifida). But because it is so important, and so bioactive, it needs to be treated with some respect as well."

Of the 550 women studied, those who took the folic acid supplements before conception and not more than several weeks into their pregnancy had no increased risk of asthma in their children.

But women who took it during weeks 16 to 30 of the pregnancy increased their risk of having a child with asthma by about 30 percent, according to the research, published in the American Journal of Epidemiology.

"Our finding should be reassuring to women who take folate for the purpose of preventing neural tube defects because we found no evidence of early supplementation (leading to asthma)," Davies told newswire AAP.

Davies said a diet rich in natural folate carried no increased risk of asthma for the baby.

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PregnancyWeekly.com