Vitamin-D und Schwangerschaft

VitD ist mittlerweile unbestritten, in Diskussion steht derzeit immer noch die Dosierung bzw. die hohen Dosen, die wir geben.

Viele Kollegen haben die “Nierenverkalkung bei Vitamin D Überdosierung” aus dem Studium noch im Kopf sowie die bisherigen Richtwerte: 100-400 IE VitD / Tag

Daraus ergeben sich natürlich auch Schwierigkeiten, sich an die neuen Daten und die hohen Dosis-Empfehlungen zu gewöhnen.

Werter Kollege, lieber interessierter Leser: wir sollten hier nicht nach “Dosierungen” therapieren sondern ergebnisorientiert nach den Serum-Konzentrationen.

Ich sehe bei den Messungen tw. 100% Abweichungen bei der selben eingenommenen Menge, hier gibt es offensichtlich hohe inter-individuelle Variabilität der Resorbtion.

Unterer Grenzwert ist 30ng/ml 25OH-VitD, Wunschwert ist 40-50ng/ml. Bei Tumorpatienten wollen wir noch höhere Werte. 

Diese Konzentrationen erreichen wir in meiner Ordination kaum unter 5000 – 7000 IE / Tag.

Jeff Bowles recherchiert (wie ich) – 2000 Studien und Eigenerfahrung in nachfolgendem Buch

Hochdosiert: Die wundersamen Auswirkungen extrem hoher Dosen von Vitamin D3: das große Geheimnis, das Ihnen die Pharmaindustrie vorenthalten will

• Bowles, Jeff T. (Autor)

2 EUR

Hier eine aktuelle neue Studie zur VitD-Gabe in Schwangerschaft besprochen vom VitD Council, einer US-Non-Profit-Gesellschaft unter ärztlicher Beteiligung, welche Vitamin D als wichtige Präventivmedizinische Massnahme zu ankern versucht und regelmässig neu veröffentlichete Studien bespricht.

Vitamin D deficiency and pregnancy risks

December 13, 2012 — John Cannell, MD
Professors Carole Wagner and Bruce Hollis and ten of their colleagues at the Medical University of South Carolina recently conducted the largest randomized controlled trial to date using meaningful daily doses (2,000 vs. 4,000 IU) of vitamin D during pregnancy.

Randomized Trial of Vitamin D Supplementation in Two Community Health Center Networks in South Carolina. Am J Obstet Gynecol. 2012 Nov 3.  Wagner CL, McNeil R, Hamilton SA, Winkler J, Cook CR, Warner G, Bivens B, Davis DJ, Smith PG, Murphy M, Shary J, Hollis BW. A

The ethics committee would not let them use a control group of 400 IU/day, as the committee felt this would endanger the women and their newborns. Sadly, most women in this country only take the 400 IU/day in their prenatal vitamin.

The researchers randomized 256 pregnant women, 160 of whom completed the study. They were separated into two groups, 2,000 or 4,000 IU per day, beginning at 3-4 months of pregnancy. They followed the 160 women through delivery and found the following:

1. At the beginning of the study, pregnant African American women had a level of 18.5 ng/ml, while Whites had notably higher mean values of 29.5 ng/ml.
2. Neither group had any side effects; in fact the blood calcium levels of the 4,000 IU group actually went down.
3. At delivery, the average cord blood vitamin D level was 22 ng/ml in the 2,000 IU/day group and 27 ng/ml in the 4,000 IU/day group, still slightly less than cord levels of hunter gatherers.
4. Overall, only 37% of the 2,000 IU group and 46% of the 4,000 IU group achieved vitamin D levels of 40 ng/ml by the end of their pregnancies. Furthermore, 40 ng/ml was the threshold level at which conversion of 25(OH)D to activated vitamin D finally flattened out during pregnancy. In other words, the more 25(OH)D the pregnant woman had, the higher the activated vitamin D level, until a 25(OH)D level of 40 ng/ml was reached, and activated vitamin D stopped increasing any more at higher levels.
5. The 4,000 IU group participants had 2.40 times higher odds of having an infant in the 50th percentile of birth weight, compared to the 2,000 IU group. That is, the 4,000 IU group was more likely to have normal weight babies.
6. Lower pre?delivery 25(OH)D was significantly predictive of preterm delivery (p=0.001)
7. Lower pre?delivery 25(OH)D was associated with more infection (p=0.026).
8. Overall, complications of pregnancy were less with the 4,000 IU/day group than with the 2,000 IU/day group, though not statistically significant.

In my opinion, this is once again great research that shows that pregnant women should have levels over 40 ng/ml, and I think it’s preferable to target levels between 50-60 ng/ml.

This is why the Council recommends 6,000 IU/day, to ensure these kinds of levels. We also recommend checking 25(OH)D levels periodically throughout pregnancy to make sure your 25(OH)D levels remain in the natural range, about 50-60 ng/ml. Some women may need more than 6,000 IU/day.