If You Are Pregnant You Must Take Vitamin D

(London) Pregnant women in the UK should be told to routinely take vitamin D supplements, researchers say.

The team at University College London Institute of Child Health says official bodies currently offer conflicting advice.

Writing in the British Journal of Nutrition, they say there is a “strong case” for a daily dose of vitamin D in pregnancy.
But one leading expert said more evidence was needed.

The Department of Health advises pregnant women to ensure they receive a certain level of vitamin D – 10 micrograms per day. The researchers say this in effect endorses use of supplements, because diet and the sun provide too little.

But the National Institute of health and Clinical Excellence (NICE) said in its guidance that it did not support supplements.

It has instead said that women should simply “be informed” about the importance of having adequate vitamin D levels during their pregnancy and while breastfeeding – adding that some women may choose to do this via supplements.

Additionally, pregnant women on low incomes are entitled to a range of nutrients – including vitamin D – as part of the Healthy Start Scheme.
‘Unacceptably high’

The paper said the UK was the only one of 31 countries examined which did not recommend that women of reproductive age took a vitamin D supplement, and that it also fails to endorse a daily supplement for expectant mothers.

Dr Elina Hypponen, co-author of the paper, said: “The incidence of vitamin D deficiency in pregnant women in Britain is unacceptably high, especially during winter and spring.
“This is compounded by a lack of exposure to sunlight and the limitations of an average diet to meet the optimal need.
“In the most severe cases, maternal vitamin D deficiency can be life threatening to a newborn.
“We believe that the routine provision of a daily supplement throughout pregnancy would significantly decrease the number of mothers who are clearly vitamin D deficient, reducing related serious risks to their babies.”

Dr Hypponen said past evidence showed a proactive approach to supplements coincided with a much lower incidence of deficiency linked diseases such as infantile hypocalcaemia [also known as William’s syndrome, which affects development], and rickets [which weakens bones].

One in four

The authors say women from some ethnic minorities are recognized to be at greater risk because their darker skin means they do not absorb as much sunlight.
But they add that the problem is also common among white women, even when they live in southern England.

Women are more likely to be vitamin D deficient than men, and a previous study found one in four pregnant mothers has been found to be vitamin D deficient during winter and spring
The Royal College of Obstetricians and Gynecologists recommends only women at risk of vitamin D deficiency should take a supplement.

Patrick O’Brien, a spokesman for the college, said: “There is gradually accumulating evidence that universal vitamin D supplementation in the UK might be beneficial for the whole population.
“But more research is needed on the balance of risks and benefits in women at low risk of vitamin D deficiency, and on the correct dosage to use.”

Surge In Infertility Tourism Leads to Viking Babies

LONDON – In vitro fertilization (IVF) has become a popular method by which women who are having trouble getting pregnant are able to use donor sperm to achieve pregnancy. In the UK, however, there is a shortage of donor sperm that is causing British women to have to travel to countries like Denmark in order to find some.

A 2005 British law change outlawed the donating of sperm anonymously. UK law also has a long-standing rule that prohibits men who donate from receiving any sort of monetary compensation. Because of these rules, and the fact that many men fear having to provide their identities with the donation because the children may eventually try to find and meet them, few British men are donating sperm these days. As a result, the waiting list to receive IVF in the UK is several years.

In 2007, Denmark changed its laws and now permits anonymous donors, which has led to a surge in foreign women coming there to receive IVF treatment. Danish donors are also compensated between $60 and $200 for their donations which has helped to facilitate a large number of casual donors. The Danish sperm bank, Cryos, is the largest sperm bank in the world and is a popular destination for “infertility tourists” seeking to have children.

Denmark is one of the few nations that allows anonymous donations as well as monetary compensation for them. For this reason, Danish clinics are flourishing with increased business. DanFert in Copenhagen more than doubled its IVF customers since 2007. Vita Nova in Copenhagen has seen a 40 percent increase in women seeking IVF from Britain alone.

Danish clinics also cater to single women who are trying to have children, a controversial scenario rejected by many other nations who aim to serve couples trying to conceive. Such liberal laws have attracted all sorts of women from around the globe who wish to bear children but are otherwise unable.

Because of the popularity of the program, Danish banks have begun opening up franchised fertility clinics in other countries that permit it, including in the US and India. In these countries, men who are looking to make some extra cash often donate to the clinic, a practice that has all but ceased in Britain due to the laws.

Many women are hoping that UK laws will once again allow for anonymous sperm donors. They believe it will help to increase supply and end the shortage that has prevented many women from receiving IVF there.

Milk During Pregnancy May Lower a Baby’s Risk of Developing MS Later in Life

Recent media reports have covered research announced ahead of the American Academy of Neurology’s (AAN) Annual Meeting in April which suggested that milk during pregnancy may lower a baby’s risk of developing multiple sclerosis (MS) later in life.

The theory from the researchers in Boston, announced in an AAN press release, was based on a survey of American mothers.

It was claimed that MS risk was lower among women born to mothers with high milk or dietary vitamin D intake in pregnancy.

Unfortunately UK media reports focused on the milk link ; however it is in fact the case that there are only trace elements of vitamin D in milk consumed in this country.

Unlike America, most of Britain’s milk is not fortified with vitamin D and so whatever quantity of milk is ingested, vitamin D levels in the body are likely to remain unaffected.

While it may be true that vitamin D has previously been shown to potentially play a role in MS, maintaining a healthy, balanced diet including oily fish and exposing skin to safe levels of sunshine are the best ways to increase levels of vitamin D.

No Need for Pregnant Women to Fast During Labor

No Need for Pregnant Women to Fast During Labor

DETROIT –  There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.

“Women should be free to eat and drink in labour, or not, as they wish,” the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.

“In my experience,” she told Reuters Health in an email, “most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities.”

Milosavlievic has “not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor.”

Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.

But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.

And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a “Committee Opinion” advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.

“As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common,” Dr. William H. Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.

But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says “women should be able to make their own decisions about whether they want to eat or drink during labour, or not.”

Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.

The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.

The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

SOURCE: Cochrane Library, 2010.

 

Cola Drinking Linked to Diabetes in Pregnancy

NEW ORLEANS – Drinking lots of sugar-sweetened cola may increase women’s likelihood of developing diabetes during pregnancy, a condition known as gestational diabetes, new research shows.

Compared to women who had less than one such beverage a month, women who drank at least five servings of non-diet cola a week were at greater risk of gestational diabetes, even after accounting for their body mass index (BMI), level of physical activity, and other diabetes risk factors, researchers found.

Sugar-sweetened beverages are the top source of added sugar in US diets, and several studies have linked high sugary drink intake with an increased risk of type 2 diabetes in women, Dr. Liwei Chen of the Louisiana State University Health Science Center in New Orleans and colleagues note in the latest edition of the journal Diabetes Care.

But there is little information on whether consumption of sugar-sweetened beverages before pregnancy might increase gestational diabetes risk, they add.

To investigate, the researchers analyzed data from the Nurses Health Study II, looking at 13, 475 women who had at least one pregnancy between 1992 and 2001. During that time, 860 women reported having been diagnosed with gestational diabetes for the first time.

Women who drank five or more sugar-sweetened beverages of any type per week were 23 percent more likely to develop gestational diabetes than those who drank less than one serving a month, and the relationship remained even after the researchers accounted for other gestational diabetes risk factors such as BMI and family history of diabetes.

But accounting for a Western-style diet — heavy in red meats, processed meats, sweets, snacks and other less-healthy foods — did explain some of the association between diabetes and sugary drinks.

The researchers looked separately at cola beverages, because the caramel coloring used in them has been linked in animal studies to insulin resistance and inflammation. They found a 22 percent increased risk of developing diabetes during pregnancy for women who drank five or more non-diet colas a week, compared to women who had less than one serving of cola a month.

There was no relationship between diet beverage consumption and gestational diabetes risk.

The demands pregnancy puts on a woman’s metabolism may “unmask” a tendency toward developing diabetes and similar conditions, Chen and colleagues note. Drinking cola could contribute to this tendency by making for a sugar-filled diet, they add, which in and of itself may be harmful to the insulin-producing beta cells of the pancreas.

Because diet cola didn’t increase gestational diabetes risk, they add, caramel coloring isn’t likely to be a major factor in the relationship observed with non-diet cola.

The findings “are particularly relevant” given that so many people drink sugar-sweetened cola, the researchers write. They call for more research on sugar-sweetened beverage consumption and gestational diabetes, as well as other pregnancy outcomes.

SOURCE: Diabetes Care, December 2009.