Vitamin D during pregnancy – dramatic changes in both metabolism and genes – Feb 2017

Vitamin D supplementation during pregnancy: Improvements in birth outcomes and complications through direct genomic alteration

Molecular and Cellular Endocrinology. Available online 7 February 2017, http://dx.doi.org/10.1016/j.mce.2017.01.039
Bruce W. Hollis, , Carol L. Wagner
Highlights

• Vitamin D metabolism during pregnancy differs drastically from the nonpregnant state.
• Vitamin D requirements during pregnancy and health effects are reviewed.
• Vitamin D plays a significant role in health outcomes of mother and fetus.
• Direct genomic alterations occur related to maternal vitamin D status.
• Childhood asthma and multiple sclerosis linked with pregnancy vitamin D status.

Pregnancy represents a time of rapid change, including dramatic shifts in vitamin D metabolism.

Circulating concentrations of the active form of vitamin D—1,25(OH)2D skyrocket early in pregnancy to levels that would be toxic to a nonpregnant adult, signaling a decoupling of vitamin D from the classic endocrine calcium metabolic pathway, likely serving an immunomodulatory function in the mother and her developing fetus.
In this review, we summarize the unique aspects of vitamin D metabolism and the data surrounding vitamin D requirements during this important period. Both observational and clinical trials are reviewed in the context of vitamin D's health effects during pregnancy that include preeclampsia, preterm birth, and later disease states such as asthma and multiple sclerosis. With enhanced knowledge about vitamin D's role as a preprohormone, it is clear that recommendations about supplementation must mirror what is clinically relevant and evidence-based. Future research that focuses on the critical period(s) leading up to conception and during pregnancy to correct deficiency or maintain optimal vitamin D status remains to be studied. In addition, what effects vitamin D has on genetic signatures that minimize the risk to the mother and her developing fetus have not been elucidated. Clearly, while there is much more research that needs to be performed, our understanding of vitamin D requirements during pregnancy has advanced significantly during the last few decades.

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Abbreviations
25(OH)D, 25-hydroxyvitamin D; 1,25(OH)2D, 1,25-dihydroxyvitamin D; IOM, Institute of Medicine; RCT, Randomized Controlled Trial; VDBP, Vitamin D binding protein; UVB, Ultraviolet B-radiation; EBM, Evidence Based Medicine; FDA, Food and Drug Administration; CDC, Centers for Disease Control; VDAART, Vitamin D Antenatal Asthma Reduction Trial; AAP, American Academy of Pediatrics; WHO, World Health Organization

Example of the many charts in the PDF: large decrease in 3 health problems with 4400 IU of vitamin D
"Effect of Vitamin D Supplementation Starting at 20 weeks of Pregnancy with Respect to the Development of Complications of Pregnancy"

gestational diabetes mellitus (GDM)
gestational hypertension (GHTN)/preeclampsia (PE)
preterm labor (PTL),