Multiple sclerosis, pregnancy and vitamin D supplementation

Posted on: June 22, 2015   by  John Cannell, MD

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Multiple sclerosis (MS) is a demyelinating disease of unknown cause, which is most common in women of childbearing age. Women who are most likely to develop MS have low vitamin D status. Low serum level of vitamin D3 appears to be a risk factor for both the development and the progression of MS. No well-designed clinical trial has used high dose vitamin D3 supplementation for routine care in pregnant women with MS.

Some test tube and animal studies have also suggested that vitamin D3 has multiple effects on the immune system. There is accumulating evidence for a possible protective role of vitamin D3 in the development and disease course of MS. Several studies have reported that low serum 25(OH)D levels may increase the risk of relapses in non-pregnant patients with MS. No researcher has properly evaluated whether treatment with vitamin D in pregnant women with MS has any effects on the course of MS. In order to do so, the study must enroll pregnant women with MS who also have low serum 25(OH)D levels, and then, treat the women with large enough doses of vitamin D3 to achieve sufficiency.

Drs. Masoud Etemadifar and Mohsen Janghorbani of Isfahan University in Isfahan, Iran, recently published the first such clinical trial.

Etemadifar M, Janghorbani M. Efficacy of high-dose vitamin D3 supplementation in vitamin D deficient pregnant women with multiple sclerosis: Preliminary findings of a randomized-controlled trial. Iran J Neurol. 2015 Apr 4;14(2):67-73.

(I may be a little biased in evaluating this study, because I spent the summer of 1973 in Isfahan studying the prevalence of rickets in nearby villages. I fondly remember how friendly the people were in Isfahan).

These scientists gave 50,000 IU/week of vitamin D3 and routine care to 6 pregnant women with MS in an open-label trial, in which both patients and investigators were aware of the type of treatment each patient received. The 9 pregnant women in the control group received routine care. Participants were evaluated by a qualified neurologist at baseline and every 8 weeks after the start of the therapy until delivery and also 6 months after delivery to evaluate disease activity.

The authors found that 5 women in the routine care group had a relapse of their MS within 6 months after delivery. However, no women relapsed within 6 months after delivery in the vitamin D3 group.

Obviously this is a small study, but the results were dramatic. Normally, these results would warrant larger randomized controlled trials. However, I doubt this study will be replicated in the future. After these findings, I do not think the ethics committees at universities are going to allow pregnant women in the placebo group to be identified as vitamin D deficient but not be treated. Perhaps some uninformed ethics committees will allow control groups to get the pathetically low 600 IU/day the federal government recommends for pregnant women.

The authors advise,

“A daily supplement of 10,000 IU of vitamin D3 is considered advisable for all adults with normal renal function and this dose should be routinely recommended to all women…during pregnancy and lactation.”

The Vitamin D Council recommends 5,000 IU/day for pregnant women but we should probably revise our recommendations up to 10,000 IU/day. What do readers think?

5 Responses to Multiple sclerosis, pregnancy and vitamin D supplementation

  1. Rita Celone Umile

    This small study gives such large hope, doesn’t it? I certainly do think 10,000 iu D3 daily should be considered advisable for all adults with normal renal function–and especially recommended for women who are pregnant or lactating. But, I think that at least in the United States this recommendation is far from occurring. I know that in some esteemed health facilities in New Haven, Connecticut, to recommend between 1,000 iu D3 and 4,000 iu D3 daily is still considered so controversial as to be cutting edge–and that is for the adult who is NOT pregnant or lactating.

  2. brandonr@tds.net

    I agree that all pregnant women should receive 10,000 Iu daily. It looks like the OB program at Medical University of South Carolina is the first program to test and treat their pregnant patients.

  3. Rita Celone Umile

    Yes the South Carolina program is a glimmer of hope, but I don’t think even it doses expectant moms at 10,000 iu D3 daily–though it should. Actually, I think 25(OH)D level is so much more important than daily dose. Folks should take whatever daily dose of D3 that gets them to that optimal range. But of course, that “golden” range is unfortunately still not recognized by mainstream medicine. Most mainstream physicians cheer for a level of 35 ng/ml. Any wonder why so many folks are sick with chronic illness? I used to work for a leading health facility that stated “vitamin D was miraculous for those with MS–at a level of 40 ng/ml.” I feel so sorry for those MS patients being cared for at this health facility. THAT level will only succeed in keeping MS patients ill, in my opinion.

  4. SunFriend

    SunFriend wearable UV monitor when optimizing vitamin D from the sun! The summer is the best time to get your UVB’s from 10-3, but you never want to get burned. The best news about the sun is you can’t overdose, which could be important when you are pregnant.

  5. Rebecca Oshiro

    I think 10,000 IU per day as a routine dose is a little high unless the individual is significantly obese. In my experience, supplementing adults with between 3 and 6 thousand IU per day does the trick and frequently achieves dramatic improvements in health. However, for an MS patient, pregnant or not, there is nothing to lose (and potentially everything to gain) in experimenting with 10,000 IU per day.

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