CPD issues paper urging monitoring of vitamin D levels in pregnant women

October 12, 2017 by JoLynne Lyon

Many Utahns are deficient, with potential consequences for mothers and children

photo of a pregnant woman

In light of chronic and sometimes serious health conditions that stem from vitamin D deficiency in  prenatal development, and noting that a majority of Utahns are not getting enough of the vitamin, the Center for Persons with Disabilities has issued a statement urging physicians of pregnant mothers to test for deficiency and correct low levels.

The statement cites numerous studies that show Vitamin D–which is eventually converted by the body into an active hormone–does much more than help strengthen bones. What’s more, prenatal vitamins typically contain much less than is suggested by the Endocrine Society, the world’s largest organization in the field of medicine concerned with endocrine glands and hormones.

“Recent research indicates that low vitamin D levels during pregnancy are associated with various negative health outcomes,” state Thayne L. Sweeten, Ph.D.; Anthony R. Torres, M.D.; Dennis Odell, M.D.; and Matthew Wappett, Ph.D and director of the Center for Persons with Disabilities. The four authors cite studies linking adequate levels of vitamin D with reduced risk of the immunological aspects of asthma in newborns, as well as a lowered risk of preeclampsia and preterm birth in mothers.

Autism may also be linked to a deficiency of the vitamin. “Over the last ten years, at least 15 studies have reported lower than normal blood levels of vitamin D in individuals with autism,” the statement reads. “Related studies show that mothers who give birth to children with autism are more likely to be deficient in vitamin D. …

“It is unknown what role, if any, this deficiency plays in the onset of autism; however, given the wide spread deficiency of this vitamin, we recommend that serum 25-hydroxyvitamin D levels be measured prior to and during pregnancy in all mothers, especially those who have previously given birth to a child with an autism spectrum disorder.”

The statement follows in its entirety.

 

Vitamin D supplementation in pregnancy

Position paper from The Center for Persons with Disabilities
Utah State University

Thayne L. Sweeten, Ph.D.
Anthony R. Torres, M.D.
Dennis Odell, M.D.
Matthew Wappett, Ph.D.

Vitamin D deficiency has reached epidemic proportions in the United States. In the Intermountain Healthcare population covering Utah and parts of Idaho, the deficiency affects over 60% of individuals (Anderson, 2010). Vitamin D plays important roles throughout the body and vitamin D deficiency is associated with many disease states including: bone health (rickets), hypertension, renal disease, diabetes mellitus, coronary heart disease, pregnancy issues and autoimmune diseases (Kriegel, 2011; Wang, 2017). Although vitamin D is important throughout life, adequate amounts are especially vital during pregnancy and in a newborn child (Thorne-Lyman, 2012).

The American College of Obstetricians and Gynecologists notes that vitamin D deficiency is common during pregnancy especially in high risk groups like vegetarians, women living in northern latitudes, those using sun protection, and individuals with darker skin pigmentation. The Food and Nutrition Board in the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine established in 2010 that 600 international units (IU) of vitamin D per day are adequate during pregnancy and lactation (Food and Nutrition Board, 2010). The Endocrine Society suggests that pregnant and lactating women may require at least 1500-2000 IU/day of the vitamin (Holick, 2011).

Most prenatal vitamin contain olny 400 IU of vitamin D. While this amount may be sufficient to prevent bone problems, it does little to correct the low vitamin D blood levels that are common among pregnant women (Hollis, 2011). Recent research indicates that low vitamin D levels during pregnancy are associated with various negative health outcomes. These negative outcomes are mitigated by maintaining adequate blood levels of vitamin D, obtained by taking 4000 – 5000 IU daily. For instance, a study published in the Journal of Allergy and Clinical Immunology (Hornsby, 2017) suggests that 4400 IU/day vitamin D taken in the later stages of pregnancy helps correct the immunological aspects of asthma in newborns. Other studies show that the risk of preeclampsia and preterm birth are significantly reduce when pregnant mothers maintain adequate vitamin D blood levels of 30 ng/ml and 40 ng/ml respectively (Mirzakhani, 2016; McDonnell, 2017).

Vitamin D is known for its role in strengthening and regulating immune responses, and deficiencies are common in a variety of autoimmune diseases. Our research group at Utah State University has studied the immune system in individuals with autism for decades and has noted similarities between autism and autoimmune diseases (Torres, 2016; Sweeten, 2016). Over the last ten years, at least 15 studies have reported lower than normal blood levels of vitamin D in individuals with autism (Wang, 2016; Cannell, 2017). Related studies show that mothers who give birth to children with autism are more likely to be deficient in vitamin D (Chen, 2016; Vinkhuyzen, 2017).

It is unknown what role, if any, this deficiency plays in the onset of autism; however, given the wide spread deficiency of this vitamin, we recommend that serum 25-hydroxyvitamin D [25(OH)D] levels be measured prior to and during pregnancy in all mothers, especially those who have previously given birth to a child with an autism spectrum disorder. Deficiencies should be corrected by bringing levels into the normal range, under the care of a health care provider. Vitamin D deficiency is easily treated.

References:
Anderson, J. L., May, H. T., Horne, B. D., Bair, T. L., Hall, N. L., Carlquist, J. F., . . . Muhlestein, J. B. (2010). Relation of Vitamin D Deficiency to Cardiovascular Risk Factors, Disease Status, and Incident Events in a General Healthcare Population. The American Journal of Cardiology, 106(7), 963-968. doi:10.1016/j.amjcard.2010.05.027
http://www.sciencedirect.com/science/article/pii/S0002914910011318

Cannell, J. J. (2017). Vitamin D and autism, what’s new? Reviews in Endocrine and Metabolic Disorders, 18(2), 183-193. doi:10.1007/s11154-017-9409-0
https://link.springer.com/article/10.1007/s11154-017-9409-0

Chen, J., Xin, K., Wei, J., Zhang, K., & Xiao, H. (2016). Lower maternal serum 25(OH) D in first trimester associated with higher autism risk in Chinese offspring. Journal of Psychosomatic Research, 89, 98-101. doi:10.1016/j.jpsychores.2016.08.013
http://www.sciencedirect.com/science/article/pii/S0022399916303804

Food and Nutrition Board. (2010). Dietary Reference Intakes for Vitamin D and Calcium. Washington, D.C.: National Academy Press. http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Vitamin%20D%20and%20Calcium %202010%20Report % 20Brief.pdf
Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., . . . Weaver, C. M. (2011). Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(7), 1911-1930. doi:10.1210/jc.2011-0385
https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-0385

Hollis, B. W., Johnson, D., Hulsey, T. C., Ebeling, M., & Wagner, C. L. (2011). Erratum: Vitamin D supplementation during pregnancy: Double-blind, randomized clinical trial of safety and effectiveness. Journal of Bone and Mineral Research, 26(12), 2341-2357. doi:10.1002/jbmr.537
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183324/

Hornsby, E., Pfeffer, P. E., Laranjo, N., Cruikshank, W., Tuzova, M., Litonjua, A. A., . . . Hawrylowicz, C. (2017). Vitamin D supplementation during pregnancy: Effect on the neonatal immune system in a randomized controlled trial. Journal of Allergy and Clinical Immunology. Advance online publication. doi:10.1016/j.jaci.2017.02.039
http://www.jacionline.org/article/S0091-6749(17)30575-4/fulltext

Kriegel, M. A., Manson, J. E., & Costenbader, K. H. (2011). Does Vitamin D Affect Risk of Developing Autoimmune Disease?: A Systematic Review. Seminars in Arthritis and Rheumatism, 40(6), 512-531. doi:10.1016/j.semarthrit.2010.07.009
http://www.sciencedirect.com/science/article/pii/S0049017210001484

Mcdonnell, S. L., Baggerly, K. A., Baggerly, C. A., Aliano, J. L., French, C. B., Baggerly, L. L., . . . Wagner, C. L. (2017). Maternal 25(OH)D concentrations ≥40 ng/mL associated with 60% lower preterm birth risk among general obstetrical patients at an urban medical center. Plos One, 12(7), E0180483. doi:10.1371/journal.pone.0180483
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0180483

Mirzakhani, H., Litonjua, A. A., Mcelrath, T. F., O’Connor, G., Lee-Parritz, A., Iverson, R., . . . Weiss, S. T. (2016). Early pregnancy vitamin D status and risk of preeclampsia. Journal of Clinical Investigation, 126(12), 4702-4715. doi:10.1172/jci89031
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127689/

Sweeten, T.L., & McDougle, C.J. (2016). Immunological aspects of autism. In C.J. McDougle (Ed.), Primer on Autism Spectrum Disorder. Oxford, England: Oxford University Press. http://dx.doi.org/10.1093/med/9780199349722.001.0001
Thorne-Lyman, A., & Fawzi, W. W. (2012). Vitamin D During Pregnancy and Maternal, Neonatal and Infant Health Outcomes: A Systematic Review and Meta-analysis. Paediatric and Perinatal Epidemiology, 26, 75-90. doi:10.1111/j.1365-3016.2012.01283.x
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-3016.2012.01283.x/abstract
Torres, A. R., Sweeten, T. L., Johnson, R. C., Odell, D., Westover, J. B., Bray-Ward, P., . . . Benson, M. (2016). Common Genetic Variants Found in HLA and KIR Immune Genes in Autism Spectrum Disorder. Frontiers in Neuroscience, 10, 463. doi:10.3389/fnins.2016.00463
http://doi.org/10.3389/fnins.2016.00463

Vinkhuyzen, A. A., Eyles, D. W., Burne, T. H., Blanken, L. M., Kruithof, C. J., Verhulst, F., . . . Mcgrath, J. J. (2017). Gestational vitamin D deficiency and autism spectrum disorder. British Journal of Psychiatry Open, 3(2), 85-90. doi:10.1192/bjpo.bp.116.004077
http://bjpo.rcpsych.org/content/3/2/85

Wang, H., Chen, W., Li, D., Yin, X., Olsen, N., & Zheng, S. (2017). Vitamin D and Chronic Diseases. Aging and Disease, 8(3), 346-353. doi:10.14336/AD.2016.1021
http://www.aginganddisease.org/EN/10.14336/AD.2016.1021

Wang, T., Shan, L., Du, L., Feng, J., Xu, Z., Staal, W. G., & Jia, F. (2015). Serum concentration of 25-hydroxyvitamin D in autism spectrum disorder: a systematic review and meta-analysis. European Child & Adolescent Psychiatry, 25(4), 341-350. doi:10.1007/s00787-015-0786-1
https://link.springer.com/article/10.1007/s00787-015-0786-1

The CPD’s Employability Clinic: linking adults with disabilities with that first job

September 29, 2017 by JoLynne Lyon

photo of Marissa

 Six weeks into her new job, Marissa Bell is still a happy employee. “I’m loving it. … I’m trying to do my best.”

Marissa Bell began working her first job six weeks ago, and she loved it from her first day. “I feel wonderful!” she told her job coach. “Like Wonder Woman!”

She works at a recycling center, where she was hired after attending the Disability Skills Laboratory, part of the Center for Persons with Disabilities at Utah State University. Her family decided to take Marissa there after moving to Logan and talking with a service coordinator from the Division of Services for People with Disabilities. The division recently required supported employment services before new day program services could be added to an individual’s plan.

“That’s how we heard about it [the Disability Skills Laboratory’s Employability Clinic] initially,” said Kim Jensen, Marissa’s mother. “I heard a lot of positive things about Utah State and their work with people with special needs,” she said. “They have all the new data on what helps people with disabilities.”

So Marissa began attending DSL. Vocational Rehabilitation also worked with Marissa, as did Daisha Lopez, the supported employment Coordinator at the Disability Skills Laboratory.

Typically, when the DSL’s Employment Clinic helps people find employment, it starts with meeting the family to find out more about the client’s strengths at home. “Then we meet again with the client and talk to them about different pathways to employment where they could be successful,” Lopez said.

Her advice to families of adults with disabilities who are seeking employment: Support and encourage your family member. “It can be a scary process. Just interviewing for a job alone can be a scary thing,” she said. It’s helpful when families support the job seeker, in addition to the providers.

The DSL’s Employability Clinic guides clients through a process of identifying interests and skills, then working on teaching application and interview techniques. They look at how to build a resume and find an employer to match, Lopez said. “Whether it is an individual with disabilities or not, I think there’s a lot of work… finding the perfect job. I don’t personally believe that it’s necessarily harder for people with disabilities.”

In Marissa’s case, recycling was one of her interests. They contacted an employer and brought her in to explore whether it was something she wanted to do. Sometimes an internship is a good option, but in Marissa’s case the employer wanted to hire her right away.

“I’m loving it,” Marissa said. “I love it because I am sorting papers, cardboard, magazines, all that stuff… I like doing that.” While it means less free time, she said it was a good thing. “I’m trying to do my best. The best I can.”

Visiting researcher links Vitamin D levels to mother & child health

September 25, 2017 by JoLynne Lyon

photo of Dr. Hollis

Dr. Bruce Hollis at a presentation to students and CPD staff at Utah State University

After reviewing and performing multiple clinical studies, Dr. Bruce Hollis argues vitamin D does much more than strengthen bones–and that a failure to understand its role in human health can have serious implications for pregnant and nursing mothers.

The Immunology and Genetic Laboratory at the Center for Persons with Disabilities recently hosted a seminar by Dr. Hollis, Director of Pediatric Nutritional Sciences at the Medical University of South Carolina. He spoke to USU students and CPD employees about his research on vitamin D and serum 25-hydroxyvitamin D, the chemical the vitamin becomes after it is converted in the body. Blood tests can measure the level of this chemical to determine whether a person is deficient in vitamin D. Eventually it is converted into an active hormone.

“What is a normal level of vitamin D? That is still being fought today,” Dr. Hollis said. The medical profession has not reached a consensus, and a fear of toxicity has led doctors to be conservative–too conservative, in his opinion–in how much they supplement vitamin D.

Most prenatal vitamin supplements contain 400 international units (IU) of vitamin D, while the Endocrine Society suggests pregnant and lactating women may need 1500-2000 IU. The Vitamin D Council recommends 4000, and at the Medical University of South Carolina hospital, all pregnant women are given 4000 units. After all the research done and reviewed there, Dr. Hollis said, “Our physicians have seen enough.”

The nutrient’s level in the blood varies according to a number of factors, including an individual’s exposure to sunlight, which gives it a natural boost. A 1971 study showed that lifeguards, who spent lots of time in the sun, had 250 percent higher serum 25-hydroxyvitamin D than the average, indoor-dwelling person who did not have symptoms of skeletal weakness.

In his presentation, Dr. Hollis argued that for thousands of years, vitamin D levels among most humans–hunters, gatherers, farmers–were closer to those exhibited by the lifeguards in 1971.

What’s more, the nutrient plays a role in preventing a number of diseases, including asthma in newborns (Wang, 2016). Researchers have also found links between vitamin D deficiency and hypertension, metabolic syndrome, diabetes mellitus, renal disease, autoimmune diseases and coronary heart disease (Wang, 2017 and Kriegel, 2011.)

Other researchers have reported a link between vitamin D deficiency and autism, in 15 separate studies (Cannell, 2017).

Dr. Hollis said studies show that a number of complications for pregnant women, including preterm births and pre-eclampsia, were significantly reduced when the women were given vitamin D supplements far above those found in prenatal vitamins.

 

photo of pregnant woman

A number of complications for pregnant women were significantly reduced when they were given vitamin D supplements far above those found in most prenatal vitamins.

Other studies show that nursing mothers with low vitamin D levels do not pass enough of the nutrient on to their babies. “It is well known that human milk is low in vitamin D,” Dr. Hollis said. “Of course human milk is deficient in vitamin D, because the mother doesn’t have it.”

He was the lead author in a 2015 study that found nursing mothers could pass sufficient vitamin D to their babies if they received 6400 units of vitamin D a day. When the mother’s own levels were high enough, she also passed the nutrient on to her child via breast milk. While nursing mothers are encouraged to give their babies vitamin D supplements, many don’t do it, he said—and in extreme cases their children can suffer fractures caused by weak bones brought on through the deficiency.

“Dr. Hollis and his colleagues have conducted some ground breaking studies regarding the nutritional needs of Vitamin D during pregnancy and lactation,” said Dr. Thayne Sweeten, director of the Immunology and Genetic Research Laboratory at the Center for Persons with Disabilities. “Deficiency of this hormone occurs in over 60% of individuals in Utah.  People need to know about these findings so that they can make informed choices to hopefully improve their vitamin D levels.”

Hollis visited USU on September 20.

CPD study continues longitudinal look at environment, children’s health

September 6, 2017 by JoLynne Lyon

 

photo of children holding hands

CPD researchers are re-enrolling National Children’s Study participants in a new effort to understand how the environment affects children’s health. During the National Children’s Study, the CPD site enrolled more participants than any other site in the nation.

The Center for Persons with Disabilities at Utah State University is partnering with the University of Utah on a landmark project to help researchers better understand children’s health.

For a year now, data for what is now called the Utah Children’s Project has been collected on a number of different factors: the effects of exposure to air pollution and environmental chemicals; stress, sleep and nutrition.  This year, researches added the effects of the microbiome (microorganisms carried on the skin, nasal cavities and the digestive system) to the list of factors being studied.

The Utah Children’s Project has joined with other research sites around the country in re-enrolling the National Children’s Study participants who contributed data from 2009 through 2012. This national effort combines information from former National Children’s Study sites in an initiative called the Environmental Influences on Children’s Health Outcomes (ECHO). It is funded through the National Institutes of Health, and it continues the longitudinal collection of data for up to seven years.

The CPD site enrolled more families in the National Children’s Study than any other site in the country. Re-enrollment is going well, said Dr. Mark Innocenti, who directs the research and evaluation division of the CPD. He is leading the Utah Children’s Project at the CPD site. “We have a friendly population here in Utah. … It’s nice that they’re willing to help move science along.”

Both ECHO and the Utah Children’s Project aim to understand the effects of environment on children’s health, from before birth and on into childhood. Thanks to the information collected, future researchers can better understand factors that affect children’s health, and in what ways.

Data comes to the project via questionnaires, physical exams, swabs and blood draws at the Center for Persons with Disabilities and other sites involved in the Utah Children’s Project.

The ECHO initiative will examine how the factors might influence gene expression and health through childhood and adolescence, especially as it relates to upper and lower airway health, obesity, neurodevelopment, positive health outcomes and satisfaction with life.

The data collected will later be analyzed to answer a number of future research questions, Innocenti said.

Dickey’s DSL Scoop: August 2017

August 30, 2017 by JoLynne Lyon

by Ryan and Sara Dickey

In August we were able to do many fun, new and exciting things here at DSL! Summer Program came to an end on the August 19th.  We celebrated the end of summer by having the 2nd Annual DSL Summer Olympics! Some of the events included:  Bean Bag toss, a watermelon eating contest, water balloon toss which is just a nice way to say WATER FIGHT!!! We also had pizza and drinks and had a terrific time.

 

 

We also went to the park many times in August.  We had many water fights.  We played water balloon baseball, and Frisbee throwing.

 

A participant smiles under the pavilion.

 

We were very busy in the kitchen!  We made fruit salsa with tortillas, and graham crackers, it was delicious!  We also made peanut butter cookies, pumpkin cookies, and a milk can lunch.  Our milk can lunch consisted of smoked sausage, potatoes, corn, carrots, and cabbage, Justis was in charge and it was DELICIOUS!

We went swimming at the Logan Aquatic Center and HPER building, a great way to cool off! We did many activities with Common Ground: Cycling, fishing, and a Dutch oven lunch of mac and cheese.

We tried something new this month at the movies. We decided that we would choose between two different choices at the movies.  We could go see Spiderman or the Emoji Movie.  That worked really well, everyone loved their movie choice.

Some of our staff and participants went to the CPD picnic and had a great time eating and swimming.

We also had random act of kindness day.  We painted rocks with kind words. We will distribute them in different parks.  Looking forward to fall weather and September!