biochemical dose-response curve would have been improved by the inclusion of other dose levels, enrolment was limited to healthy and low risk, and those who would adhere to the protocol (p.14). Also enrolment was not placed during the entire season but it occurred during the peak summer months. Additional, “studies of equal or lesser doses are required to establish amaternal-infant benefits and longer-term safety (15-16).”A low maternal vitamin D levels at the time of delivery is related to an increase in caesarean section thus affecting health outcome. In this study they found that first-trimester maternal serum vitamin D levels are similar between pregnancies resulting in vaginal delivery and those that required an elective or emergency caesarean section, this is was unlikely that the levels in the first-trimester play a role in mode of delivery (Savvidou, Makgoba, Castro, Akolekar, & Nicolaides, 2012, p. 1975). The rationale behind the study was that vitamin D is needed for both maintenance and for muscular contractility, muscle growth and function (p.1974). The role of vitamin D is expanding, recent studies have shown that low vitamin D in “pregnancy is associated with multiple potential adverse maternal, fetal and infant outcomes and contributes to low vitamin D status is infants at birth (Dawodu & Akinbi, 2013, p. 333).” Defining the optimal level of a vitamin D status in pregnancy remains very controversial and intervention trials are needed to identify a safe vitamin D intake for mothers and their offspring (p.340).Using the “Cochran Pregnancy and Childbirth Group’s Trials Register , the International Clinical Trials Registry Platform and the Networked Digital Library of Theses and Dissertations
VITAMIN D AND CALCIUM RESEARCH PROPOSAL8and also contacted relevant organization (De-Regil, Palacios, Ansary, Kulier, & Pena-Rosas, 2013, p. 1).” Two review authors impartially evaluated the studies contrary to the inclusion criteria and removed data from those studies and evaluated the peril of bias of those studies (p. 1). Further studies were suggested to evaluate the role of vitamin D supplementation in pregnancy and to increase the serum vitamin D concentration related to improved maternal and infant outcomes (p. 19-20).The results of this article stated that “vitamin D levels of >32 and <50-60 ng/mL seems tobe associated with the lowest risk of disease (Principi, Bianchini, Baggi, & Esposito, 2012, p. 2).” Further studies are needed to determine how much vitamin D is needed to assure regular evolution of pregnancy and development of the fetus and child (p. 2).There is a wide range of health outcomes because vitamin D acts as a marker for obesity. A strive to reach levels of greater than 50 nmo/L in most populations including pregnant women seems to be reasonable (Barrett & McElduff, 2010, p. 536). There needs to be randomized trials of vitamin D supplementation with vitamin D to determine a baseline status (p. 536).
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