Bacteria-coated vaginal epithelial cells in Bacterial Vaginosis
Bacterial vaginosis (or BV for short) is the most common vaginal infection in women, and in pregnancy has been linked to premature labor and delivery. Despite this, interventions to diagnose and treat BV in pregnancy have had only modest impact, and then only in the subgroup of women with a history of previous preterm birth.
The results of this study, if confirmed in larger trials, would suggest that vitamin D deficiency may be the cause for bacterial vaginosis in pregnancy, and that supplementation of this vitamin might be worth investigating as an intervention to prevent preterm birth.
It’s an interesting idea, but just a hypothesis at this point. Although the study is well-done, it does not prove causality. Both BV and vitamin D deficiency are incredibly common conditions, both in pregnant and non-pregnant women. To find them together in the same patient would not be unexpected given their relatively high frequency in general. (In this study, almost half the women had BV – that’s a very high incidence.)
On the other hand, the researchers did find a dose-response relationship between vitamin D levels and BV incidence, and that would support a real effect rather than mere association. Interestingly, vitamin D deficiency has also been linked to periodontal disease, another condition that is found to be associated with preterm labor and delivery.
The most intriguing aspect of this study lies in the fact that all three conditions – vitamin D deficiency, preterm birth and BV – occur more often in African American women, individuals whose darker skin requires longer sun exposures to convert vitamin D to its active form. Preterm labor in this group has been especially hard to explain because this increased risk is independent of socioeconomic status. Could Vitamin D deficiency in African American women be the common factor that explains this increased risk? Wouldn’t it be neat if correcting that deficiency were to prevent preterm labor and delivery?
Unfortunately, most things in medicine these days don’t present solutions that are so neatly packaged as this one. Not to mention the fact that BV was present in almost a quarter of the group with the highest vitamin D levels in this study, which would argue that something other than vitamin D is at play. So while it is intruguing, it is much too soon to jump on this bandwagon. But I will be watching the parade closely.
By the way, most prenatal vitamins carry about 400 IU of vitamin D. Emerging data are beginning to suggest that higher doses of vitamin D may be necessary, but this remains controversial. I am comfortable recommending vitamin D supplementation doses up to 800-1000 IU daily in my non-pregnant patients. These doses are safe, and in my experience, usually result in vitamin D levels in the mid 30’s ng/dl.(equivalent to the highest levels in this study). If you are pregnant and have questions about vitamin D, it’s best to talk to your doctor before going above current dose recommendations (200-400 IU daily).
I’ve been thinking about getting my vitamin D levels checked… I don’t get out in the sun much- and when I do I have SPF 50 on usually! 🙂 Interesting hypothesis – it would be neat if pre-term birth could be reduced with a vitamin.
I’ve seen this study making the rounds in the media as well and it seems to be part of a trend of vitamin D being the new panacea (for prevention of everything from autism to c-section). But anyone who studies preterm birth knows its multifactorial and there will be no magic bullet that is as simple to administer as a vitamin supplement (same with autism and c-section, for that matter). I’m curious if you’re familiar with the research on the Centering model of prenatal care. To my knowledge, it’s the only intervention to significantly lower preterm birth rates. It was evaluated in this multi-center RCT . The intervention was in fact more protective for African American women. But reorganizing how we deliver prenatal care is a lot trickier than drawing more bloodwork and dispensing another medication (Although its been implemented successfully in dozens (maybe even hundreds? of sites.)
Thanks for this really nice post!
There is this new dilemma of having or not having or not having vitamins.pretty confusing for the beginners.
The research is pointing to a link between sufficient vitamin D and the production of specific bacteria-killing immune proteins. At healthy vitamin D levels, the cells make a normal amount of these antibacterial proteins. At insufficient vitamin D levels, the product is slowed down, and at excessive Vitamin D levels, production is also hindered. There seems to be a healthy sweet spot for Vitamin D and immune health.
There is a lot of talk about vitamins and whether supplements should be taken or not,whether diet could be the source of sufficient vitamins or not.
Howdy! I could have sworn I’ve visited this website before but after browsing through some of the posts I realized it’s new to me. Anyhow, I’m definitely happy I stumbled upon it and I’ll be bookmarking it and checking back regularly!