Use of vitamin D supplements during pregnancy has long been a matter of concern but now researchers writing in the Journal of Bone and Mineral Research report that even a high supplementation amount in healthy pregnant women was safe and effective in raising circulating vitamin D to a level thought by some to be optimal. The study also found no adverse effects of vitamin D supplementation, even at the highest amount, in women or their newborns.

The research team, led by Dr. Bruce Hollis from the Medical University of South Carolina in Charleston, used a randomized controlled trial with healthy expectant mothers to discover how varying dosages of daily supplements could safely sustain a circulating vitamin D level of at least 32 nanograms per milliliter.

“Vitamin D supplementation during pregnancy remains controversial largely due to severe misconceptions about the potential harm it may cause to the fetus,” said Dr Hollis. “Surprisingly the scientific debate has made little progress since Dr. Gilbert Forbes made a recommendation of 200 IU (international units) per day in 1963, which was based on a hunch.”

While the threat of vitamin D during pregnancy has remained little known, it has been established that the vitamin plays a role in homeostasis, the body’s internal regulation, during pregnancy and that a deficiency can effect immune, pancreatic and cardiovascular systems.

Dr Hollis’ team monitored the pregnancies of 350 women, from a variety of ethnic and socio-economic backgrounds, who were all between 12 and 16 weeks into gestation. The women were randomly assigned to one of three groups. One group received 400 IU of vitamin D per day, the second group received 2,000 IU per day and the third received 4,000 IU daily.

The team found that women who received the highest level of supplementation (4,000 IU per day) were more likely to achieve and sustain the desired level of circulating levels of vitamin D throughout their pregnancy. Moreover, the researchers found that pregnant women who received lower levels of vitamin D supplementation did not attain the threshold circulating level of the vitamin.

“In our study subjects, a daily dosage of up to 4,000 IU of vitamin D was required to sustain normal metabolism in pregnant women,” concluded Dr Hollis. “Furthermore, following decades of speculation into its safety our research has demonstrated vitamin D supplementation to be both safe and effective.”

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The survey, conducted as part of the 2007 National Health Interview Survey (NHIS), an annual study in which tens of thousands of Americans are interviewed about their health- and illness-related experiences, was developed by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health (NIH) and the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention (CDC). The survey included questions on 36 types of CAM therapies commonly used in the United States—10 types of provider-based therapies, such as acupuncture and chiropractic, and 26 other therapies that do not require a provider, such as herbal supplements and meditation.

“The 2007 NHIS provides the most current, comprehensive, and reliable source of information on Americans’ use of CAM,” said Josephine P. Briggs, M.D., director of NCCAM. “These statistics confirm that CAM practices are a frequently used component of Americans’ health care regimens, and reinforce the need for rigorous research to study the safety and effectiveness of these therapies. The data also point out the need for patients and health care providers to openly discuss CAM use to ensure safe and coordinated care.”

The 2007 survey results, released in a National Health Statistics Report by NCHS, are based on data from more than 23,300 interviews with American adults and more than 9,400 interviews with adults on behalf a child in their household. The 2007 survey is the second conducted by NCCAM and NCHS—the first was done as part of the 2002 NHIS.**

CAM Use Among Adults

Comparison of the data from the 2002 and 2007 surveys suggests that overall use of CAM among adults has remained relatively steady—36 percent in 2002 and 38 percent in 2007. However, there has been substantial variation in the use of some specific CAM therapies, such as deep breathing, meditation, massage therapy, and yoga, which all showed significant increases.

The most commonly used CAM therapies among U.S. adults were

* Nonvitamin, nonmineral, natural products (17.7 percent) Most common: fish oil/omega 3/DHA, glucosamine, echinacea, flaxseed oil or pills, and ginseng***

* Deep breathing exercises (12.7 percent)

* Meditation (9.4 percent)

* Chiropractic or osteopathic manipulation (8.6 percent)

* Massage (8.3 percent)

* Yoga (6.1 percent).

Adults used CAM most often to treat pain including back pain or problems, neck pain or problems, joint pain or stiffness/other joint condition, arthritis, and other musculoskeletal conditions. Adult use of CAM therapies for head or chest colds showed a marked decrease from 2002 to 2007 (9.5 percent in 2002 to 2.0 percent in 2007).

Consistent with results from the 2002 data, in 2007 CAM use among adults was greater among:.

* Women (42.8 percent, compared to men 33.5 percent)

* Those aged 30-69 (30-39 years: 39.6 percent, 40-49 years: 40.1 percent, 50-59 years: 44.1 percent, 60-69 years: 41.0 percent)

* Those with higher levels of education (Masters, doctorate or professional: 55.4 percent)

* Those who were not poor (poor: 28.9 percent, near poor: 30.9 percent, not poor: 43.3 percent)

* Those living in the West (44.6 percent)

* Those who have quit smoking (48.1 percent)

CAM Use Among Children

Overall, CAM use among children is nearly 12 percent, or about 1 in 9 children. Children are five times more likely to use CAM if a parent or other relative uses CAM. Other characteristics of adult and child CAM users are similar—factors such as socioeconomic status, geographic region, the number of health conditions, the number of doctor visits in the last 12 months, and delaying or not receiving conventional care because of cost are all associated with CAM use.

Among children who used CAM in the past 12 months, CAM therapies were used most often for back or neck pain, head or chest colds, anxiety or stress, other musculoskeletal problems, and Attention Deficit/Hyperactivity Disorder (ADD/ADHD).

The most commonly used CAM therapies among children were

* Nonvitamin, nonmineral, natural products (3.9 percent) Most common: echinacea, fish oil/omega 3/DHA, combination herb pill, flaxseed oil or pills, and prebiotics or probiotics

* Chiropractic or osteopathic manipulation (2.8 percent)

* Deep breathing exercises (2.2 percent)

* Yoga (2.1 percent).

“The survey results provide information on trends and a rich set of data for investigating who in America is using CAM, the practices they use, and why,” said Richard L. Nahin, Ph.D., MPH, acting director of NCCAM’s Division of Extramural Research and co-author of the National Health Statistics Report. “Future analyses of these data may help explain some of the observed variation in the use of individual CAM therapies and provide greater insights into CAM use patterns among Americans.”