Vitamin D Benefits Women in Every Phase of Life, Says Dr. Raman Marwaha

Dr. Raman Marwaha, is a distinguished medical practitioner based in the vibrant city of New Delhi, India. With a remarkable focus on research surrounding Vitamin D benefits, he has become a leading authority in the field, delving into its multifaceted impact on health and well-being. Dr. Marwaha's expertise extends far beyond his groundbreaking contributions to Vitamin D studies, as he has also garnered extensive knowledge and experience in addressing crucial health concerns such as Malnutrition, Vitamin D Deficiency, Hypothyroidism, Bone Marrow Aspiration, and Splenectomy.

Importance of vitamin D in women’s bodies

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While vitamin D in women's bodies is important for musculoskeletal health, there is accumulating data suggesting that it may also be important for fertility, pregnancy outcomes, and lactation. The physiological relevance of this vitamin in women's bodies is based on the fact that there is an almost 2-fold rise in serum levels of active vitamin D {1,25(OH)D} in the first trimester with a further 2 to 3 times rise during later pregnancy as compared to non-pregnant women.

The role of vitamin D in women's bodies is now particularly being recognized for immune modulation of the maternal-fetal interface. It is believed to stimulate sex hormones, implantation/ placentation, and respiratory maturation. Findings from systemic reviews and meta-analyses on vitamin D status and outcomes of assisted reproductive treatment (ART) show that compared to women with deficient or insufficient vitamin D status, women with replete vitamin status had more live births (Odd Ratio (OR): 1.33), more positive pregnancy tests (OR: 1.34), and more clinical pregnancies (OR 1.46). Some studies have even documented a significant increase in early spontaneous pregnancy loss with low serum vitamin D in women's bodies.

Vitamin D During Pregnancy and lactation

Low vitamin D in women's bodies levels are a risk factor for hypertensive disorders in Pregnancy such as pre-eclampsia, gestational diabetes mellitus, osteomalacia, and cesarean sections. Moreover, in the majority of published meta-analyses of observational studies, low serum vitamin D {25(OH)D} concentrations are associated with the increased risk of small for gestational age (SGA), preterm birth, rickets in utero/at birth neonatal tetany, hypocalcemic seizures, etc. In several metanalyses, low serum concentrations in pregnant women have been shown to be associated with an increased risk of their children suffering from childhood asthma, wheezing, respiratory infections, allergic rhinitis, and eczema. Some studies even suggest its role in brain development, cognitive function, and psychological function and may reduce the risk of autism spectrum disorders. As of today, vitamin D supplementation in the first trimester is not recommended because

a) we do not have sufficient evidence of benefits with vitamin D supplementation during the first trimester

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b) the fetus is most susceptible to being damaged by drugs, medicines, alcohol, illness, etc during this period as all organs are formed in this trimester. It is therefore advisable to recommend women planning to conceive achieve adequate levels (>30ng) before conception through supplementation so that sufficient levels of vitamin D in women's bodies are maintained during the first three months because of its long half-life.

Vitamin D and Pre-Menstrual Syndrome (PMS)

PMS is a common disorder that affects millions of women of reproductive age worldwide with a prevalence of 20-40%. Physical complaints of edema, weight gain, mastalgia, headache, paraesthesia, nasal obstruction, and psychological complaints of irritability, anxiety & depression are experienced by most women during the luteal phase of the menstrual cycle (14-28th day of the cycle). There are conflicting reports with regard to the role of vitamin D in PMS. However, a recent systemic review analyzing the results of most high-quality studies regarding the role of calcium and vitamin D in PMS indicates that low levels of vitamin D and calcium during the luteal phase of the menstrual cycle can cause/intensify the symptoms of PMS.

Vitamin D and Calcium supplementation can increase serum levels of both these micronutrients and may eliminate or reduce the severity of PMS symptoms. Vitamin D and calcium supplementation are considered to be a safer, more effective, acceptable, low cost and convenient method for reducing the intensity and frequency of PMS symptoms and improving women’s quality of life when compared with treatments such as YOGA, cognitive behavioral therapy ( CBT), medications like fluoxetine, and combined oral contraceptive pills (COC), etc. Whether there is a causal relationship between vitamin D deficiency and PMS has not been established.

Role of Vitamin D in PCOS

Polycystic Ovary Syndrome (PCOS) is one of the most commonly encountered in reproductive-aged women with a prevalence of 5-20%. The root cause of PCOS has yet not been established. It is probably multifactorial where both genetic and environmental factors play a role. It is commonly responsible for infertility among women and is characterized by clinical/and or biochemical hyperandrogenism, menstrual disorders like amenorrhea/oligomenorrhea, and ovarian dysfunction. Whether vitamin D adjuvant therapy improves hormonal, inflammation, and oxidative damage in PCOS patients has aroused widespread interest, but the results are controversial. Though vitamin D deficiency has been commonly observed (67-85%) in PCOS patients, but, whether vitamin D adjuvant therapy is linked to reproductive function, metabolic alterations like insulin resistance and mental health is truly beneficial in them is controversial. Recent reviews have shown vitamin D therapy to decrease serum androgens and Anti-Mullerian

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Hormone (AMH) in PCOS patients, resulting in the decrease of endometrial thickness and having positive effects on the menstrual cycle and folliculogenesis. The probability of ovulation seems to correlate with vitamin D levels in PCOS and the maximum probability of ovulation (78%) was observed in subjects with serum vitamin D levels > 30ng/ml as compared to those with serum levels <20ng/ml. These effects of vitamin D may also be explained by its immunomodulatory effects through a decrease in inflammatory cytokine and an increase in anti-inflammatory cytokines in animal studies. In view of controversial results with regard to the benefits of supplementing vitamin D therapy in PCOS patients, it is recommended to keep the serum vitamin D levels to around 30ng/ml which is necessary for normal bone health.

How does vitamin D help during menopause?

There are several prevalent conditions in postmenopausal women associated with low serum 25(OH)D; hence, normalization of serum 25(OH)D levels may improve those conditions. Post-menopausal bone loss, related to estrogen deficiency, is the primary contributor to osteoporosis which increases the risk of fractures that can be associated with significant morbidity and mortality. Other important risk factors include Ca & vitamin D deficiency, smoking, alcohol, advancing age, genetics, thinness, etc. In postmenopausal women, low vitamin D levels are associated with hypersecretion of PTH resulting in increased bone loss and reduction in bone density. Vitamin D supplementation reduces serum PTH and increases 25(OH)D levels resulting in the prevention of bone loss and reducing cortical bone porosity. Subjects aged 65 years who have low serum 25(OH)D levels, have low muscle function and are more frail. The number of fragility fractures is higher among those with confirmed low muscle mass (sarcopenia). Cholecalciferol (D3) treatment not only increases serum 25(OH)D levels and improves physical performance but also reduces the risks of falls.

Women who are not vitamin D deficient would not obtain benefits from vitamin D supplementation. However, elderly women that do not receive active bone-forming treatments and have osteoporosis and low serum vitamin D should receive vitamin D supplementation as an anti-fracture agent. Meta-analysis of randomized controlled trials (RCTs) indicates that vitamin D and calcium supplementation produce a significant reduction of fracture risk (spine and hip).

Given its numerous benefits, women should be mindful of their vitamin D intake and ensure they meet the recommended daily allowance. Talk to Gytree Experts to know more about the importance of vitamin D in women's bodies. Regular monitoring of vitamin D levels and consulting with healthcare professionals can help women optimize their vitamin D status and ultimately contribute to their overall health and quality of life.