Acta Neurol Scand DOI: 10.1111/ane.12306
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Clinical Commentary
Multiple sclerosis and vitamin D during pregnancy and lactation Jalkanen A, Kauko T, Turpeinen U, H€ am€ al€ ainen E, Airas L. Multiple sclerosis and vitamin D during pregnancy and lactation. Acta Neurol Scand: 10.1111/ane.12306. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background – Both pregnancy and high vitamin D concentration seem to generate a protective environment against multiple sclerosis (MS) relapses. Longitudinal case–control analysis of vitamin D concentrations during pregnancy and lactation of MS mothers is lacking. Aims of the study – To examine serum 25-hydroxyvitamin-D3 levels of MS patients during and after pregnancy and compare these to the levels measured in healthy controls. Methods – Fifteen relapsing–remitting MS mothers underwent repeated testing for 25-hydroxyvitamin-D3 at 10–12, 26–28 and 35–37 gestational weeks and 1, 3 and 6 months post-partum. An identical series of samples was collected from six control mothers. Results – The prevalence of vitamin D deficiency ( 75 nmol/l and the infant’s requirements for calcium (2). In Europe, consensus on the optimal dietary vitamin D intake, however, has not yet been reached and there is large variation in recommended intakes across different countries (14). Current Nordic recommendation (10 lg, 400 IU) from 2004 seems inadequate, especially during the winter months in these northern latitudes (15). Optimising the vitamin D intake of our MS patients is safe and cheap. We would thus recommend daily vitamin D supplementation of at least 35 lg (1400 IU) regardless the season for pregnant and lactating MS mothers to ensure that also the non-skeletal health benefits are attained. Acknowledgements The following people are acknowledged for contributions to data acquisition: Dr Saara V€ ais€ anen, Department of Neurology, and Dr Anna Alanen, Department of ObGyn, Turku University Hospital; Dr Markus F€ arkkil€ a and Dr Juha Multanen, Department of Neurology, and Dr Risto Kaaja, Department of ObGyn, Helsinki University Hospital; Dr Tuula Pirttil€ a, Department of Neurology, and Dr Maritta R€as€anen, Department of ObGyn, Kuopio University Hospital; Dr Taneli Sarasoja, Department of Neurology, KeskiSuomi Central Hospital, Jyv€ askyl€ a; Dr Juha Huhtakangas; Dr Peter Baumann, Dr Seppo Tuisku, Department of Neurology, Keski-Pohjanmaa Central Hospital, Kokkola; Dr Annikki Salmivaara, Department of Neurology, P€ aij€ at-H€ ame Central Hospital, Lahti; and Dr Laura Kupila, Department of Neurology, Rauma District Hospital.
Conflicts of interests and Sources of Funding Statement Authors declare no conflict of interest. This work was supported by the Finnish Medical Foundation, the University of Turku Graduate School and a grant from Turku University.
References 1. WEINSTOCK-GUTTMAN B, MEHTA BK, RAMANATHAN M et al. Vitamin D and multiple sclerosis. Neurologist 2012;18:179–83.
4
2. HOLICK MF, BINKLEY NC, BISCHOFF-FERRARI HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30. 3. PATAS K, ENGLER JB, FRIESE MA et al. Pregnancy and multiple sclerosis: feto-maternal immune cross talk and its implications for disease activity. J Reprod Immunol 2013;97:140–6. 4. BRANNON PM, PICCIANO MF. Vitamin D in pregnancy and lactation in humans. Annu Rev Nutr 2011;31:89– 115. 5. DAWODU A, AKINBI H. Vitamin D nutrition in pregnancy: current opinion. Int J Womens Health 2013;5:333–43. 6. JALKANEN A, ALANEN A, AIRAS L. Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler 2010;16:950–5. 7. TURPEINEN U, HOHENTHAL U, STENMAN UH. Determination of 25-hydroxyvitamin D in serum by HPLC and immunoassay. Clin Chem 2003;49:1521–4. 8. HEWER S, LUCAS R, VAN DER MEI IA et al. Vitamin D and multiple sclerosis. J Clin Neurosci 2013;20:634–41. 9. MIRZAEI F, MICHELS KB, MUNGER K et al. Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol 2011;70:30–40. 10. VAN DER MEI IA, PONSONBY AL, DWYER T et al. Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol 2007;254:581– 90. 11. TORKILDSEN O, LOKEN-AMSRUD KI, WERGELAND S et al. Fat-soluble vitamins as disease modulators in multiple sclerosis. Acta Neurol Scand Suppl 2013;196:16–23. 12. NASHOLD FE, SPACH KM, SPANIER JA et al. Estrogen controls vitamin D3-mediated resistance to experimental autoimmune encephalomyelitis by controlling vitamin D3 metabolism and receptor expression. J Immunol 2009;183:3672–81. 13. LAMBERG-ALLARDT C, LARJOSTO M, SCHULTZ E. 25Hydroxyvitamin D concentrations in maternal and cord blood at delivery and in maternal blood during lactation in Finland. Hum Nutr Clin Nutr 1984;38:261–8. 14. BROUWER-BROLSMA EM, BISCHOFF-FERRARI HA, BOUILLON R et al. Vitamin D: do we get enough? A discussion between vitamin D experts in order to make a step towards the harmonisation of dietary reference intakes for vitamin D across Europe. Osteoporos Int 2013;24: 1567–77. 15. Nordic Nutrition Recommendations. Nord 2004, 4th edn, Vol. 13. Copenhagen: Nordic Council of Ministers, 2004. Integrating nutrition and physical activity (NNR 2004).
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd ACTA NEUROLOGICA SCANDINAVICA
Clinical Commentary
Multiple sclerosis and vitamin D during pregnancy and lactation Jalkanen A, Kauko T, Turpeinen U, H€ am€ al€ ainen E, Airas L. Multiple sclerosis and vitamin D during pregnancy and lactation. Acta Neurol Scand: 10.1111/ane.12306. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. Background – Both pregnancy and high vitamin D concentration seem to generate a protective environment against multiple sclerosis (MS) relapses. Longitudinal case–control analysis of vitamin D concentrations during pregnancy and lactation of MS mothers is lacking. Aims of the study – To examine serum 25-hydroxyvitamin-D3 levels of MS patients during and after pregnancy and compare these to the levels measured in healthy controls. Methods – Fifteen relapsing–remitting MS mothers underwent repeated testing for 25-hydroxyvitamin-D3 at 10–12, 26–28 and 35–37 gestational weeks and 1, 3 and 6 months post-partum. An identical series of samples was collected from six control mothers. Results – The prevalence of vitamin D deficiency ( 75 nmol/l and the infant’s requirements for calcium (2). In Europe, consensus on the optimal dietary vitamin D intake, however, has not yet been reached and there is large variation in recommended intakes across different countries (14). Current Nordic recommendation (10 lg, 400 IU) from 2004 seems inadequate, especially during the winter months in these northern latitudes (15). Optimising the vitamin D intake of our MS patients is safe and cheap. We would thus recommend daily vitamin D supplementation of at least 35 lg (1400 IU) regardless the season for pregnant and lactating MS mothers to ensure that also the non-skeletal health benefits are attained. Acknowledgements The following people are acknowledged for contributions to data acquisition: Dr Saara V€ ais€ anen, Department of Neurology, and Dr Anna Alanen, Department of ObGyn, Turku University Hospital; Dr Markus F€ arkkil€ a and Dr Juha Multanen, Department of Neurology, and Dr Risto Kaaja, Department of ObGyn, Helsinki University Hospital; Dr Tuula Pirttil€ a, Department of Neurology, and Dr Maritta R€as€anen, Department of ObGyn, Kuopio University Hospital; Dr Taneli Sarasoja, Department of Neurology, KeskiSuomi Central Hospital, Jyv€ askyl€ a; Dr Juha Huhtakangas; Dr Peter Baumann, Dr Seppo Tuisku, Department of Neurology, Keski-Pohjanmaa Central Hospital, Kokkola; Dr Annikki Salmivaara, Department of Neurology, P€ aij€ at-H€ ame Central Hospital, Lahti; and Dr Laura Kupila, Department of Neurology, Rauma District Hospital.
Conflicts of interests and Sources of Funding Statement Authors declare no conflict of interest. This work was supported by the Finnish Medical Foundation, the University of Turku Graduate School and a grant from Turku University.
References 1. WEINSTOCK-GUTTMAN B, MEHTA BK, RAMANATHAN M et al. Vitamin D and multiple sclerosis. Neurologist 2012;18:179–83.
4
2. HOLICK MF, BINKLEY NC, BISCHOFF-FERRARI HA et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911–30. 3. PATAS K, ENGLER JB, FRIESE MA et al. Pregnancy and multiple sclerosis: feto-maternal immune cross talk and its implications for disease activity. J Reprod Immunol 2013;97:140–6. 4. BRANNON PM, PICCIANO MF. Vitamin D in pregnancy and lactation in humans. Annu Rev Nutr 2011;31:89– 115. 5. DAWODU A, AKINBI H. Vitamin D nutrition in pregnancy: current opinion. Int J Womens Health 2013;5:333–43. 6. JALKANEN A, ALANEN A, AIRAS L. Pregnancy outcome in women with multiple sclerosis: results from a prospective nationwide study in Finland. Mult Scler 2010;16:950–5. 7. TURPEINEN U, HOHENTHAL U, STENMAN UH. Determination of 25-hydroxyvitamin D in serum by HPLC and immunoassay. Clin Chem 2003;49:1521–4. 8. HEWER S, LUCAS R, VAN DER MEI IA et al. Vitamin D and multiple sclerosis. J Clin Neurosci 2013;20:634–41. 9. MIRZAEI F, MICHELS KB, MUNGER K et al. Gestational vitamin D and the risk of multiple sclerosis in offspring. Ann Neurol 2011;70:30–40. 10. VAN DER MEI IA, PONSONBY AL, DWYER T et al. Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol 2007;254:581– 90. 11. TORKILDSEN O, LOKEN-AMSRUD KI, WERGELAND S et al. Fat-soluble vitamins as disease modulators in multiple sclerosis. Acta Neurol Scand Suppl 2013;196:16–23. 12. NASHOLD FE, SPACH KM, SPANIER JA et al. Estrogen controls vitamin D3-mediated resistance to experimental autoimmune encephalomyelitis by controlling vitamin D3 metabolism and receptor expression. J Immunol 2009;183:3672–81. 13. LAMBERG-ALLARDT C, LARJOSTO M, SCHULTZ E. 25Hydroxyvitamin D concentrations in maternal and cord blood at delivery and in maternal blood during lactation in Finland. Hum Nutr Clin Nutr 1984;38:261–8. 14. BROUWER-BROLSMA EM, BISCHOFF-FERRARI HA, BOUILLON R et al. Vitamin D: do we get enough? A discussion between vitamin D experts in order to make a step towards the harmonisation of dietary reference intakes for vitamin D across Europe. Osteoporos Int 2013;24: 1567–77. 15. Nordic Nutrition Recommendations. Nord 2004, 4th edn, Vol. 13. Copenhagen: Nordic Council of Ministers, 2004. Integrating nutrition and physical activity (NNR 2004).
