Join our webinar to know more about ‘HOW VITAMIN-D DEFICIENCY AFFECTS WOMEN’S HEALTH’ from expert at Apollo Cradle & Children’s Hospital
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Good afternoon everyone today’s session is going to be really helpful and it’s led by Dr SEMA Sharma from Apollo cradle and Children’s Hospital uh she’s going to talk about how vitamin D deficiency affects women’s health so stick around until the end and ask us questions if you have any doctor you have the
Stage yeah hi good afternoon everyone who has joined the Facebook live and I’m Dr s Sharma as uh she has already introduced me I’m a senior consultant with Apollo credle Amisa today we are going to uh talk about uh vitamin role of vitamin D in Women Health so as this
Talk uh um first question that comes to my mind is what is vitamin D and why it is so important in women’s life and uh what is its function what are it sources from where we get vitamin D what is its requ daily requirement and vitamin D how
Important is vitamin D in pregnancy and lactation role in pcus and infertility and menstrual irregularities so I’ll take up all these uh one by one so first of all coming to what is vitamin D vitamin D as we know is a sunshine vitamin D it’s a f fat soluble Factor D
So uh it comes from sunlight so vitamin is also called calciferol since it was found to boost calcium deposit in the bone so despite its Discovery 100 years ago vitamin D has emerged as one of the most controversial nutrients and pro hormones of this 21st century so vitamin
D was also called uh calciferol but it is uh as it was found to increase the calcium metabolism and hence deposition in the bones so the there are two types of vitamin D uh arerol is the basic building block of vitamin D which is found in plants so and 17d hydroch
Cholesterol is a basic building uh block of vitamin D in human beings so a major source of what are the sources of vitamin D as we all know everybody knows that if we sit in the sun we get vitamin D this much everyone knows but it is
Important to know when to sit and how to take vitamin D from the sunlight so uh it is uh the time when the vitamin D is available to us is between 10: a.m. to 12:00 p.m. that is um between 10: to 12:00 p.m. in the morning so whenever
Because that at that time the UV light which is in the wavelength of 290 to 300 nanometer that is useful and that converts when it hits the human beings it converts the 7D hydroch cholesterol in the skin to PO calciferol similarly in Plants also when the sunlight uh hits
The leaf of the plants ergosterol is converted to ergocalciferol or vitamin D2 so this is the major source Sunshine is the major source of vitamin D and Quality quality is that is uh appropriate wavelength of sunlight and quantity both are important other sources of vitamin D are
Dietary vitamin D and mainly it comes from the meat fish and fortified dairy products soya products so they are minor sources of vitamin D so this uh from the diet the uh how it is converted into uh vitamin D3 whenever we take dietary pro pro vitamin D that goes to
The liver and in from liver it get metabolized and then it goes to the kidneys and from kidneys it gets converted into dihydro 17 dihydro kic calero and this kic calciferol uh this has with the help of parat hormone there’s one hormone called paraone it increas increases the calcium metabolism
And calcium absorption from the small intestine increases calcium absorption from uh urinary tract that increases excretion is less in the presence of para hormone so calcium metabolism is improved and it is utilized in the body so this is how The vitamin D affects the calcium metabolism so what causes the uh how how prevalent is the vitamin D deficiency so in India Indian scenario more than 90% of Indians have vitamin deficiency or insufficiency and this picture is same across whole of the country in rural as
Well as urban areas and it is common across all age groups including pregnant and lactating mothers so what are the causes of this deficiency because as we see in urban and polluted areas the UV light that is required is filtered out so skin doesn’t get enough of these
Light and uh because of poor dietary intake also some of the uh Chron diseases also like chronic liver and kidney diseases they also are deficient sometime because of Mal absorption option syndrome also the utilization is not good and sometimes patient is very obese and uh they are
Not vitamin D gets deposited in the subcutaneous fat if you have dark skin that also leads to less absorption of vitamin D from sunshine you excessive use of sunscreens high altitudes where the sun is less and smoking and certain drugs like anti-convulsant drugs they also lead to vitamin D deficiency so
Coming to what are the levels which are required to label vitamin D as deficient or insufficient or sufficient so we measure the vitamin D in the uh nanog per ML and if the level is less than 20 nog per ml then it is called uh it is labeled as vitamin D deficiency
If the level is between 21 to 29 nog per ml it is insufficient and if it is greater than 30 nog per ml then it is sufficient so uh what is the role of vitamin D coming to the role of vitamin D uh vitamin D traditionally vitamin D is always
Labeled to be associated with calcium metabolism so it traditional role is in the calcium metabolism and Bone mineral metabolism so it works with para hormone acts on kidney bone intestine and influence and influences the gene expression and it enhances the it regulates its own synthesis and Bone mineral metabolism and calcium and
Phosphorus homeostasis so maintaining the calcium phosphorus uh level in the body so uh for uh decades it’s a thought that kidney has the capacity to metabolize 25 Hydro uh V uh D cholesterol calciferol however now extrenal metabolism has been demonstrated in every organ system in the body so beside kidney extrenal
Metabolism vitamin D so extrenal function vitamin D that is more uh to help with the immune function of the body and the innate immunity adaptive innate immunity so it en enhances the uh immunity against certain diseases so emerging role of vitamin D uh it is now considered important in cell differentiation and cell
Proliferation and immune function so prevention and treatment of various cancers it helps in prevention and treatment of various cancers it helps in osteoporosis that is uh depletion of calcium from the bones it helps in boosting the calcium metabolism and hence improves the uh uh bone density of
Menopausal age groups it helps in rheid arthritis multiple sclerosis hypertension cardiovascular diseases obesity psorisis a skin disease which is metabolized by scaling of epidermal layer so it helps in those patient also which have immune uh basis and in certain psychiatric disorders also so uh
It has so many roles in general of uh in general in the females and now coming specifically to the vitamin uh D and its role in the pregnant females so PR uh prevalence of vitamin D deficiency is in pregnant women is around 70 to 90% uh this deficiency can be because of
Increased demand during the pregnancy because of developing feters or it can be due to increase urinary excretion urinary calcium excretion increase in pregnancy which increases as the pregnancy advances so this leads to the deficiency uh of vitamin D as well uh and further in patients females who are
With darker skin who have limited access to the sunlight who have limited outdoor activity and because of tradition of the cultural practices their clothing are like they are covered from head to toe or because of excessive use of sunscreen so they might be having deficiency during pregnancy and in obese
Patient P if the BMI is more than 30 so there is increased risk of deficiency because adipose tissue that is fat tissue that acts as a repository for vitamin D that does not get into circulation so you deposit fat and leads to deficiency in the body so uh what is
The uh level when we label uh the pregnant women to be deficient in vitamin D it is considered to be 30 nanogram per ml as uh is the uh line where we say below that level women are deficient in vitamin D and what is the role if the wom is deficient in vitamin
What occurs to the pregnancy uh we have clearly seen that several studies have indicated that there is poor maternal outcome that is increased risk of precl lsia that is women with vitamin D deficiency they have more chances of getting high blood pressure during the pregnancy they have more chances of
Getting gestational diabetes in pregnancy and it has also been associated with uh infection of vagina normally whenever the women come to us with the uh infection with vaginal infection we always say keep the part clean keep your hygiene and use is use that and we give antibiotic but it has
Very uh the this correlation has never been thought of that vitamin D deficiency also leads leads to vag repeated vaginal infection so it has to be noted that in every pregnant female we should do the screening for vitamin D in the early pregnancy and during mid pregnancy low level of vitamin D in
Pregnancy they are also Al associated with poor neonatal outcome the babies are low birth weight babies they have rickets they can have ret ret is a disease where bones of the baby are very soft and they can get bored and they can be fractured also so very easily so these
Babies can also have Calcium deficiency uh if the mother is deficient in vitamin D so they this leads to vitamin deficiency in the uh babies also and further they have very less level of calcium further leading to uh Cesar during the Neal period so they can also land up with sometimes cardiomyopathy hypocalcemic
Cardiomyopathy so so this has very important role in uh pregnancy has very important uh vitamin D has very important uh role in keeping the pregnant women healthy and out so that it outcome also is healthy so next coming to how it is uh important in cases of uh how it is important in
Lactation so during lactation it is required uh because it increases the efficiency of dietary absorption of calcium and to ensure adequate calcium ium content in her milk so low concentration is not sufficient to maintain an optimal vitamin D level in newborn and if exposure to sunlight is also limited so
Vitamin D supplementation is required to achieve vitamin d sufficiency in mother so how to prevent vitamin D deficiency in pregnancy according to our uh uh ACOG uh during pregnancy and lactation uh requirement of vitamin D is in normal femal is for 400 to 600 International unit per day but in
Highrisk cases it can be given around up to 4,000 International unit per day so now coming to uh vitamin D and pcus pcod as we all know everybody knows is a very common uh metabolic disorder which is occurring in young adolescent girls and in the reproductive age group it is
Characterized by polycystic ovaries menstrual disturbances irregular period or delayed periods and further on leading to infertility and there is increased level of male hormones leading to acne hair loss and or hair growth on the chin or area where normally females don’t have here so this is a very common metabolic and endocrine abnormality
Which is happening very frequent these days so uh this is also associated with vitamin D deficiency and if the vitamin D level is less than 20 nog per ml how how the vitamin D acts in PCS it plays a physiological role in reproduction including like Ovular ovulatory follicular development and luteinization Via altering amh signaling FSH sensitivity and progesterone production in human Grena cell so uh vitamin D deficiency leads to increased level of paraone paraone leads to menstrual abnormalties and also it leads to defective ovulation and hence infertility this increased para hormone also leads to increased level of
Testosterone leading to increase level of male hormones hence hairism that is growth of hair on the face chin Etc and acne the females so it leads to infertility as well as menstrual irregular irregularities so uh menual irregularities happen because it is it interferes with the calcium metabolism so follicular
Follicles that is the follicle arrest is happens and ovulation doesn’t occur and it also leads to menstrual abnormalities so how it can be corrected by supplementation of vitamin D vitamin D we have seen from the data that if vitamin D supplementation is given to a infertile women with PCOS they it
Returns to normal if it returns to normal level there is Improvement in the quality of embryos and higher clinically pregnancy rates so maintaining normal serum vitamin D in uh females with PCS is very important to have successful clinical pregnancy pregnancies following IVF or
I so V we have seen that vitamin D as a Coe supplement has uh is it significantly increases the uh signifant significantly improves the fasting blood sugar level and resistance to the insulin insulin resistance also decreases so it sensitizes insulin and leads to uh lesser level of fasting
Blood glucose so uh whenever uh in PCS cases with infertility uh Whenever there is deficiency it is better to supplement uh the vitamin D and uh we can supplement up to 4,000 International unit per day so uh treatment now coming to treatment of vitamin D deficiency uh
There are few uh two options either we give the weekly dose uh followed by maintenance do so in weekly dose we give 60,000 uh International unit of vitamin D once a week for 8 weeks followed by maintenance of 60,000 International unit once a month or we can give 1500 to
2,000 International unit per day our treatment with the higher doses is required in case of obese patient in patient with malabsorption syndrome patient on an anti-epileptic drugs or anti-tubercular drugs so uh second option is we give uh 62 60,000 to 1.2 lakh unit in International unit per
Month so uh now coming to type of preparation it’s a normal preparation in a sachche form or tablet form that is dissolvable in water which was a which we used to use earlier now we have nanop particle based vitamin D which is pre- solubilized it is already
Digested form of vitamin D and it is encapsulated in lipid uh so and it has very small particle less than 115 NM in diameter so in harsh condition of git that is in very acidic conditions or in besses also they me this nanop particle uh maintains a structural
Integrity so it is very effective Nano Nano droplet based formulation vitamin D3 is very effective in correcting vitamin D levels in patient of vitamin D deficiency or insufficiency so uh to conclude uh it is that uh there’s a large prevalence of in uh prevalence of population which is
Vitamin D deficient around 62 to 87% of females are uh vitamin D deficient and in PCS cases prevalence rate is 67 to 85% and number of obser observational Studies have demonstrated the association of vitamin D levels and various conditions like preclampsia PCOS uh symptoms infertility and menual irregularities and vitamin D is an
Emerging Factor influencing female fertility and IVF outcome intervention with vitamin D at doses as high as 50 ,000 to 60,000 International urit is given uh in PCS females and vitamin D in Nano form is highly stable readily absorbable effective in normalizing vitamin D levels in deficient individuals thank you very much any
Questions you are most welcome to ask thank you very much
