Vitamin D and Recurrent Pregnancy Loss

Early pregnancy loss (>20 weeks gestation), especially when recurrent, is both physically and emotionally traumatic. In fact, researchers believe that the trauma associated with a pregnancy loss whether it be 4, 8 or 12 weeks, has the same psychological impact on our health. So, what causes recurrent pregnancy loss and is there anything we can do to prevent them from happening?  Although the cause of recurrent pregnancy loss (RPL) can be multifactorial, there is a common link between autoimmunity and RPL. Some researchers theorize that if we reduce autoimmunity, we can reduce recurrent pregnancy loss. Since vitamin D has a major function on the immune system, specifically immune modulation, researchers have begun investigating whether vitamin D could be an effective method to treat patients with RPL. 

Vitamin D and Antiphospholipid Syndrome (APS) 

Antiphospholipid Syndrome (APS) is a specific autoimmune disease associated with recurrent pregnancy loss. APS occurs when the immune system mistakenly begins to create antibodies against your own blood cells. This leads to an increase in blood clot formation and can cause dangerous blood clots in your legs, kidneys, lungs and brain. Many women have no idea they have APS until they try to conceive and experience a miscarriage. Unfortunately, since the current conventional medical community only requires additional testing for patients who have experienced 3 or more consecutive miscarriages, many women unfortunately experience the trauma of recurrent pregnancy loss before being properly diagnosed. Hopefully in the future, comprehensive testing will become more readily available allowing less women to suffer through recurrent pregnancy losses in order to be diagnosed. Although for years APS was considered an autoimmune disease that had no cure, researchers have reported that vitamin D supplementation could potentially prevent the occurence of APS by reducing the expression levels of anti-β2 glycoprotein and tissue factor commonly elevated in women who have APS and experience recurrent pregnancy loss. 

Vitamin D and Thyroid Disease

Researchers have learned that not only are women with hypothyroidism more at risk of recurrent miscarriages, but even women with subclinical hypothyroidism or elevated thyroid antibodies [Side note: this is the reason why at NMD Wellness of Scottsdale, we always make sure to check a comprehensive thyroid panel on all of our patients. A comprehensive thyroid panel should include TSH (Thyroid Stimulating Hormone), Free T3, Free T4, as well as anti-thyroglobulin and anti-thyroid peroxidase (thyroid antibodies). If you have experienced recurrent pregnancy loss or have had trouble conceiving and have not had your thyroid antibodies evaluated and monitored, it’s time to get a second opinion ]. If you have elevated thyroid antibodies, please make sure your doctor is also monitoring your serum Vitamin D levels as well, since researchers have indicated a link between vitamin D status and thyroid peroxidase antibody activity. In other words, women who were deficient in Vitamin D and who also had autoimmune thyroid disease, appeared to be more predisposed to experiencing recurrent pregnancy loss. 

Immunomodulatory Therapies and RPL 

Researchers have identified a strong correlation between recurrent pregnancy loss and immune dysfunction. Many of the pharmaceutical interventions being created for women with recurrent pregnancy loss focus on immune regulation. For example, the common steroid, Prednisone, has been reported to help women who have experienced RPL by reducing inflammation and inhibiting the function of multiple types of immune cells, including T cells. T cells play a critical role in our immune function, especially against foreign (threatening) substances. Remember, since autoimmune disease is categorized by our body mistaking our own cells/tissues as foreign invaders, it can be extremely powerful to use treatment therapies that focus on regulating T cell activity. Another common pharmaceutical intervention used for those with recurrent pregnancy loss, and particularly those with Antiphospholipid Syndrome (APS), is plaquenil. Not only does plaquenil have antithrombotic activity (reducing clot formation), but it also appears to have immune regulating properties that could also improve immune dysfunction so often associated with recurrent pregnancy loss. 

Vitamin D and Your Immune System 

Although we often think of Vitamin D as a vitamin, because it's called a vitamin, Vitamin D is a particular type of vitamin that is involved in a variety of immune related responses. In fact, Vitamin D is critical for not only proper immune function but also hormone secretion. Vitamin D also plays a critical role in the function of maternal-fetal immune regulation. This is particularly important because clinically many doctors have seen that women who are vitamin D deficient are more predisposed to experiencing recurrent pregnancy loss. 

Before you start downing that bottle of Vitamin D

As a naturopathic doctor, I am thrilled to hear that not only have researchers learned about the possible triggers of autoimmunity and recurrent pregnancy loss, but they have found a natural alternative that is readily available to most patients. The problem, unfortunately, with this research is that this information should always be applied after consulting with your doctor. Although vitamin D supplements are “natural” and available over-the-counter this does not mean they are safe. In fact, unlike other vitamins, like B12 for example, vitamin D is liquid soluble which means if you consume too much Vitamin D, that vitamin D can accumulate in your body and has been shown to negatively impact the production of oocytes (eggs) and even the quality of embryos due to its anti-estrogen effect. Always make sure before starting any supplement, especially Vitamin D, that you talk to your doctor. I also suggest getting your vitamin D levels checked with a simple blood test so the correct dosing of Vitamin D can be provided. Make sure to discontinue all biotin-containing supplements at least 72 hours prior to getting your Vitamin D levels drawn as researchers have found that biotin - containing supplements (like many prenatals and Hair, Skin and Nail supplements) may interfere with the accuracy of the test results


What is an optimal Vitamin D level?

If you recently had your vitamin D levels drawn, I encourage you to take a moment to find your most recent lab results. Although some labs may vary when it comes to the reference range (normal level) of vitamin D, most labs will indicate a 25-hydroxy Vitamin D serum level as being “normal” between 30.0-100.0ng/mL. Some labs, Like Sonora Quest and Quest Diagnostic, just list the “normal” reference range for Vitamin D to be above 20.0ng/ml. That being said, when it comes to reducing your risk of recurrent pregnancy loss, we don’t want your levels to be simply “normal”, we want them to be optimal. Also interestingly enough, although you would think a lab would determine their “normal” reference range based on only healthy individuals, the reference range actually includes just the average population, sick or healthy. I don’t know about you but, I don’t want to be in the same range as those that are sick, I want to only be with those that are healthy. This is where optimal ranges are often indicated as a more fine tuned range within the “normal” range. For my patients, especially those with autoimmune disease and those struggling to conceive, I want their 25-hydroxy Vitamin D levels to be between 60-80ng/mL. 


Do I have to take a Vitamin D supplement or are there other ways to get Vitamin D?

Spending time outside is one of the best ways to activate Vitamin D. However, many doctors have found that unless you are spending 30 minutes to 1 hour in your underwear outside every single day between 10-2pm chances are, you aren’t getting enough Vitamin D from the sun alone. This is the reason why if you were testing the average American, most of us would be Vitamin D deficient. There are however a few important foods to incorporate to also improve Vitamin D status, including cod liver oil, salmon, swordfish and tuna. Vitamin D is also added to other foods including dairy products like milk, however this is not a naturally occurring vitamin found in milk. Instead, we often suggest vitamin D supplementation in patients with vitamin D deficiency. When selecting a vitamin D supplement, there are two important factors to remember: 

  1. Vitamin D is a lipid soluble vitamin, which means in order for it to be properly absorbed it should always be taken with a meal containing a healthy fat, like an avocado. 

  2. The best form of oral vitamin D supplementation should be in the form of vitamin D3 or cholecalciferol. This is the natural form of vitamin D that your body makes from sunlight and is the more efficient form of vitamin D. 

About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...