To say that the body undergoes many changes during pregnancy is an understatement. A woman increases blood volume by up to 50%, the lung capacity increases, muscles get stretched as they have never been extended before, and many other biological processes are altered. The changes in digestion and bile circulation during pregnancy are just some reasons why gallstones and gallbladder issues are more likely to develop.
But did you know that vitamin D deficiency can make it worse for pregnant women?
What happens to the gallbladder during pregnancy?
To accommodate the nutritional needs of the fetus, a woman’s body automatically slows down the digestive process, which helps to increase absorption. This includes decreased gallbladder motility, bile secretion with increased amounts of cholesterol, and reduced amounts of chenodeoxycholic acid. The extraordinarily high estrogen and progesterone hormones during pregnancy also have a huge impact on the digestive process.
Because of the impaired gallbladder emptying, the bile becomes stagnant, causing calcification or formation of gallstones. Excessive cholesterol saturation may lead to bile sludge that may obstruct biliary ducts. These metabolic changes mess up the bile circulation, leading to gallbladder inflammation or cholesterol gallstone formation. Sex hormones also can change bile acid composition and influence gallbladder motility. Lower chenodeoxycholic acid levels also affect cholesterol and bile acid metabolism.
Now, what does Vitamin D Deficiency have to do with it?
The primary role of vitamin D is to maintain calcium and phosphorus levels in our body to allow metabolism, bone mineralization, and neuromuscular transmission (a process by which the central nervous system controls the movement of muscles in the body). This means that vitamin D directly influences gallbladder motility and ejection fraction. For individuals with vitamin D deficiency (VDD), this can be an issue, so much more for pregnant women who are undergoing a lot of biological changes affecting the gallbladder and digestive process as a whole.
According to several studies, vitamin D deficiency is associated with gallbladder stasis and biliary dyskinesia or low functioning gallbladder. These are important risk factors for gallstones. Vitamin D Deficiency also affects the gallbladder since it is associated with gestational diabetes and insulin resistance, which may lead to systemic inflammation. On the other hand, sufficient levels of vitamin D help decrease fasting blood sugar, reduce visceral fat, and decrease inflammation. All these can lower the risk of gallstone formation.
If you are pregnant and obese, then you’re at greater risk.
Pregnant women who are obese and suffering from fat malabsorption are more prone to vitamin D deficiency. Since vitamin D is fat-soluble, obesity during pregnancy is associated with VDD because vitamin D is sequestered by body fat. Fat malabsorption among those with pre-existing conditions, like gallbladder disease, cystic fibrosis, celiac disease, and Chron’s disease, also affects the body’s amount of vitamin D. These reasons make pregnant women a high-risk group for vitamin D deficiency.
Other factors that may lead to vitamin D deficiency:
- inadequate sun exposure
- use of sunscreen with SPF 30 or higher
- skin aging
- atmospheric contamination and overcast
- location and season of the year
Vitamin D deficiency in pregnancy and its impact on the fetus, the newborn, and childhood
There are many ways vitamin D influences placental, fetal, and maternal health during pregnancy. In one of our past blog posts, we emphasized the importance of Vitamin D3 and K2 in boosting the immune system. This also applies to expectant mothers and their unborn children.
Vitamin D also plays a crucial role in the following processes:
- Proper implantation of the placenta
- Prenatal and postpartum infection prevention
- Production of sex hormones
- Glucose and insulin metabolism
- Musculoskeletal growth of the baby
Given the importance of the sunshine vitamin, recent studies have associated vitamin D deficiency with preeclampsia, insulin resistance, gestational diabetes, bacterial vaginosis, preterm birth, and a greater probability of cesarean delivery.
Vitamin D Deficiency affects not just the mother but the child as well. VDD can have a profound impact that can be carried up to adulthood. Recent evidence indicates that nutrients can modify the immune and metabolic programming during sensitive fetal and child development periods. Children born to mothers with vitamin D deficiency are more likely to have acute lower respiratory tract infections, recurrent wheezing, and allergic diseases. In a study among school-aged children, vitamin D supplementation was associated with a reduction in the incidence of diabetes during a 30-year follow-up.
Vitamin D Supplementation during Pregnancy
Vitamin D Supplementation during PregnancyVitamin D is produced by the body during exposure to sunlight but is also found in oily fish, eggs, and fortified food products. Unfortunately, pregnant women and those will gallbladder issues cannot eat some of these food sources. Also, consuming these foods cannot make up for the lack of sun exposure. Aside from having an insufficient amount of vitamin D, products that claim to be fortified usually contain Vitamin D2 which cannot be easily absorbed by the body. This is why vitamin D supplementation is necessary.
According to the American College of Obstetricians and Gynecologists, there should be supplementation with 1.000-2.000IU/day of Vitamin D. The Canadian Academy of Pediatrics recommends supplementation with 2.000IU/d during pregnancy and lactation to prevent Vitamin D Deficiency. A 2013 study on patients with gallstones showed that vitamin D supplementation could improve gallbladder ejection fraction by 20% and result in significant resolution of gallbladder stasis.
In our previous blog post, we explained that the most effective form of vitamin D is D3 which works best with vitamin K2. We recommend a D3K2 combo by Genestra, a quality brand that carries one in an emulsified form that is designed for optimal absorption. (Available on Amazon)
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References:
Bakacak, M., Serin, S., Ercan, O., Köstü, B., Avci, F., Kılınç, M., … & Kiran, G. (2015). Comparison of Vitamin D levels in cases with preeclampsia, eclampsia and healthy pregnant women. International journal of clinical and experimental medicine, 8(9), 16280.
Onal, E. D., Berker, D., & Guler, S. (2015). Vitamin D deficiency and gallbladder stasis. Digestive diseases and sciences, 60(12), 3823-3824.
Pérez-López, F. R., Pasupuleti, V., Mezones-Holguin, E., Benites-Zapata, V. A., Thota, P., Deshpande, A., & Hernandez, A. V. (2015). Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials. Fertility and sterility, 103(5), 1278-1288.
Scott, L. D. (1992). Gallstone disease and pancreatitis in pregnancy. Gastroenterology Clinics of North America, 21(4), 803.
Singla, R., Dutta, U., Aggarwal, N., Bhadada, S. K., Kochhar, R., & Dhaliwal, L. K. (2015). Vitamin-D deficiency is associated with gallbladder stasis among pregnant women. Digestive diseases and sciences, 60(9), 2793-2799.
Urrutia-Pereira, M., & Solé, D. (2015). Vitamin D deficiency in pregnancy and its impact on the fetus, the newborn and in childhood. Revista Paulista de Pediatria (English Edition), 33(1), 104-113.
