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• W1964202017 abstract "I appreciate the concerns you voiced in a recent editorial on the advertisement the Vitamin D Council ran in the Journal in March 2009 and the reasons you refused to run it twice.1Garite T.J. Kim M. The “Vitamin D Council” advertisement.Am J Obstet Gynecol. 2009; 201: 2Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar As you wrote, the Journal had not seen fit to “censor controversy” in the 100 years of its existence.Ten times you referred to our piece as an advertisement. What was I selling? What product? What service? What drug? Frankly, we paid to run it, because I was afraid you would not print it otherwise, a fear I now see was unfounded. The only thing I was trying to sell was an idea: obstetricians should diligently diagnose and adequately treat vitamin D deficiency in all pregnant women, thus heeding the new guidance of the American Academy of Pediatrics (AAP):“Given the growing evidence that adequate maternal vitamin D status is essential during pregnancy, not only for maternal well-being but also for fetal development, health care professionals who provide obstetric care should consider assessing maternal vitamin D status by measuring the 25-OH-D concentrations of pregnant women. On an individual basis, a mother should be supplemented with adequate amounts of vitamin D3 to ensure that her 25-OH-D levels are in a sufficient range (80 nmol/L or 32 ng/mL). The knowledge that prenatal vitamins containing 400 IU of vitamin D3 have little effect on circulating maternal 25-OH-D concentrations, especially during the winter months, should be imparted to all health care professionals involved in the care of pregnant women”2Wagner C.L. Greer F.R. American Academy of Pediatrics Section on breastfeeding; American Academy of Pediatrics Committee on NutritionPrevention of rickets and vitamin D deficiency in infants, children, and adolescents.Pediatrics. 2008; 122: 1142-1152Crossref PubMed Scopus (1177) Google Scholar (page 1145).I understand that the “all autism is caused by vaccinations” community can be very persuasive, and I infer from your editorial that it was that community that persuaded you to censor. George Bernard Shaw once said, “Progress is impossible without change; and those who cannot change their minds, cannot change anything.” Perhaps Scientific American can change the minds of the autism/vaccinations community, although I doubt it. Scientific American just ran a lengthy story on the autism and vitamin D connection,3Glaser G. What if vitamin D deficiency is a cause of autism? Sci Am Apr 24, 2009.http://www.scientificamerican.com/article.cfm?id=vitamin-d-and-autism/Google Scholar and the autism/vaccinations community stridently objected in the Comment section.For 2 years, I have been trying to warn the world that the environmental trigger for autism is not vaccinations but gestational vitamin D deficiency, first via a May 2007 Internet publication, which meticulously laid out the case,4The Vitamin D NewsletterAutism and vitamin D. May 2007.http://www.vitamindcouncil.org/health/autismGoogle Scholar and then in a peer-reviewed 2008 article.5Cannell J.J. Autism and vitamin D.Med Hypotheses. 2008; 70: 750-759Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar Now, as referenced above, a 2009 Scientific American headline asks, “What if vitamin D deficiency is a cause of autism?” What if it is? How will this affect obstetricians, medically and legally?A recent review detailed the devastating effect gestational vitamin D deficiency has on developing mammalian brains,6Levenson C.W. Figueirôa S.M. Gestational vitamin D deficiency: long-term effects on the brain.Nutr Rev. 2008; 66: 726-729Crossref PubMed Scopus (29) Google Scholar and that alarming review does not stand alone.7Kalueff A.V. Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition.Curr Opin Clin Nutr Metab Care. 2007; 10: 12-19Crossref PubMed Scopus (206) Google Scholar In fact, the deleterious effects vitamin D deficiency has on mammalian brains are so well documented that Feldman,8Brachet P. Neveu I. Naveilhan P. Garcion E. Wion D. A neuroactive hormone: from brain development to pathological disorders.in: Feldman D. Pike J.W. Glorieux F.H. Vitamin D. Elsevier, San Diego, CA2005: 1779-1789Crossref Scopus (6) Google Scholar in his latest textbook on vitamin D (2005), dedicates an entire chapter to it.I also wanted to warn obstetricians, like the AAP did, of the growing literature showing that the tiny 10 μm (400 IU) dose in prenatal vitamins is irrelevant in preventing the current epidemic of gestational vitamin D deficiency.9Bodnar L.M. Simhan H.N. Powers R.W. Frank M.P. Cooperstein E. Roberts J.M. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates.J Nutr. 2007; 137: 447-452PubMed Google Scholar, 10Holmes V.A. Barnes M.S. Alexander H.D. McFaul P. Wallace J.M. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study.Br J Nutr. 2009; 31: 1-6Google Scholar For this reason, in 2007, the Canadian Paediatric Society cautioned that pregnant women may require 5 times that amount, or even more.11Canadian Paediatric SocietyVitamin D supplementation: recommendations for Canadian mothers and infants.Paediatr Child Health. 2007; 12: 583-598PubMed Google ScholarI fear for the future liability of obstetricians. Autism is but one of several alleged harms that obstetricians may hear about when their attorneys call. Gestational vitamin D deficiency is associated with a significantly increased risk of neonatal pneumonia,12Karatekin G. Kaya A. Salihoğlu O. Balci H. Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers.Eur J Clin Nutr. 2009; 63: 473-477Crossref PubMed Scopus (205) Google Scholar a doubled risk for preeclampsia,13Bodnar L.M. Catov J.M. Simhan H.N. Holick M.F. Powers R.W. Roberts J.M. Maternal vitamin D deficiency increases the risk of preeclampsia.J Clin Endocrinol Metab. 2007; 92: 3517-3522Crossref PubMed Scopus (644) Google Scholar a tripled risk for gestational diabetes,14Zhang C. Qiu C. Hu F.B. et al.Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus.PLoS One. 2008; 3: e3753Crossref PubMed Scopus (281) Google Scholar and a quadrupled risk for primary cesarean section.15Merewood A. Mehta S.D. Chen T.C. Bauchner H. Holick M.F. Association between vitamin D deficiency and primary cesarean section.J Clin Endocrinol Metab. 2009; 94: 940-945Crossref PubMed Scopus (266) Google ScholarObstetricians are already being driven out of practice by malpractice suits, a fact you appreciate better than I. Now a warning from the AAP, combined with an article in Scientific American, should worry obstetricians and their attorneys. Medical malpractice claims may be filed for several years after the injury is recognized; only then do the statutes of limitations begin their sad toll.Thus, because autism is often first diagnosed when the child is 3–4 years of age, a malpractice claim could arise 4–5 years from today, alleging today's obstetrician did not follow the AAP's advice, was unmindful of the brain damage/vitamin D risk, and did not do a proper risk/benefit assessment.That is, jurors in 2013 may ask themselves what the risk was of diagnosing and treating gestational vitamin D deficiency in 2009. Why did the obstetrician not do it? Such future liability exposure could be lessened if obstetricians would simply follow the AAP's current guidance to diligently diagnosis and adequately treat vitamin D deficiency in all pregnant patients. I appreciate the concerns you voiced in a recent editorial on the advertisement the Vitamin D Council ran in the Journal in March 2009 and the reasons you refused to run it twice.1Garite T.J. Kim M. The “Vitamin D Council” advertisement.Am J Obstet Gynecol. 2009; 201: 2Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar As you wrote, the Journal had not seen fit to “censor controversy” in the 100 years of its existence. Ten times you referred to our piece as an advertisement. What was I selling? What product? What service? What drug? Frankly, we paid to run it, because I was afraid you would not print it otherwise, a fear I now see was unfounded. The only thing I was trying to sell was an idea: obstetricians should diligently diagnose and adequately treat vitamin D deficiency in all pregnant women, thus heeding the new guidance of the American Academy of Pediatrics (AAP): “Given the growing evidence that adequate maternal vitamin D status is essential during pregnancy, not only for maternal well-being but also for fetal development, health care professionals who provide obstetric care should consider assessing maternal vitamin D status by measuring the 25-OH-D concentrations of pregnant women. On an individual basis, a mother should be supplemented with adequate amounts of vitamin D3 to ensure that her 25-OH-D levels are in a sufficient range (80 nmol/L or 32 ng/mL). The knowledge that prenatal vitamins containing 400 IU of vitamin D3 have little effect on circulating maternal 25-OH-D concentrations, especially during the winter months, should be imparted to all health care professionals involved in the care of pregnant women”2Wagner C.L. Greer F.R. American Academy of Pediatrics Section on breastfeeding; American Academy of Pediatrics Committee on NutritionPrevention of rickets and vitamin D deficiency in infants, children, and adolescents.Pediatrics. 2008; 122: 1142-1152Crossref PubMed Scopus (1177) Google Scholar (page 1145). I understand that the “all autism is caused by vaccinations” community can be very persuasive, and I infer from your editorial that it was that community that persuaded you to censor. George Bernard Shaw once said, “Progress is impossible without change; and those who cannot change their minds, cannot change anything.” Perhaps Scientific American can change the minds of the autism/vaccinations community, although I doubt it. Scientific American just ran a lengthy story on the autism and vitamin D connection,3Glaser G. What if vitamin D deficiency is a cause of autism? Sci Am Apr 24, 2009.http://www.scientificamerican.com/article.cfm?id=vitamin-d-and-autism/Google Scholar and the autism/vaccinations community stridently objected in the Comment section. For 2 years, I have been trying to warn the world that the environmental trigger for autism is not vaccinations but gestational vitamin D deficiency, first via a May 2007 Internet publication, which meticulously laid out the case,4The Vitamin D NewsletterAutism and vitamin D. May 2007.http://www.vitamindcouncil.org/health/autismGoogle Scholar and then in a peer-reviewed 2008 article.5Cannell J.J. Autism and vitamin D.Med Hypotheses. 2008; 70: 750-759Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar Now, as referenced above, a 2009 Scientific American headline asks, “What if vitamin D deficiency is a cause of autism?” What if it is? How will this affect obstetricians, medically and legally? A recent review detailed the devastating effect gestational vitamin D deficiency has on developing mammalian brains,6Levenson C.W. Figueirôa S.M. Gestational vitamin D deficiency: long-term effects on the brain.Nutr Rev. 2008; 66: 726-729Crossref PubMed Scopus (29) Google Scholar and that alarming review does not stand alone.7Kalueff A.V. Tuohimaa P. Neurosteroid hormone vitamin D and its utility in clinical nutrition.Curr Opin Clin Nutr Metab Care. 2007; 10: 12-19Crossref PubMed Scopus (206) Google Scholar In fact, the deleterious effects vitamin D deficiency has on mammalian brains are so well documented that Feldman,8Brachet P. Neveu I. Naveilhan P. Garcion E. Wion D. A neuroactive hormone: from brain development to pathological disorders.in: Feldman D. Pike J.W. Glorieux F.H. Vitamin D. Elsevier, San Diego, CA2005: 1779-1789Crossref Scopus (6) Google Scholar in his latest textbook on vitamin D (2005), dedicates an entire chapter to it. I also wanted to warn obstetricians, like the AAP did, of the growing literature showing that the tiny 10 μm (400 IU) dose in prenatal vitamins is irrelevant in preventing the current epidemic of gestational vitamin D deficiency.9Bodnar L.M. Simhan H.N. Powers R.W. Frank M.P. Cooperstein E. Roberts J.M. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates.J Nutr. 2007; 137: 447-452PubMed Google Scholar, 10Holmes V.A. Barnes M.S. Alexander H.D. McFaul P. Wallace J.M. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study.Br J Nutr. 2009; 31: 1-6Google Scholar For this reason, in 2007, the Canadian Paediatric Society cautioned that pregnant women may require 5 times that amount, or even more.11Canadian Paediatric SocietyVitamin D supplementation: recommendations for Canadian mothers and infants.Paediatr Child Health. 2007; 12: 583-598PubMed Google Scholar I fear for the future liability of obstetricians. Autism is but one of several alleged harms that obstetricians may hear about when their attorneys call. Gestational vitamin D deficiency is associated with a significantly increased risk of neonatal pneumonia,12Karatekin G. Kaya A. Salihoğlu O. Balci H. Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers.Eur J Clin Nutr. 2009; 63: 473-477Crossref PubMed Scopus (205) Google Scholar a doubled risk for preeclampsia,13Bodnar L.M. Catov J.M. Simhan H.N. Holick M.F. Powers R.W. Roberts J.M. Maternal vitamin D deficiency increases the risk of preeclampsia.J Clin Endocrinol Metab. 2007; 92: 3517-3522Crossref PubMed Scopus (644) Google Scholar a tripled risk for gestational diabetes,14Zhang C. Qiu C. Hu F.B. et al.Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus.PLoS One. 2008; 3: e3753Crossref PubMed Scopus (281) Google Scholar and a quadrupled risk for primary cesarean section.15Merewood A. Mehta S.D. Chen T.C. Bauchner H. Holick M.F. Association between vitamin D deficiency and primary cesarean section.J Clin Endocrinol Metab. 2009; 94: 940-945Crossref PubMed Scopus (266) Google Scholar Obstetricians are already being driven out of practice by malpractice suits, a fact you appreciate better than I. Now a warning from the AAP, combined with an article in Scientific American, should worry obstetricians and their attorneys. Medical malpractice claims may be filed for several years after the injury is recognized; only then do the statutes of limitations begin their sad toll. Thus, because autism is often first diagnosed when the child is 3–4 years of age, a malpractice claim could arise 4–5 years from today, alleging today's obstetrician did not follow the AAP's advice, was unmindful of the brain damage/vitamin D risk, and did not do a proper risk/benefit assessment. That is, jurors in 2013 may ask themselves what the risk was of diagnosing and treating gestational vitamin D deficiency in 2009. Why did the obstetrician not do it? Such future liability exposure could be lessened if obstetricians would simply follow the AAP's current guidance to diligently diagnosis and adequately treat vitamin D deficiency in all pregnant patients. The “Vitamin D Council” advertisementAmerican Journal of Obstetrics & GynecologyVol. 201Issue 1PreviewIn the March issue (page 13A) of the American Journal of Obstetrics & Gynecology an advertisement appeared that was placed by the “Vitamin D Council.” A number of readers wrote letters to the Publisher and Editors regarding this advertisement that claimed, among other things, a relationship between Vitamin D deficiency and autism that these readers believed was unfounded. Furthermore, as they pointed out, the advertisement was laid out in such a way that it could have been interpreted as editorial comment rather than advertisement. Full-Text PDF ReplyAmerican Journal of Obstetrics & GynecologyVol. 202Issue 5PreviewThank you for your letter regarding the removal of the advertisement regarding vitamin D in pregnancy and subsequent editorial on this decision. You point out precisely in this letter why the action was necessary and appropriate. You feared we would not publish the information contained in this ad if it were submitted as a normal manuscript. Full-Text PDF" @default.
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