Vitamin K

When I see my clients during pregnancy, one of the topics we always discuss is that of Vitamin K for the baby. I provide the standard pamphlet on Vitamin K, along with books and encourage my clients to read widely about Vitamin K, and then we talk through what they have learned and clear up any questions. Several years ago, there was concern that the Vitamin K injection might cause leukaemia. Consequently, some families opted not to give their babies Vitamin K at birth, and the rates of Vitamin K Deficiency Bleeding increased. Something needed to be done!

Babies are naturally born with low levels of Vitamin K, and this is totally normal. However, it does predispose babies to a rare form of bleeding called Vitamin K Deficiency Bleeding, since Vitamin K is one of many elements that is needed for successful blood clotting. Without adequate levels of Vitamin K, babies may haemorrhage - this may be internal or external. The risk is not very high: about one in every ten thousand babies born. Or to put it another way, 100 babies out of every million that are born. Vitamin K drops at birth, day 4 and week four will reduce the risk of Vitamin K Deficiency Bleeding to 23 per million, while an injection will reduce it even further to one in a million. It sounds like a no-brainer to give all babies some form of Vitamin K at birth, whether drops or an injection.

Not everyone agrees. One of the common arguments is that if all babies have low levels of Vitamin K, this is normal for them and who are we to go administering a medication / Vitamin to alter their natural state? This might be a valid argument, as we probably are improving on nature when we give babies Vitamin K. But let's think about other areas of life. Do we withhold antibiotics if we are sick? Do we withhold Insulin from a person with diabetes? And do we withhold a wheelchair from an elderly person who cannot walk? In each of these cases, we are improving on nature. Is Vitamin K any different?

The other arguments I often hear are mentioned here: 1. Synthetic vitamins (including synthetic Vitamin K) should be avoided because synthetic vitamin A supposedly causes the type of birth defects that natural vitamin A prevents. This argument is far from logical. Should all medications be avoided because some are unsafe?

2. The administration of Vitamin K is linked to childhood cancers and leukaemia: this used to be the case; the formulation was changed and there have been no reports of childhood cancers and leukaemia following the changed formulation.

3. Emotive words such as "disturbing" and "more disturbing" are used to generate anxiety in the reader, while offering no solid evidence to back this "disturbance". Vitamin K is fat soluble; this is true. The article suggests that little to no vitamin K shows up in urine or bile, but it does not let the reader know at what stage the urine and bile were tested for the presence of Vitamin K. Vitamin K, being fat soluble, will take some time to become evident in urine or bile. The authors imply that as Vitamin K is not showing up in urine or bile, it must therefore be accumulating in body tissues, causing untold harms. Of course. Never mind that this has never been proven, despite almost every baby receiving Vitamin K at birth. Readers should be "disturbed" by this mere suggestion, without proof. This is disturbing, indeed.

4. The author cites the manufacturer’s insert which contains a warning about severe reactions following intravenous injection of Vitamin K. The average reader might be frightened to learn this, yet the author does not let readers know that Vitamin K is not given to babies intravenously: it is given into the muscle or by drops into the mouth.

5. "If that isn’t enough to scare you, Midwifery Digest ... September 1992 estimated that the chance of your child developing leukemia from the vitamin K shot is about one in 500! This means that the risk of developing leukemia from the vitamin K shot is much higher than the risk of bleeding on the brain which the vitamin K shot is supposed to prevent!" That would be very scary indeed, if only it were true. No academic article could cite 1992 research in a contemporary article, unless the article was about historical data. Since the formulation of Vitamin K was changed, there have been no reported cases of leukaemia, if the link ever existed.

The authors go on to say, "Does any of this make any sense to you? It makes absolutely no sense to me. How could anyone say that this shot is safe and effective for newborns?" Quite easily: Vitamin K does reduce the chance of a baby developing Vitamin K Deficiency Bleeding from 100 / 1,000,000 down to 1 / 1,000,000. That certainly makes sense to the 99 / 1,000,000 families and babies who benefit from the injection.

Next, the author recommends that pregnant women "eat lots of leafy greens in the weeks before your due date to make sure your blood is high in vitamin K", and assumes that said Vitamin K *will* transfer to the baby. Two flaws in this argument. One: there is no quantifiable amount of leafy greens that need to be consumed to raise the mother's Vitamin K levels to a high level, and no quantifiable level that the mother would need to raise her levels to - and maintain - in order to meet her baby's needs. And two: we have no evidence that maternal Vitamin K transfers through breastmilk to the baby, and if it does, how much the baby would actually receive.

The discussion on Vitamin K is always interesting, and people will "do their research", which I always encourage. I only wish that the material out there on the WWW was accurate and balanced so that people could rely on the information.

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