25-Hydroxyvitamin D and Total Calcium: Extraordinarily Low Plasma Concentrations in Saudi Mothers and Their Neonates

Abstract

SummaryVenous blood was obtained from 100 consecutive and unselected Saudi Arabian mothers and their neonates within 48 h after delivery. Plasma levels of 25-hydroxyvitamin D (25-0HD) and total calcium were measured in paired samples. Fifty-nine mothers and 70 neonates had subnormal (less than 10 ngJml) 25-OHD levels. Plasma Ca concentrations were low in 61% of the mothers and 59% of the newborns consisting of 10 preterm and 38 full term babies. There were significant correlation between the plasma levels of maternal and neonatal 25-0HD (r = 0.54; P = 0.0001), maternal 25-0HD and Ca (r = -0.22; P = 0.03), neonatal 25-0HD and Ca (r =-0.28; P =0.0009), and maternal and neonatal calcium levels (r = 0.46; P = 0.0001). Nevertheless, maternal 25-0HD was not invariably higher than that in the infant. Normocalcemia was observed in 29 neonates and 26 mothers (20 mother/baby pairs) in the presence of subnormal maternal 25-0HD. Twenty babies and 16 mothers including nine mother/baby pairs had hypocalcemia in the presence of normal levels of 25-0HD. This indicates that vitamin D plays a crucial, but not exclusive, role in calcium homeostasis during pregnancy.This study revealed that vitamin D deficiency is very prevalent during pregnancy in Saudi Arabia. It also showed that asymptomatic hypocalcemia in full term babies is far commoner than is generally appreciated. It is considered that vitamin D deficiency is primarily due to lack of exposure to sunlight. Encouragement to obtain sunlight exposure and fortification of food are the only alternative measures. Abbreviation 25-0HD, 25-hydroxyvitamin D Saudis, especially women, avoid exposure to sunlight due to cultural and traditional beliefs. Ultraviolet light has been shown to produce changes in circulating 25-0HD equivalent to those produced by a daily dose of 10,000 IU i.e. several times the recommended daily adult intake in food (21). Second, the dietary intake of vitamin D by Saudi Arabians has been shown to be far below the amount recommended by FAO/WHO, in the United States and in the United Kingdom (20,24).In spite of abundant sunlight throughout the year, several vitamin D deficiency diseases have been reported in Saudi Arabia, including rickets (8,9), fractures of the head of the femur in the elderly, and osteomalacia (24). We have noticed a strikingly high incidence of hypocalcemia in full term infants delivered at King Abdul Aziz University Hospital. In view of the wide pre". alence of vitamin D deficiency diseases, we sought to define the role of this vitamin in the pathogenesis of neonatal hypocalcemia. Since 25-0HD is the major circulating form of vitamin D and since its plasma concentrations directly reflect its status (6), we opted to measure this metabolite and total calcium concentrations in mothers and their neonates. PATIENTS AND METHODS Clinical.A 5-ml sample of venous blood was taken from each of 100 unselected mothers and 2 ml from their corresponding babies, within 48 h of delivery at King Abdul Aziz University Hospital for estimation of plasma 25-0HD ...

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

“…In 100 Saudi mothers and their newborns, Taha et al found that 59 mothers and 70 newborns had levels below 10 ng/mL or 25 nmol/L 1920. These and other studies emphasize the need for urgent measures such as vitamin D supplementation in some food items like milk.…”

Resurrection of vitamin D deficiency and rickets

“…Remarkably, in the sunniest areas of the world, rickets is a major health problem. Because of the practice of purdah or wearing a burka (45,46), avoidance of exposure of any skin to sunlight, and the fact that few foods are fortified with vitamin D, upward of 35-80% of children in Saudi Arabia (46,47), India (48), Turkey (29), New Zealand (49), Israel (50), Egypt (51), Hong Kong (52), China (53), Libya (54), Lebanon (55), Spain (56), Australia (57), San Diego, California (58), and the southeastern United States (59) are vitamin D deficient. When the deficiency occurs during fetal life, there is data to suggest that this may cause an increased risk of hip fractures and bone loss later in life (56,60,61).…”

Assessment of serum 25(OH)D concentration in women of childbearing age and their preschool children in Northern Jordan during summer

“…A few studies reported inadequate vitamin D status among infants and their mothers in the United Arab Emirates (Dawodu et al, 2001(Dawodu et al, , 2003, Turkey (Hatun et al, 2005), Kuwait (Molla et al, 2005) and Saudi Arabia (Taha et al, 1984); infants and preschool children (aged 4-72 months) in Saudi Arabia (Bahijri, 2001); and schoolchildren (aged 10-16 years) in Lebanon (El-Hajj Fuleihan et al, 2001).…”