Effect of vitamin D supplementation during pregnancy on neonatal mineral homeostasis and anthropometry of the newborn and infant

Abstract

Hypovitaminosis D is common in India. In the present prospective partially randomised study of vitamin D (D 3 ) supplementation during pregnancy, subjects were randomised in the second trimester to receive either one oral dose of 1500 mg vitamin D 3 (group 1, n 48) or two doses of 3000 mg vitamin D 3 each in the second and third trimesters (group 2, n 49). Maternal 25-hydroxyvitamin D (25(OH)D) at term, cord blood (CB) alkaline phosphatase (ALP), neonatal serum Ca and anthropometry were measured in these subjects and in forty-three non-supplemented mother -infant pairs (usual care). Median maternal 25(OH)D at term was higher in group 2 (58·7, interquartile range (IQR) 38·4 -89·4 nmol/l) v. group 1 (26·2, IQR 17·7-57·7 nmol/l) and usual-care group (39·2, IQR 21·2 -73·4 nmol/l) (P¼ 0·000). CB ALP was increased ( . 8.02 mkat/l or .480 IU/l) in 66·7 % of the usual-care group v. 41·9 % of group 1 and 38·9 % of group 2 (P¼0·03). Neonatal Ca and CB 25(OH)D did not differ significantly in the three groups. Birth weight, length and head circumference were greater and the anterior fontanelle was smaller in groups 1 and 2 (3·08 and 3·03 kg, 50·3 and 50·1 cm, 34·5 and 34·4 cm, 2·6 and 2·5 cm, respectively) v. usual care (2·77 kg, 49·4, 33·6, 3·3 cm; P¼0·000 for length, head circumference and fontanelle and P¼ 0·003 for weight). These differences were still evident at 9 months. We conclude that both 1500 mg and two doses of 3000 mg vitamin D 3 had a beneficial effect on infant anthropometry, the larger dose also improving CB ALP and maternal 25(OH)D.Key words: Vitamin D supplementation: Pregnancy: Infant anthropometry: Neonatal calcium Vitamin D deficiency has been reported to be frequent among adolescent girls and pregnant women in India, with approximately 80 % of both urban and rural subjects having serum 25-hydroxyvitamin D (25(OH)D) ,50 nmol/l (1,2) . Exposure to the abundant sunlight in India is poor in women because of the traditional modest style of dressing. The resulting consequences to the fetus and the newborn include low cord blood (CB) vitamin D and high alkaline phosphatase (ALP), neonatal hypocalcaemia and poor fetal growth, among others (2,3) . Thus, pharmacological supplementation may be necessary, especially in such vulnerable groups.Although several studies are available on vitamin D supplementation during pregnancy, its appropriate dose is not clear (4) . In a study by Datta et al. (5) , 160 pregnant Asian women in the UK were supplemented with a dose of 20 mg/d, which was later increased to 40 mg/d. However, the rise in maternal serum 25(OH)D was from 14·98 nmol/l to only 27·5 nmol/l. Similar results have been found in other studies that administered small daily doses of similar magnitude (6,7) , though one study (3) found significantly improved CB 25(OH)D in subjects receiving 25 mg/d when compared with controls. Studies that used larger (stoss) doses have done so only in the third trimester, whereas Ca transfer to the fetus has been shown to occur in the second trimester (8) . Marya et al. (...

Bone Development and Mineral Homeostasis in the Fetus and Neonate: Roles of the Calciotropic and Phosphotropic Hormones

“…Postnatally the infants continued in their treatment arms by receiving placebo, 400 IU, or 800 IU of vitamin D daily. 25-Hydroxyvitamin D rose faster in the high-dose group, but by 6 mo of age the values were no different among the three groups of infants (78,85, and 84 nM, respectively), and there was no difference in serum calcium at any postnatal time point (233 (294). Small increments in length, head circumference, and weight, and a slight decrease in anterior fonatelle length, were seen in the both vitamin D groups compared with the nonrandomized controls (294).…”

Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery

“…There was no effect on mode of delivery, C-section rates, adverse events, live versus stillbirths, or gestational age at delivery. (455). There were no differences in obstetrical outcomes, including gestational age at delivery, intrauterine death, pregnancy-induced hypertension, cephalopelvic disproportion, nonprogression of labor, cesarean section, and placenta previa (455).…”

“…But maternal overweight/obesity also causes low 25OHD by binding the fat-soluble vitamin D into the maternal fat stores, and by additional associations with reduced vitamin D intake, less time spent outdoors, etc. Consequently, the studies reporting associations between vitamin D intake or 25OHD levels and obstetrical outcomes may really be demonstrating residual confounding from the link between obesity and these outcomes, and also need to consider that the results of the existing randomized trials did not find these outcomes in their primary analyses (183,184,367,399,455,710,779,966,1013). Larger randomized trials that compare truly vitamin D-deficient to sufficient mothers are needed to properly test the hypothesis, and eliminate the confounding caused by maternal overweight and obesity.…”

Favorable Effects of Vitamin D Supplementation on Pregnancy Outcomes in Gestational Diabetes: A Double Blind Randomized Controlled Clinical Trial

“…We found that vitamin D supplementation in pregnant women with GDM resulted in decreased newborn's hyperbilirubinemia. Improved liver enzyme levels in cord blood (CB) of the infants whose mothers received one dose of 1 500 μg vitamin D3 in the second trimester or 2 doses of 3 000 μg vitamin D3 each in the second and third trimesters were seen compared with the controls [18]. In another study by Marya et al [33] supplementation with 2 large doses of 600 000 IU each in the 7 th and 8 th months has led to a significant improvement in serum liver enzyme in [17,34].…”