Effects of Pre-Natal Vitamin D Supplementation with Partial Correction of Vitamin D Deficiency on Early Life Healthcare Utilisation: A Randomised Controlled Trial

Abstract

BackgroundSome observational studies have suggested that higher prenatal Vitamin D intake may be associated with improved health outcomes in childhood. However there have been mixed results in this area with some negative studies, especially for effects on atopic and respiratory outcomes. We examined the effect of prenatal Vitamin D on healthcare utilisation in the first three years of life.MethodsIn an ethnically stratified randomised controlled trial conducted at St Mary’s Hospital London, 180 women at 27 weeks gestation were allocated to no Vitamin D, 800 IU ergocalciferol daily until delivery, or a single oral bolus of 200,000 IU cholecalciferol. Participants were randomised in blocks of 15 using computer-generated numbers and investigators were blinded to group assignment. Supplementation increased maternal and cord blood 25(OH) vitamin D concentrations, but levels remained lower than current recommendations. Primary health economic outcome was overall cost of unscheduled healthcare utilisation in the first three years of life as documented in the child’s electronic health record. Secondary outcomes included cost attributable to: primary and secondary healthcare visits, respiratory and atopic complaints, cost in years 1, 2 and 3 of life and cost and frequency of prescribed medication. All costs were calculated as pounds sterling. Differences between groups were analysed using unpaired t-test or Mann-Whitney U test, and analysis of variance for adjusted analyses.ResultsWe assessed 99/180 (55%) complete electronic health records, control (n = 31), daily (n = 36) and bolus (n = 32). We found no difference in total healthcare utilisation costs between the control and daily (mean difference in costs in pounds sterling 1.02, 95%CI -1.60, 1.65; adjusted 1.07, 95%CI -1.62, 1.86) or control and bolus groups (mean difference -1.58, 95%CI -2.63, 1.06; adjusted –1.40, 95%CI -2.45, 1.24). There were no adverse effects of supplementation reported during the trial.ConclusionsWe found no evidence that prenatal vitamin D supplementation from 27 weeks gestation to delivery, at doses which failed to completely correct maternal vitamin D deficiency, influence overall healthcare utilisation in children in the first 3 years.Trial RegistrationControlled-Trials.com ISRCTN68645785

Effects of Vitamin D Supplementation During Pregnancy on Newborns and Infants: An Integrative Review

“…The studies evaluated the effect of vitamin D supplementation during pregnancy on 14 health outcomes in newborns and infants: length, weight, and head circumference at birth (nine studies), [10][11][12][13][14][15][16][17][18] vitamin D concentration (22 studies), calcium concentration, bone and dental health (seven studies), 14,18,[39][40][41][42][43] respiratory disease and wheezing (respiratory tract infections) (five studies), [44][45][46][47][48] use of health services (one study), 49 DNA methylation (two studies), 47,50 genetic variations of vitamin D-binding protein (one study), 51 insulin-like growth factor (IGF) at birth (one study) 52 , and instestinal microbiota (one study). 53 The studied samples were predominantly composed of newborns.…”

“…50 Regarding inter ventions tested in the 44 trials, seven started vitamin D supplementation in the first trimester of pregnancy, 18,27,37,38,47,51,53 21 in the second, 13,[15][16][17]22,25,26,28,29,[31][32][33]36,[40][41][42][43]46,48,50,52 and 16 in the third. [10][11][12]14,[19][20][21]23,24,30,34,35,39,44,45,49 The studies that started supplementation in the first trimester found a statistically significant difference in weight, 18 height, 18 fontanelle size, 18 vitamin D2 concentration, 7,3...…”

25-Hydroxyvitamin D supplementation and health-service utilization for upper respiratory tract infection in young children

“…Two randomized controlled trials have assessed HSU following vitamin D supplementation in pregnancy. Griffiths supplementation (placebo, 20 µg/d (800 IU/d) or a single bolus of 5000 µg (200 000 IU)) from 27 weeks to delivery influenced overall HSU in children from in London, England in the first 3 years (2) . They also found no association between 25-hydroxyvitamin D concentrations in the children at age 3 years (n 65) and HSU.…”

“…Upper respiratory tract infections (URTI) are the most common infectious disease for children in North America and account for a large portion of health-service utilization (HSU) (1) . Pre-school children experience six to eight URTI per year (2) , with approximately 50 % seeking medical attention in the outpatient or emergency department setting and roughly 1 % requiring hospitalization (3)(4)(5)(6) . A number of studies have suggested that low vitamin D levels may play a role in susceptibility to URTI in children.…”

Implicações maternas e fetais da hipovitaminose D no período gestacional: uma revisão de literatura

“…Além disso, níveis baixos de VD durante o desenvolvimento pulmonar pode afetar o crescimento pulmonar pós-natal e aumentar o risco de desenvolver doença pulmonar 74 . A suplementação materna da VD, particularmente em mães com níveis iniciais de 25[OH]D superiores a 30 ng/mL, diminui asma / sibilância recorrente na prole ao longo dos 3 primeiros anos de vida, sugerindo que é necessário um maior nível de VD iniciado no início da gravidez para prevenção da recorrência dessas doenças no início da vida 75 , mesmo que haja estudos conflitantes ou sem conclusão estatística [76][77][78] . Vários estudos não encontraram evidências positivas da suplementação materna de VD para otimizar a massa óssea da prole 39,[79][80] , embora apresentem evidente melhora das medidas antropométricas 76,81 .…”