Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers

Maternal Vitamin D Supplementation and Infantile Rickets: Secondary Analysis of a Randomized Trial

BACKGROUND

The role of maternal vitamin D supplementation in the prevention of infantile rickets is unknown, particularly in low- and middle-income countries without routine infant vitamin D supplementation. Through secondary analysis of a randomized, placebo-controlled trial in Bangladesh, we examined the dose-ranging effects of maternal vitamin D supplementation on the risk of biochemical rickets at 6 to 12 months of age.

METHODS

Pregnant women (n = 1300) were randomized into 5 groups: placebo, or vitamin D 4200 IU/week, 16 800 IU/week, or 28 000 IU/week from second trimester to delivery and placebo until 6 months postpartum; or 28 000 IU/week prenatally and until 6 months postpartum. Infants underwent biochemical rickets screening from 6 to 12 months of age (n = 790). Relative risks (RR) and 95% confidence intervals (95% CI) of biochemical rickets were estimated for each group versus placebo.

RESULTS

Overall, 39/790 (4.9%) infants had biochemical rickets. Prevalence was highest in the placebo group (7.8%), and the risk was significantly lower among infants whose mothers received combined prenatal and postpartum vitamin D at 28 000 IU/week (1.3%; RR, 0.16; 95% CI, 0.03-0.72). Risks among infants whose mothers received only prenatal supplementation (4200 IU, 16 800 IU, 28 000 IU weekly) were not significantly different from placebo: 3.8% (RR, 0.48; 95% CI, 0.19-1.22), 5.8% (RR, 0.74; 95% CI, 0.33-1.69), and 5.7% (RR, 0.73; 95% CI, 0.32-1.65), respectively.

CONCLUSIONS

Maternal vitamin D supplementation (28 000 IU/week) during the third trimester of pregnancy until 6 months postpartum reduced the risk of infantile biochemical rickets. Further research is needed to define optimal postpartum supplementation dosing during lactation.

Vitamin D3 Supplementation: Comparison of 1000 IU and 2000 IU Dose in Healthy Individuals

Background: Scientific studies point to a significant global vitamin D deficiency. The recommended dose of vitamin D for the adult population in Central Europe is 800–2000 IU/day. The aim of our study was to determine whether doses of 1000 IU or 2000 IU of vitamin D3 are adequate to achieve the sufficiency reference values of [25(OH)D]. Methods: Seventy-two healthy volunteers, average age twenty-two, took part in the study. The study was conducted from October to March in order to eliminate intra-dermal vitamin D production. Vitamin D3 in an oleaginous mixture was used. The participants used either 1000 IU or 2000 IU/daily for two 60-day periods with a 30-day break. Results: The dose of 1000 IU, taken for 60 days, increased vitamin D levels relatively little. Furthermore, serum vitamin D levels decreased in the 30 days following the cessation of supplementation. Taking 2000 IU daily led to a sharp increase in serum levels which plateaued 30 days after the subjects stopped using vitamin D3 drops. Conclusions: Both doses, taken daily, can help maintain adequate vitamin D levels during the winter months. A daily dose of 2000 IU, however, maintained the desired levels of vitamin D for a longer period.

The relationship between hematological indices as indicators of inflammation and 25-hydroxyvitamin D3 status in newborns

BACKGROUND

There is still much unknown about the relationship between hematological parameters and vitamin D status in newborns. The aim of the study is to evaluate the relationship between 25(OH)D3 (vitamin D) status and new defined systemic inflammatory markers neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), and platelet to lymphocyte ratio (PLR) in newborns.

METHODS

One hundred newborns were enrolled in the study. Serum vitamin D status, below < 12 ng/mL (< 30 nmol/L) as deficient, 12-20 ng/mL (30-50 nmol/L) as insufficient, and > 20 ng/mL (> 50 nmol/L) was considered as sufficient.

RESULTS

Parallel to maternal and newborn vitamin D status were also statistically different between the groups (p < 0.05). Moreover, there was a statistically significant difference was found between the deficient, sufficient and insufficient groups in terms of newborn hemoglobin, neutrophil, monocytes, NLR, PLT, PLR and neutrophil to monocyte ratio (NMR) (p < 0.05, in all). There was also a positive correlation between maternal and newborn vitamin D status (r = 0.975, p = 0.000). The newborn NLR were negative correlated with newborn vitamin D status (r = -0.616, p = 0.000).

CONCLUSIONS

The results of this study suggest that there may be potential new biomarkers to predict inflammation associated with the inflammatory state that may arise due to changes in NLR, LMR, and PLR in vitamin D deficiency in newborns. NLR and other hematologic indices may be non-invasive, simple, easily measurable, cost-effective markers of inflammation in newborns.

Early pregnancy vitamin D status and risk of select congenital anomalies in the National Birth Defects Prevention Study

INTRODUCTION

Vitamin D deficiency is associated with adverse pregnancy events. However, its role in the etiology of congenital anomalies remains unclear. We examined the association between vitamin D status, measured through prepregnancy diet, UV exposure, season of conception, and congenital anomalies.

METHODS

We used data from the National Birth Defects Prevention Study, a U.S. population-based case-control study (1997-2011). Prepregnancy dietary vitamin D was calculated from food frequency questionnaires and evaluated using tertiles, based on the distribution in controls. We used the National Oceanic and Atmospheric Administration Weather Service to assign UV indices based on location and estimated date of conception, then dichotomized UV exposure (low vs. high). Seasons of conception was categorized as fall/winter spring/summer. We used logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI).

RESULTS

Lower prepregnancy dietary vitamin D intake (<65.21 IU/d vs. >107.55 IU/d) was associated with increased odds of anencephaly (aOR = 1.28, 95% CI 1.01, 1.63), hypospadias (aOR = 1.21, 95% CI 1.04, 1.40), septal defects (aOR = 1.16, 95% CI 1.05, 1.30), diaphragmatic hernia (aOR = 1.42, 95% CI 1.13, 1.79), and gastroschisis (aOR = 1.27, 95% CI 1.07, 1.52). Findings were consistent when we stratified by UV exposure and season of conception.

CONCLUSIONS

Our findings suggest lower dietary intake of vitamin D may be associated with increased risk of select congenital anomalies. Further investigations are warranted to evaluate the effects of other nutrients and appropriate thresholds and sources of vitamin D using serum.

Machine learning approach for automated predicting of COVID-19 severity based on clinical and paraclinical characteristics: Serum levels of zinc, calcium, and vitamin D

Background & aims

Considering that no standard therapy has yet been found for the novel coronavirus disease (COVID-19), identifying severe cases as early as possible, and such that treatment procedures can be escalated seems necessary. Hence, the present study aimed to develop a machine learning (ML) approach for automated severity assessment of COVID-19 based on clinical and paraclinical characteristics like serum levels of zinc, calcium, and vitamin D.

Methods

In this analytical cross-sectional study which was conducted from May 2020 to May 2021, clinical and paraclinical data sets of COVID-19-positive patients with known outcomes were investigated by combining statistical comparison and correlation methods with ML algorithms, including Decision Tree (DT), Random Forest (RF), and Support Vector Machine (SVM).

Results

Our work revealed that some patients' characteristics including age, gender, cardiovascular diseases as an underlying condition, and anorexia as disease symptoms, and also some parameters which are measurable in blood samples including FBS and serum levels of calcium are factors that can be considered in predicting COVID-19 severity. In this regard, we developed ML predictive models that indicated accuracy and precision scores >90% for disease severity prediction. The SVM algorithm indicated better results than other algorithms by having a precision of 95.5%, recall of 94%, F1 score of 94.8%, the accuracy of 95%, and AUC of 94%.

Conclusions

Our results indicated that clinical and paraclinical features like calcium serum levels can be used for automated severity assessment of COVID-19.

The effect of prepregnancy body mass index on maternal micronutrient status: a meta-analysis

The relationship between prepregnancy body mass index (BMI) and maternal micronutrient status is inconsistent and has not received sufficient attention. This meta-analysis aimed to evaluate the effect of prepregnancy BMI on micronutrient levels in pregnant women. PubMed, Embase, Web of Science, and the Cochrane Library were searched for articles that contained information on micronutrient levels and prepregnancy BMI. A random-effects model was used to determine the association between prepregnancy BMI and maternal micronutrient status. Sixty-one eligible articles were eventually included, with 83,554 participants. Vitamin B12, folate, vitamin D, iron and ferritin were the main micronutrients evaluated in our meta-analysis. Prepregnancy obesity and overweight may lead to an increased risk of micronutrient deficiency, including vitamin B12, folate and vitamin D deficiency, while prepregnancy obesity or overweight may have no significant association with ferritin deficiency. Additionally, the results of the dose-response analyses demonstrated a possible significant inverse correlation between prepregnancy BMI and levels of micronutrient, except for iron and ferritin. Compared with women with normal weight, women who were overweight or obese prepregnancy have lower micronutrient concentrations and are more likely to exhibit micronutrient deficiency during pregnancy, which is harmful to both mothers and neonates.

A double burden of tuberculosis and diabetes mellitus and the possible role of vitamin D deficiency

Tuberculosis remains a major global health challenge, particularly in low-to-middle income countries such as China. At the same time, the country is facing a rapidly increasing diabetes incidence over the last 10 years. Diabetes aggravates the tuberculosis epidemic which poses a serious challenge in public health. In recent years, the high prevalence of vitamin D deficiency represents a global health problem, which is also associated with the risk of diabetes, and tuberculosis. Therefore, this review aims to provide an overall and updated understanding of the epidemiology of co-occurrence of tuberculosis and diabetes in China, and to elucidate the possible role of vitamin D deficiency. In conclusion, significant aggravation of the tuberculosis epidemic due to diabetes may exist in China for a relatively long period of time to come. Further, the double burden and its implications to public health in this country may be significantly influenced by the high prevalence of vitamin D deficiency. Bidirectional screening for tuberculosis and diabetes is recommended, and extra vitamin D may benefit especially in a situation of a heavy tuberculosis burden combined with prevalent vitamin D deficiency. Longitudinal studies to verify the role of vitamin D deficiency in the double burden, and trials on the effect of vitamin D supplementation are needed in the future.

Prevalence of Vitamin D Deficiency in a Large Newborn Cohort from Northern United States and Effect of Intrauterine Drug Exposure

Vitamin D is not only a vital element in bone health but is also a prohormone. Data regarding distribution of vitamin D status among preterm and term neonates in the United States are limited. There are no data on the effect of intrauterine drug exposure on vitamin D status. Our objective was to determine the distribution of vitamin D levels among preterm and term neonates and the effect of intrauterine illicit drug exposure. We did a retrospective chart review of neonates admitted from 2009 to 2016 to our neonatal intensive care unit with serum 25-hydroxycholecalciferol (25[OH]D) levels measured during the hospital stay. Of 1517 neonates, the median 25[OH]D level was 19 ng/mL with 31% deficient and 49% insufficient, even though 75% of mothers took prenatal vitamins. In pregnant women, 38% were vitamin-D-deficient and 44% were vitamin-D-insufficient. Four hundred seventy-one neonates had intrauterine drug exposure, with a median 25[OH]D level of 22.9 ng/mL versus 17.8 ng/mL in nonexposed neonates (p = 0.001). Despite maternal prenatal vitamin intake, neonates are at risk of vitamin D deficiency. Maternal illicit drug use was not related to lower 25[OH]D levels in neonates.

History, epidemiology and prevalence of neonatal bone mineral metabolic disorders

The evolutionary patterns of human migration and historical pre/post-industrial revolution have changed the face of bone metabolic disease through past centuries. Cultural, religious, and lifestyle practices continue to alter nutritional recommendations for this expanding diagnosis. Likewise, modern advancements in the field of neonatology and, more specifically, aggressive nutritional management of premature infants have shaped the epidemiology of neonatal bone metabolism over the past two decades. Decreased use of long-term parenteral nutrition, early fortification of enteral nutrition, and stringent American Academy of Pediatrics (AAP) practice guidelines instituting early supplementation of vitamin D have attributed to improved bone mineralization outcomes in both term and preterm infants. Nevertheless, neonatal bone mineral metabolic disorders remain prevalent. In this review, we provide an in-depth look at the diagnoses, therapeutics, and subset populations-both genetic and non-genetic-affected by neonatal bone mineral metabolic disorders.

Factors Influencing Vitamin D Levels in Neonatal Umbilical Cord Blood: A Two-Center Study From Tibet and Shenyang

Objective: To investigate the factors influencing the levels of vitamin D (vitD) in the umbilical cord blood of neonates born in Naqu, Tibet (4,500 m above sea level), and Shenyang, Liaoning Province (500 m above sea level). Methods: This prospective study was conducted from June 2017 to October 2018 in Naqu (the plateau group) and Shenyang, (the non-plateau group). Healthy mothers that gave birth to healthy neonates of >2,000g after 38 weeks' gestation were enrolled in the study, as were their neonates. After separation of serum from the umbilical cord and mothers for routine biochemical tests, discarded samples were remained for analyses of vitD, calcium, phosphorus, alkaline phosphatase (ALP) and parathyroid hormone (PTH). Questionnaires were developed covering the demographic characteristics and possible risk factors for neonatal vitD deficiency of mothers. Statistical analysis was performed to identify associations between the calcium, phosphorus, ALP, PTH, maternal factors and neonatal vitD levels. Results: In total, 295 neonates and 225 mothers were enrolled in the study. VitD deficiency was common in neonates and mothers. The risk of vitD deficiency was higher in the plateau group than in the non-plateau group. The mean levels of 25-hydroxy vitD (25(OH)D) in mothers and neonates from the plateau group were 8.49 ± 4.12 ng/mL and 10.17 ± 5.07 ng/mL, respectively. Such levels were significantly lower than those in the non-plateau group (19.77 ± 9.57 ng/mL and 23.93 ± 11.01 ng/mL, respectively). The vitD levels of neonates and mothers were highest in the summer and lowest in the winter. Cord blood vitD was positively correlated with the vitD levels in mothers' serum (r = 0.75, P < 0.05). Increased PTH levels in mothers and decreased cord blood calcium levels were risk factors for neonatal vitD deficiency. A lack of vitD supplementation during pregnancy was associated with an 8.91-fold higher probability of neonatal vitD deficiency (OR = 8.91, 95% CI = 1.521-9.429, P < 0.001). Conclusions: The levels of neonatal and maternal vitD in the plateau group were generally lower than those in the non-plateau group. VitD supplementation during pregnancy could effectively reduce the risk of vitD deficiency in neonates.

Factors Affecting Vitamin D Status in Infants

Vitamin D is critical to children's skeletal development and health. Despite this, the factors which determine vitamin D concentrations during infancy remain incompletely understood. This article reviews the literature assessing the factors which can affect vitamin D status in infancy, including antenatal and postnatal vitamin D supplementation. Observational data supports that dietary intake of vitamin D, UV exposure, and geographic factors contribute significantly to infants' vitamin D status, but the relationship is unclear regarding genetic variation, ethnicity, and maternal vitamin D status. Randomised controlled trials have compared higher versus lower doses of infant vitamin D supplementation, but no studies have compared infant vitamin D supplementation to placebo and eliminated external sources of vitamin D to fully quantify its effect on vitamin D status. Knowledge gaps remain regarding the factors associated with optimal vitamin D concentrations in infants-including key factors such as ethnicity and genetic variation-and further studies are needed.

Maternal serum vitamin D levels and preterm delivery among low-risk parturients in Lagos, Nigeria

OBJECTIVE

To determine the association between low maternal vitamin D levels and preterm delivery among parturients in Lagos, Nigeria.

METHODS

The present study was an analytical cross-sectional study of women with preterm deliveries (defined as <37 weeks) and women with term deliveries (defined as ≥37 weeks) at the labor unit of Lagos University Teaching Hospital between December 1, 2015, and October 31, 2016. Relevant information was obtained via a proforma, and maternal venous samples were collected immediately after delivery. Serum 25-hydroxy vitamin D was determined by a vitamin D enzyme-linked immunoassay kit.

RESULTS

The study enrolled 103 women in each group. The overall prevalence of vitamin D deficiency was 14.1% (29/206). 24 (23.3%) women with preterm delivery had low serum vitamin D (<30 ng/mL) as compared with only 5 (4.9%) women with term delivery (P<0.001). Compared with normal serum vitamin D levels, low maternal vitamin D had an approximately nine-fold higher likelihood of preterm delivery (adjusted odds ratio 9.41, 95% confidence interval 2.42-36.54; P<0.001).

CONCLUSION

The prevalence of serum vitamin D deficiency was higher among women with preterm delivery than among those with term delivery. The potential role of prenatal vitamin D supplementation in the prevention of preterm delivery should be further investigated.

Efficacy of daily supplementation of 800 IU vitamin D on vitamin D status at 6 months of age in term healthy Indian infants

OBJECTIVES

Most authorities recommend daily supplementation of 400 IU vitamin D for all term healthy neonates throughout infancy, however this dose was shown to be inadequate in an earlier study from our institution. We planned to evaluate if supplementation of 800 IU/day in term Indian infants would reduce the prevalence of vitamin D insufficiency (VDI) at 6 months of age.

METHODS

In a prospective study, we supplemented 800 IU/day of vitamin D in 70 term infants from birth till 6 months of age. Serum 25-hydroxy cholecalciferol [25(OH)D] was measured at birth and 6 months for all infants; and at 6, 10 and 14 weeks of age in subsets of 23 infants each. The primary outcome was prevalence of VDI (defined as serum 25(OH)D level < 50 nmol/L) at 6 months of age.

RESULTS

A total of 58 out of 70 (83%) infants were followed up until 6 months of age. The median (nmol/L; IQR) serum 25(OH)D at birth and 6 months of age was 25 (12.5-35) and 92.5 (72.5-137.5), respectively. The prevalence of VDI at birth was 91.3% (63/69), which reduced to 6.9% (4/58) at 6 months of age. However, four infants (6.9%, 95% CI 1.9-16.7) developed vitamin D excess (serum 25(OH)D 250-375 nmol/L) requiring reduction of the dose of supplementation. No infant developed vitamin D toxicity (serum 25(OH)D > 375 nmol/L).

CONCLUSIONS

Daily supplementation of 800 IU of vitamin D resulted in vitamin D sufficiency in most term healthy infants at 6 months of age but with potential risk of toxicity.

Racial difference in preterm birth and low birthweight: Towards a new hypothesis involving the interaction of 25-hydroxyvitamin D with maternal fat mass

Preterm birth (PB) and low birthweight (LBW) remain a leading cause of infant mortality worldwide. Persistent racial disparities in prevalence rates have been reported, with the highest values observed in Subsaharan Africa and South Asia. In United States, non-Hispanic Black women are more likely to have a premature or low-birth-weight baby. Beyond the speculative debate on factors explaining such racial disparity, the key-question remains about the path from race to birth outcomes. Several hypotheses emerged from the published literature to explain the racial difference in likelihood for PB and LBW. However, the 'Hispanic paradox' remains unexplained. We relied here on published data to hypothesize that the racial disparity in PB/LBW is a consequence to the joint influence of 25-hydroxyvitamin D and fat mass. Beyond its role as a source of 1,25-dihydroxyvitamin D, the 25-hydroxyvitamin D is directly implicated in the fetal growth and the normal completion of pregnancy. Because of its lipophilic property, a large part of 25-hydroxyvitamin D is swiftly trapped into fat mass and the circulating fraction impact the body development during fetal period. We postulate that the positive effect of vitamin D to prevent PB/LBW is less beneficial for women with high fat mass, independent of race. The core problem may be related to bioavailable 25-hydroxyvitamin D, not directly to race.

Do infants with cow's milk protein allergy have inadequate levels of vitamin D?

OBJECTIVE

To verify whether infants with cow's milk protein allergy have inadequate vitamin D levels.

METHODS

This cross-sectional study included 120 children aged 2 years or younger, one group with cow's milk protein allergy and a control group. The children were recruited at the pediatric gastroenterology, allergology, and pediatric outpatient clinics of a university hospital in the Northeast of Brazil. A questionnaire was administered to the caregiver and blood samples were collected for vitamin D quantification. Vitamin D levels <30ng/mL were considered inadequate. Vitamin D level was expressed as mean and standard deviation, and the frequency of the degrees of sufficiency and other variables, as proportions.

RESULTS

Infants with cow's milk protein allergy had lower mean vitamin D levels (30.93 vs.35.29ng/mL; p=0.041) and higher deficiency frequency (20.3% vs.8.2; p=0.049) than the healthy controls. Exclusively or predominantly breastfed infants with cow's milk protein allergy had higher frequency of inadequate vitamin D levels (p=0.002). Regardless of sun exposure time, the groups had similar frequencies of inadequate vitamin D levels (p=0.972).

CONCLUSIONS

Lower vitamin D levels were found in infants with CMPA, especially those who were exclusively or predominantly breastfed, making these infants a possible risk group for vitamin D deficiency.

Prenatal Vitamin D Intake, Cord Blood 25-Hydroxyvitamin D, and Offspring Body Composition: The Healthy Start Study

Vitamin D deficiency in pregnancy may be associated with increased offspring adiposity, but evidence from human studies is inconclusive. We examined associations between prenatal vitamin D intake, 25-hydroxyvitamin D (25(OH)D) in cord blood, and offspring size and body composition at birth and 5 months. Participants included 605 mother-offspring dyads from the Healthy Start study, an ongoing, pre-birth prospective cohort study in Denver, Colorado, USA. Prenatal vitamin D intake was assessed with diet recalls and questionnaires, and offspring body composition was measured via air displacement plethysmography at birth and 5 months. General linear univariate models were used for analysis, adjusting for maternal age, race/ethnicity, pre-pregnancy body mass index (BMI), offspring sex, and gestational age at birth. Non-Hispanic white race, lower pre-pregnancy BMI, higher prenatal vitamin D intake, and summer births were associated with higher cord blood 25(OH)D. Higher 25(OH)D was associated with lower birthweight (β = -6.22, p = 0.02), but as maternal BMI increased, this association became increasingly positive in direction and magnitude (β = 1.05, p = 0.04). Higher 25(OH)D was also associated with lower neonatal adiposity (β = -0.02, p < 0.05) but not after adjustment for maternal BMI (β = -0.01, p = 0.25). Cord blood 25(OH)D was not associated with offspring size or body composition at 5 months. Our data confirm the hypothesis that vitamin D exposure in early life is associated with neonatal body size and composition. Future research is needed to understand the implications of these associations as infants grow.

The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention

Vitamin D deficiency and insufficiency is a global health issue that afflicts more than one billion children and adults worldwide. The consequences of vitamin D deficiency cannot be under estimated. There has been an association of vitamin D deficiency with a myriad of acute and chronic illnesses including preeclampsia, childhood dental caries, periodontitis, autoimmune disorders, infectious diseases, cardiovascular disease, deadly cancers, type 2 diabetes and neurological disorders. This review is to put into perspective the controversy surrounding the definition for vitamin D deficiency and insufficiency as well as providing guidance for how to treat and prevent vitamin D deficiency.

Prevalence of Vitamin D Deficiency and Its Associations with Skin Color in Pregnant Women in the First Trimester in a Sample from Switzerland

Vitamin D deficiency in pregnancy has negative clinical consequences, such as associations with glucose intolerance, and has been shown to be distributed differently in certain ethnic groups. In some countries, a difference in the rate of vitamin D deficiency was detected in pregnant women depending on their skin color. We examined the prevalence of vitamin D deficiency (<20 ng/mL) in women in early pregnancy in Switzerland and evaluated the association of skin color with vitamin D deficiency. In a single-center cohort study, the validated Fitzpatrick scale and objective melanin index were used to determine skin color. Of the 204 pregnant women included, 63% were vitamin D deficient. The mean serum 25-hydroxyvitamin D concentration was 26.1 ng/mL (95% confidence interval (CI) 24.8-27.4) in vitamin D-sufficient women and 10.5 ng/mL (95% CI 9.7-11.5) in women with deficiency. In the most parsimonious model, women with dark skin color were statistically significantly more often vitamin D deficient compared to women with light skin color (OR 2.60; 95% CI 1.08-6.22; adjusted for age, season, vitamin D supplement use, body mass index, smoking, parity). This calls for more intense counseling as one policy option to improve vitamin D status during pregnancy, i.e., use of vitamin D supplements during pregnancy, in particular for women with darker skin color.

Determinants of vitamin D status in pregnant women and neonates

OBJECTIVES

Evidence suggests a beneficial effect of vitamin D on perinatal health; however, low vitamin D status is prevalent in pregnant women and neonates. The objective was to determine factors that are associated with vitamin D status of mothers in early pregnancy and neonates.

METHODS

The study comprised 1,635 pregnant women from Quebec City and Halifax, Canada, 2002-2010. Vitamin D status was based on the concentration of 25-hydroxy-vitamin D [25(OH)D] determined with a chemiluminescence immunoassay in maternal sera collected at a median of 15 weeks' gestation and in neonatal cord sera at delivery. A questionnaire with information on potential determinants was completed midpregnancy.

RESULTS

A total of 44.8% of mothers and 24.4% of neonates had 25(OH)D concentrations &lt;50 nmol/L. Adjusted mean (95% confidence interval) maternal 25(OH)D levels were higher in summer than in winter by 16.1 nmol/L (13.6-18.7), and in those in the highest versus the lowest category of education by 6.1 nmol/L (0.5-11.8), in BMI &lt;25 kg/m2 versus BMI ≥35 kg/m2 by 8.2 nmol/L (4.0-12.3), and in the highest versus the lowest physical activity category by up to 9.5 nmol/L (2.9-16.1). Determinants of neonatal 25(OH)D levels were similar but also included maternal age, dairy intake, supplement use and 25(OH)D level.

CONCLUSION

This study suggests that vitamin D status of pregnant women and/or neonates might be improved through supplementation, adequate dairy intake, a move towards a healthy pre-pregnancy body weight, and participation in physical activity. Controlled studies are needed to determine the effectiveness of interventions aimed at these factors.

Effects of early enteral micro-feeding on neonatal serum Vitamin D levels

Objective:

To evaluate the effects of early enteral micro-feeding on neonatal serum vitamin D levels, and to analyze the application value of glutamine.

Methods:

One hundred ninty neonates enrolled in intensive care unit were randomly divided into a treatment group and a control group (n=95) that were both given enteral and parenteral nutrition support. Meanwhile, the treatment group was fed formula milk containing 0.3 g/(kg·d) glutamine as enteral nutrition support for 14 days.

Results:

The weight of the treatment group increased significantly faster than that of the control group did (P<0.05). The treatment group had significantly higher milk amount and calorie intake than those of the control group (P<0.05), and neonates in the treatment group who reached calorie intake of 50/80/100 kcal/kg/d were significantly younger (P<0.05). Meanwhile, the treatment group was significantly less prone to feeding intolerance than the control group (P<0.05). After 14 days of feeding, the serum motilin, gastrin and vitamin D levels of both groups all increased, with significant intra-group and inter-group differences. Such levels of the treatment group significantly exceeded those of the control group (P<0.05).

Conclusion:

Supplementing early enteral micro-feeding with glutamine promoted the absorption of neonatal routine nutrients and vitamin D, obviously regulated gastrointestinal hormones, and elevated weight as a result.

Autism spectrum disorder and low vitamin D at birth: a sibling control study

BACKGROUND

Insufficient vitamin D activity has attracted increasing interest as a possible underlying risk factor in disorders of the central nervous system, including autism.

METHODS

In this study, 25-hydroxyvitamin D (25(OH)D) was analysed in 58 Sweden-born sibling pairs, in which one child had autism spectrum disorder (ASD) and the other did not. The study group consisted of two representative samples; 47 Gothenburg sibling pairs with mixed ethnicities and 11 Stockholm sibling pairs with Somali background. 25(OH)D levels were analysed in the stored dried blood spots taken in the neonatal period for metabolic screening.

RESULTS

The collapsed group of children with ASD had significantly lower vitamin D levels (M = 24.0 nM, SD = 19.6) as compared with their siblings (M = 31.9 nM, SD = 27.7), according to a paired samples t-test (P = 0.013). The difference was - most likely - not only accounted for by a difference in season of birth between ASD and non-ASD siblings since the mean 25(OH)D levels differed with similar effect size between the sibling pairs born during winter and summer, respectively. All children with African/Middle East background, both the children with ASD and their non-ASD siblings, had vitamin D deficiency.

CONCLUSIONS

The findings suggest that low prenatal vitamin D may act as a risk factor for ASD, however, there is a need for replication with larger samples. Future research should study whether or not adequate supplementation of vitamin D to pregnant women might lower the risk for ASD in the offspring.

Prenatal factors associated with the neonatal line thickness in human deciduous incisors

The neonatal line (NNL) is used to distinguish developmental events observed in enamel which occurred before and after birth. However, there are few studies reporting relationship between the characteristics of the NNL and factors affecting prenatal conditions. The aim of the study was to determine prenatal factors that may influence the NNL thickness in human deciduous teeth. The material consisted of longitudinal ground sections of 60 modern human deciduous incisors obtained from full-term healthy children with reported birth histories and prenatal factors. All teeth were sectioned in the labio-lingual plane using diamond blade (Buechler IsoMet 1000). Final specimens were observed using scanning electron microscopy at magnifications 320×. For each tooth, linear measurements of the NNL thickness were taken on its labial surface at the three levels from the cemento-enamel junction. The difference in the neonatal line thickness between tooth types and between males and females was statistically significant. A multiple regression analyses confirmed influence of two variables on the NNL thickness standardised on tooth type and the children's sex (z-score values). These variables are the taking of an antispasmodic medicine by the mother during pregnancy and the season of the child's birth. These two variables together explain nearly 17% of the variability of the NNL. Children of mothers taking a spasmolytic medicine during pregnancy were characterised by a thinner NNL compared with children whose mothers did not take such medication. Children born in summer and spring had a thinner NNL than children born in winter. These results indicate that the prenatal environment significantly contributes to the thickness of the NNL influencing the pace of reaching the post-delivery homeostasis by the newborn's organism.

Congenital rickets due to vitamin D deficiency in the mothers

BACKGROUND & AIMS

We wished to review all published reports of congenital rickets to identify the causes and characteristics.

METHODS

25 cases were identified in 19 published reports in which there was radiological and/or histological evidence of rickets in the first two weeks after birth. Cases of rickets associated with maternal renal failure were excluded as were infants born at less than 32 weeks gestation.

RESULTS

There was evidence of maternal deficiency in 24 of these cases. In 16 cases the diagnosis of the rickets led to the identification of symptomatic osteomalacia in the mothers. Of the 12 mothers who had assays for serum 25-hydroxyvitamin D (25OHD) 11 had values less than 10 ng/mL. Presentations in the infants included craniotabes, wide skull sutures, rachitic rosaries, enlargement of the wrists, tetany and convulsions. In two cases rickets had been suspected from antenatal X-rays. In five cases fractures were found at the time of initial presentation. Of the 16 infants with serum calcium assays 15 had values lower than 8.8 mg/dL. Of 13 infants who had serum alkaline phosphatase assays 12 had abnormally high levels. Of the seven infants in whom serum 25OHD was measured before treatment, all had values less than 10 ng/mL.

CONCLUSIONS

These reports provide strong support for the view that maternal deficiency leads to overt bone disease from before birth. Maternal deficiency probably also leads to impairment of bone quality in postnatal life. The importance of ensuring adequate vitamin D nutrition in pregnancy is emphasised.

Vitamin D supplementation of breastfed infants: a randomized dose-response trial

BACKGROUND

Breastfed infants require supplementation with vitamin D (vD), but little is known about the necessary dose. This double blind trial evaluated four different doses of vD.

METHODS

Exclusively breastfed infants (N = 213) were randomized at 1 mo to one of four doses, which they received through 9 mo while receiving no formula. The supplements provided daily 200 IU, 400 IU, 600 IU, or 800 IU of vD. The primary endpoint was plasma 25(OH)D level, and secondary outcomes were plasma parathyroid hormone and calcium, and illness incidence. The study was conducted during winter at 41° N.

RESULTS

Most infants had low (<50 nmol/l) 25(OH)D levels at 1 mo, but with supplementation levels rose. Overall, levels of 25(OH)D differed significantly in proportion to vD dose. There were no effects of vD on illness incidence or growth. Low levels were common, with 7.8% of levels being <50 nmol/l and 15 infants having 2 to 4 low levels.

CONCLUSION

The four doses of vD produced different plasma levels of 25(OH)D. The higher doses were somewhat more efficacious in maintaining vD sufficiency in breastfed infants. The findings support the recommended dose of 400 IU/d, and stress the need to start supplementation at birth.

Vitamin D status and adequacy of standard supplementation in preterm neonates from South India

OBJECTIVE

The aim of this study was to assess vitamin D status of preterm babies at birth and adequacy of daily supplementation with vitamin D.

METHODS

This prospective cohort study recruited 111 preterm babies, 25 to 32 weeks' gestation from a tertiary care perinatal center in south India. Cord blood was assayed for serum calcium, phosphate, alkaline phosphatase, and 25-hydroxyvitamin D (25(OH)D). All of the babies were fed unfortified breast-milk and supplemented daily with calcium, phosphate, and 400 IU of vitamin D. At 6 weeks serum calcium, phosphate, alkaline phosphatase, parathyroid hormone, and 25(OH)D levels were estimated.

RESULTS

Of 111 preterm babies recruited, a total of 90 (81%) of the preterm babies were followed up until 6 weeks. The median (interquartile range) vitamin D level in the preterm group was 34.7 (25.6-50.1) and 19.3 (13.9-27.1) ng/mL at birth and 6 weeks, respectively. Using a cutoff value of <20 ng/mL to determine vitamin D insufficiency (VDI), it was observed that 12.6% of the babies were vitamin D insufficient at birth. This increased to 52.2% at 6 weeks despite the recommended supplementation with vitamin D (P < 0.001).

CONCLUSIONS

The prevalence of VDI was not high at birth; however, a large proportion of preterm babies were vitamin D insufficient at 6 weeks despite being supplemented with vitamin D 400 IU/day. The recommended vitamin D supplementation of 400 IU appears to be inadequate to prevent VDI, and hence randomized controlled trials looking at higher doses of vitamin D supplementation are needed.

Vitamin D deficiency in minority populations

OBJECTIVE

Black and Hispanic individuals synthesize less vitamin D per unit of sun exposure than white individuals. The relationship between UV radiation and vitamin D insufficiency in minorities has not been well explored.

DESIGN

Prospective cohort study.

SETTING

Using the National Health and Nutrition Examination Survey, we obtained serum vitamin D levels for non-Hispanic Whites, Hispanics and non-Hispanic Blacks aged ≥18 years from 2000-2006. We linked these data with the average monthly solar UV index by census tract and data on sun exposure, vitamin D supplementation, health and demographics. We used multivariable regression analyses to assess vitamin D deficiency (<15 ng/ml) and insufficiency (<20 ng/ml) in January (when the UV index was lowest) by race/ethnicity and geography.

SUBJECTS

Adults (n 14,319) aged ≥18 years.

RESULTS

A 1-point increase in the UV index was associated with a 0·51 ng/ml increase in vitamin D (95% CI 0·35, 0·67 ng/ml; P<0·001). Non-Hispanic Black race and Hispanic ethnicity were associated with a 7·47 and 3·41 ng/ml decrease in vitamin D, respectively (both P<0·001). In January, an estimated 65·4% of non-Hispanic Blacks were deficient in vitamin D, compared with 28·9% of Hispanics and 14·0% of non-Hispanic Whites. An estimated 84·2% of non-Hispanic Blacks were insufficient in vitamin D v. 56·3% of Hispanics and 34·8% of non-Hispanic Whites. More non-Hispanic Blacks were estimated to be deficient in vitamin D in January in the highest UV index quartile than were non-Hispanic Whites in the lowest UV index quartile (60·2% v. 25·7%).

CONCLUSIONS

Wintertime vitamin D insufficiency is pervasive among minority populations, and not uncommon among non-Hispanic Whites.

Early-life vitamin D deficiency and childhood-onset coeliac disease

Many studies have investigated the aetiological roles of genetic and environmental factors in coeliac disease (CD) with the long-term goal of developing an effective primary prevention strategy. CD is a condition with dysregulated systemic and intestinal mucosal immune responses to dietary gluten proteins among genetically predisposed individuals. We recently described spring birth as a novel risk factor for CD in children. We believe that the association between season of birth and CD is due to seasonal differences in sunlight exposure and subsequent vitamin D status. Concomitant with global increases in CD prevalence, vitamin D deficiency also is increasingly recognized in children worldwide. Recent studies have shown that vitamin D deficiency can cause improper immune responses, abnormal intestinal mucosal integrity and impaired local defence to pathogenic microbial agents. In conjunction with other potential aetiological factors, we propose a hypothesis model of early-life vitamin D deficiency in the pathogenesis of childhood-onset CD.

Vitamin D levels in children born to vitamin D-deficient mothers

AIM

To determine whether a standard daily dose of 400 IU vitamin D is sufficient to normalize vitamin D levels in infants born to vitamin D-deficient mothers.

METHODS

The children were recruited from a study cohort of 68 immigrant and 51 non-immigrant pregnant women living in Stockholm. The women were monitored at 12 weeks of pregnancy, at delivery and together with their children, 6-18 months after birth. During pregnancy, most immigrant women (78%) had 25(OH)D3 levels <25 nmol/l. We here report the outcome of 25 infants born to these mothers. All infants received a daily supplementation dose of 400 IU vitamin D from 2 weeks of age.

RESULTS

At birth, most children in the immigrant group were vitamin D-deficient (23.3 nmol/l (12-54); mean and range) while at 6-18 months of age vitamin D levels were essentially normalized (82.8 nmol/l (38-142)) although 4 children still had subnormal levels consistent with vitamin D insufficiency.

CONCLUSION

A daily recommended supplementation dose of 400 IU vitamin D is sufficient in most children of vitamin D-deficient immigrant women living in Sweden.

Association between cord blood 25-hydroxyvitamin D concentrations and respiratory tract infections in the first 6 months of age in a Korean population: a birth cohort study (COCOA)

PURPOSE

Previous studies suggest that the concentration of 25-hydroxyvitamin D [25(OH)D] in cord blood may show an inverse association with respiratory tract infections (RTI) during childhood. The aim of the present study was to examine the influence of 25(OH)D concentrations in cord blood on infant RTI in a Korean birth cohort.

METHODS

The levels of 25(OH)D in cord blood obtained from 525 Korean newborns in the prospective COhort for Childhood Origin of Asthma and allergic diseases were examined. The primary outcome variable of interest was the prevalence of RTI at 6-month follow-up, as diagnosed by pediatricians and pediatric allergy and pulmonology specialists. RTI included acute nasopharyngitis, rhinosinusitis, otitis media, croup, tracheobronchitis, bronchiolitis, and pneumonia.

RESULTS

The median concentration of 25(OH)D in cord blood was 32.0 nmol/L (interquartile range, 21.4 to 53.2). One hundred and eighty neonates (34.3%) showed 25(OH)D concentrations less than 25.0 nmol/L, 292 (55.6%) showed 25(OH)D concentrations of 25.0-74.9 nmol/L, and 53 (10.1%) showed concentrations of ≥75.0 nmol/L. Adjusting for the season of birth, multivitamin intake during pregnancy, and exposure to passive smoking during pregnancy, 25(OH)D concentrations showed an inverse association with the risk of acquiring acute nasopharyngitis by 6 months of age (P for trend=0.0004).

CONCLUSION

The results show that 89.9% of healthy newborns in Korea are born with vitamin D insufficiency or deficiency (55.6% and 34.3%, respectively). Cord blood vitamin D insufficiency or deficiency in healthy neonates is associated with an increased risk of acute nasopharyngitis by 6 months of age. More time spent outdoors and more intensified vitamin D supplementation for pregnant women may be needed to prevent the onset of acute nasopharyngitis in infants.

A Framework for Intentional Cultural Change

We present a framework for a pragmatic science of cultural evolution. It is now possible for behavioral science to systematically influence the further evolution of cultural practices. As this science develops, it may become possible to prevent many of the problems affecting human wellbeing. By cultural practices, we refer to everything that humans do, above and beyond instinctual or unconditioned behaviors: not only art and literature, but also agriculture, manufacturing, recreation, war making, childrearing, science-everything. We can analyze cultural practices usefully in terms of the incidence and prevalence of individual behavior and group and organization actions. An effective science of intentional cultural evolution must guide efforts to influence the incidence and prevalence of individuals' behaviors and the actions of groups and organizations. In this paper, we briefly sketch advances in scientific understanding of the influences on individual behavior. Then we describe principles that could guide efforts to influence groups and organizations. Finally, we discuss legitimate concerns about the use and misuse of a science for intentional cultural change.

Association between vitamin D insufficiency and adverse pregnancy outcome: global comparisons

Background

Vitamin D insufficiency has been associated with a number of adverse pregnancy outcomes, and has been recognized as a public health concern.

Aim

The objective of this study was to determine the impact of vitamin D deficiency on maternal complications like gestational diabetes mellitus (GDM), anemia, iron deficiency, and preeclampsia among pregnant women.

Subjects and methods

This was a cohort study undertaken at antenatal clinics at the Women’s Hospital of Hamad Medical Corporation in Doha. A total of 2,487 Arab pregnant women above 24 weeks’ gestation with any maternal complication were approached, and 1,873 women (75.3%) consented to participate in the study. Data on sociodemographic and clinical characteristics by interview and biochemistry parameters were retrieved from medical records. Multivariate logistic regression analysis was performed to determine the associated risk factors.

Results

Of the studied pregnant women, nearly half of them had vitamin D deficiency (48.4%). Younger women below 30 years old (43.2%, P = 0.032), housewives (65.3%, P = 0.008), and those on low monthly household incomes (QR5,000–9,999) (49.2%, P = 0.03) were significantly more likely to have lower vitamin D compared with those who had sufficient vitamin D levels. Exposure to sunlight (63.4%, P = 0.05), daily physical activity (64.4%, P = 0.05), and vitamin D supplement intake (89.7%, P < 0.001) were significantly lower in deficient pregnant women. In the study sample of pregnant women, 13.9% had GDM, 11.5% had anemia, 8.6% had iron deficiency, and 6.9% had preeclampsia. Severe vitamin D deficiency was significantly higher in pregnant women with GDM (16.5% vs 11%), anemia (17.1% vs 11%), iron deficiency (18.5% vs 11.2%), and preeclampsia (19.8% vs 11.4%) when compared to the uncomplicated group. Socioeconomic status was low in pregnant women with complications like GDM, anemia, iron deficiency, and pre-eclampsia. Pregnancy complications like GDM (52.7%), anemia (53.2%), iron deficiency (55.6%), and preeclampsia (51.9%) were higher in Qataris. Also, GDM (66.2%), anemia (66.2%), iron deficiency (68.5%), and preeclampsia (58.1%) were observed more commonly among housewives compared to working women. Obesity was significantly more common in pregnant women with GDM (41.5%) and preeclampsia (41.1%).

Conclusion

The study findings revealed that maternal vitamin D deficiency in pregnancy is significantly associated with elevated risk for GDM, anemia, and preeclampsia. The risk of vitamin D deficiency was higher in Qataris, housewives and those with low monthly household income.

Maternal and infant vitamin D status during the first 9 months of infant life-a cohort study

BACKGROUND/OBJECTIVES

The objective of this study was to assess vitamin D status and possible consequences of low plasma 25-hydroxyvitamin D (25OHD) levels in a population of healthy mothers and their infants.

SUBJECTS/METHODS

A total of 107 women aged 24-41 years gave birth to 108 infants. They were followed up three times during 9 months.

RESULTS

Cord blood 25OHD level (43.3 ± 20.4  nmol/l) on average was 62 ± 16% of maternal levels (73.3 ± 30.7  nmol/l), measured 1-2 weeks postpartum. Cord blood 25OHD correlated positively with maternal 25OHD levels (r=0.83, P<0.001). At birth, 23% of mothers and 61% of infants had 25OHD <50  nmol/l. Vitamin D deficiency (25OHD<25  nmol/l) was present in 66% of the children born by mothers with 25OHD levels below 50  nmol/l (P<0.01), whereas only one child was born with deficiency among mothers with 25OHD >50  nmol/l. During follow-up, most of the children (>85%) had 25OHD levels >50  nmol/l, which most likely was attributable to the use of supplements, as more than 95% of the children were given daily vitamin D supplements of 10  μg of vitamin D.Cord blood parathyroid hormone levels were very low (median 0.21; interquartile range 0.11-0.33  pmol/l), with increasing levels (P<0.01) reaching 3.08 (2.67-3.92  pmol/l) at the last visit. Vitamin D levels were not associated with anthropometric indices of the newborn infant or their growth during follow-up.

CONCLUSIONS

Vitamin D deficiency is widespread in newborn. Maternal 25OHD levels above 50  nmol/l are needed to prevent vitamin D deficiency among newborn.

Higher vitamin D intake in preterm infants fed an isocaloric, protein- and mineral-enriched postdischarge formula is associated with increased bone accretion

During the first half of infancy, bone accretion in preterm infants fed an isocaloric, protein- and mineral-enriched postdischarge formula (PDF) is higher compared with those fed term formula (TF) or human milk (HM). This may be related to higher protein, calcium, phosphorus, and vitamin D intakes. This study investigated serum calcium, phosphate, and 25-hydroxyvitamin D [25(OH)D] in relation to bone mineral content (BMC) in PDF-, TF-, and HM-fed preterm infants between term age (40 wk postmenstrual age) and 6 mo corrected age (CA). Between term age and 6 mo CA, 52 preterm infants were fed PDF (per 100 mL: 67 kcal, 1.7 g protein, 65 mg calcium, 38 mg phosphorus, 56 IU vitamin D), 41 were fed TF (per 100 mL: 67 kcal, 1.47 g protein, 50 mg calcium, 30 mg phosphorus, 48 IU vitamin D), and 46 were fed HM. Serum calcium, phosphorus, and 25(OH)D were measured at term age and at 3 and 6 mo CA. BMC (g) was measured by whole-body dual-energy X-ray absorptiometry at term age and at 6 mo CA. Between term age and 6 mo CA, intakes of calcium, phosphorus, and vitamin D were significantly higher in PDF- compared with TF-fed infants, and PDF-fed infants reached significantly higher serum 25(OH)D concentrations at 6 mo CA (103 ± 24.3 vs. 92.8 ± 15.5 nmol/L, P = 0.003). Between term age and 6 mo CA, increases in serum 25(OH)D were associated with an increase in BMC (β = 0.001; 95% CI: 0.00, 0.003; P = 0.046). In conclusion, during the first 6 mo postterm, higher vitamin D intake and greater increase in serum 25(OH)D concentration in PDF-fed preterm infants were associated with increased bone accretion.

Maternal vitamin D deficiency causes smaller muscle fibers and altered transcript levels of genes involved in protein degradation, myogenesis, and cytoskeleton organization in the newborn rat

SCOPE

Epidemiologic data reveal associations between low serum concentrations of 25-hydroxyvitamin D (25(OH)D) and higher risk of falls and muscle weakness. Fetal stage is critical for the development of skeletal muscle, but little information is available on the impact of maternal vitamin D deficiency on muscles of offspring.

METHODS AND RESULTS

To investigate the morphology and transcriptome of gastrocnemius muscle in newborns in response to maternal vitamin D deficiency, 14 female rats were fed either a vitamin D₃ deficient (0 IU/kg) or a vitamin D₃ adequate diet (1000 IU/kg) 8 weeks prior to conception, during pregnancy, and lactation. Analysis of cholecalciferol, 25(OH)D₃ and 1,25-dihydroxyvitamin D₃ show that dams fed the vitamin D deficient diet and their newborns suffered from a relevant vitamin D deficiency. Muscle cells of vitamin D deficient newborns were smaller than those of vitamin D adequate newborns (p < 0.05). Muscle transcriptome of the newborns revealed 426 probe sets as differentially expressed (259 upregulated, 167 downregulated) in response to vitamin D deficiency (fold change ≥1.5, p < 0.05). The effected genes are involved in protein catabolism, cell differentiation and proliferation, muscle cell development, and cytoskeleton organization.

CONCLUSION

Maternal vitamin D deficiency has a major impact on morphology and gene expression profile of skeletal muscle in newborns.

Prenatal vitamin d supplementation and child respiratory health: a randomised controlled trial

BACKGROUND

Observational studies suggest high prenatal vitamin D intake may be associated with reduced childhood wheezing. We examined the effect of prenatal vitamin D on childhood wheezing in an interventional study.

METHODS

We randomised 180 pregnant women at 27 weeks gestation to either no vitamin D, 800 IU ergocalciferol daily until delivery or single oral bolus of 200,000 IU cholecalciferol, in an ethnically stratified, randomised controlled trial. Supplementation improved but did not optimise vitamin D status. Researchers blind to allocation assessed offspring at 3 years. Primary outcome was any history of wheeze assessed by validated questionnaire. Secondary outcomes included atopy, respiratory infection, impulse oscillometry and exhaled nitric oxide. Primary analyses used logistic and linear regression.

RESULTS

We evaluated 158 of 180 (88%) offspring at age 3 years for the primary outcome. Atopy was assessed by skin test for 95 children (53%), serum IgE for 86 (48%), exhaled nitric oxide for 62 (34%) and impulse oscillometry of acceptable quality for 51 (28%). We found no difference between supplemented and control groups in risk of wheeze [no vitamin D: 14/50 (28%); any vitamin D: 26/108 (24%) (risk ratio 0.86; 95% confidence interval 0.49, 1.50; P = 0.69)]. There was no significant difference in atopy, eczema risk, lung function or exhaled nitric oxide between supplemented groups and controls.

CONCLUSION

Prenatal vitamin D supplementation in late pregnancy that had a modest effect on cord blood vitamin D level, was not associated with decreased wheezing in offspring at age three years.

TRIAL REGISTRATION

Controlled-Trials.com ISRCTN68645785.

Maternal vitamin D supplementation to meet the needs of the breastfed infant: a systematic review

Maternal vitamin D insufficiency during lactation, related to lack of sun exposure and minimal intake of vitamin D from the diet, contributes to low breast milk vitamin D content and, therefore, infant vitamin D deficiency. The objective of this review was to examine the literature regarding evidence for achieving maternal vitamin D status that promotes sufficient vitamin D transfer from mother to infant exclusively from breast milk. PubMed and CINAHL databases were searched using the terms lactation or breastfeeding or milk, human and vitamin D. The resulting articles were further limited to those written in English, published within the last 10 years, and involving clinical or randomized controlled trials of humans. The search yielded 13 studies, 3 of which provide evidence for maternal intake of vitamin D and the correlation with exclusively breastfed infants' serum 25-hydroxyvitamin D level. A strong positive correlation exists between maternal vitamin D intake during exclusive breastfeeding and infant serum 25-hydroxyvitamin D levels. There is support to conclude that when maternal vitamin D intake is sufficient, vitamin D transfer via breast milk is adequate to meet infant needs. In the reviewed studies, doses up to 10 times the current recommended daily intake of vitamin D were needed to produce sufficient transfer from mother to breastfed infant. Further research is needed to refine the dose and gestational timing of maternal vitamin D supplementation. Due to the high rates of vitamin D deficiency during lactation and the correlations between vitamin D deficiency and multiple diseases, providers should consider monitoring lactating mothers' vitamin D status.

Latitude, sunlight, vitamin D, and childhood food allergy/anaphylaxis

Vitamin D is widely known for its role in bone metabolism, but this sterol hormone also has important immunomodulatory properties. Vitamin D is produced by the conversion of D3 in the skin following UVB exposure, or after ingestion of D2 or D3. At the extremes of latitude, there is insufficient UVB intensity in the autumn and winter months for adequate synthesis of vitamin D to occur. Growing evidence implicates vitamin D deficiency in early life in the pathogenesis of nonskeletal disorders (e. g., type 1 diabetes and multiple sclerosis) and, more recently, atopic disorders. Several studies have reported higher rates of food allergy/anaphylaxis or proxy measures at higher absolute latitudes. Although causality remains to be determined, these studies suggest a possible role for sunlight and/or vitamin D in the pathogenesis of food allergy/anaphylaxis.

Impact of maternal vitamin D status during pregnancy on the prevalence of neonatal vitamin D deficiency

Maternal vitamin D deficiency is not uncommon. The lack of vitamin D during pregnancy may result in poor fetal growth and altered neonatal development that may persist into later life. Recognition of risk factors and early detection of vitamin D deficiency during pregnancy is important in order to prevent neonatal vitamin D deficiency and related complications. The aim of the current study is to assess the effect of maternal vitamin D status on the neonatal vitamin D stores. A total of 92 pregnant women at the end of the 3(rd) trimester and their newborns were recruited from Al Khafji Joint Operation Hospital, Saudi Arabia, during the year 2011. Maternal and cord blood samples were taken for determination of serum levels of circulating 25-hydroxyvitamin D3 [25(OH)D3] concentration, serum calcium (Ca(++)), phosphorus (PO4) and alkaline phosphatase (ALP). Compared with pregnant women with adequate vitamin D levels, women deficient in vitamin D had infants with vitamin D deficiency (X±SD 33.44±18.33 nmol/L vs 55.39±17.37 nmol/L, P=0.01). Maternal and neonatal serum 25(OH)D3 levels showed a positive correlation with serum Ca(++) and negative correlation with serum PO4 and ALP. Neonatal 25(OH)D was related to maternal 3(rd) trimester levels (r=0.89, P=0.01). The newborn serum 25(OH)D3 concentrations rely on maternal vitamin D status. Poor maternal vitamin D status may adversely affect neonatal vitamin D status and, consequently, calcium homeostasis.

Racial variation in vitamin D cord blood concentration in white and black male neonates

AIM

The aim of this study is to evaluate racial variation in umbilical cord blood concentration of vitamin D and to explore its correlation with markers of the insulin-like growth factor axis (IGFs) and sex steroid hormones in white and black male neonates.

METHODS

In 2004-2005, venous umbilical cord blood samples were collected from 75 black and 38 white male neonates, along with maternal and birth characteristics from two hospitals in Maryland, United States. 25-Hydroxyvitamin D [25(OH)D] and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] were measured by radioimmunoassay and testosterone, estradiol, and sex hormone-binding globulin (SHBG) by immunoassay and IGF-1, IGF-2, and IGF-binding protein-3 by ELISA. Crude and multivariable-adjusted geometric mean concentrations were computed.

RESULTS

Mean 25(OH)D levels were lower in black than in white neonates (11.44; 95 % CI 10.10-12.95 ng/mL vs. 18.24; 95 % CI 15.32-21.72 ng/mL; p < 0.0001). Black neonates were at higher risk of suboptimal vitamin D levels [25(OH)D < 20 ng/mL] than whites (84 vs. 63 %). 25(OH)D concentrations varied by season in whites but not in blacks and were significantly inversely correlated with mother's parity (number of live births) in blacks but not in whites. Mean concentration of 1,25(OH)(2)D did not differ by race. 25(OH)D and 1,25(OH)(2)D did not correlate with IGFs, sex steroid hormones, and SHBG.

CONCLUSIONS

Suboptimal vitamin D levels were prevalent especially in blacks and influenced by mother's parity and by season. The observed vitamin D differences between black and white neonates warrant further evaluation of the etiology of the disparity in chronic diseases in adulthood.

Vitamin D in the maternal-fetal-neonatal interface: clinical implications and requirements for supplementation

Identification of the current evidence regarding the pathophysiological and clinical facets of vitamin D in the maternal-fetal-neonatal interface is of value because of the significance of the vitamin D endocrine system in human health and high prevalence of vitamin D deficiency in mothers and their infants. Although many questions have still not been answered by the existing literature, we found evidence that: (i) during pregnancy vitamin D participates in fetal skeletal mineralization and growth, (ii) neonatal vitamin D levels are dependent on the maternal vitamin D status at delivery, (iii) a vitamin D sufficient status at birth may decrease the risk for the development of asthma and type 1 diabetes mellitus in later life, (iv) recommendations for maintaining serum 25-hydroxyvitamin D [25(OH)D] levels ≥32 ng/mL to avoid secondary hyperparathyroidism in adults have not been applied to mothers and their infants, (v) American Academy of Pediatrics recommended supplementation of 400 IU of vitamin D per day is sufficient only for infants who are born with normal vitamin D levels and (vii) supplementation of lactating mothers with high doses of vitamin D (4000 IU/d) allows the achievement of optimal 25(OH)D concentrations (>32 ng/mL) in the maternal and infant serum without any risk of hypervitaminosis D in the mother. We believe that inconsistency in the recognition of sufficient levels of vitamin D in mothers and their infants affects the identification of adequate doses for vitamin D supplementation during pregnancy, lactation and infancy.

Parenteral nutrition additive shortages: the short-term, long-term and potential epigenetic implications in premature and hospitalized infants

Nutrition support practitioners are currently dealing with shortages of parenteral nutrition micronutrients, including multivitamins (MVI), selenium and zinc. A recent survey from the American Society of Enteral and Parenteral Nutrition (ASPEN) indicates that this shortage is having a profound effect on clinical practice. A majority of respondents reported taking some aggressive measures to ration existing supplies. Most premature infants and many infants with congenital anomalies are dependent on parenteral nutrition for the first weeks of life to meet nutritional needs. Because of fragile health and poor reserves, they are uniquely susceptible to this problem. It should be understood that shortages and rationing have been associated with adverse outcomes, such as lactic acidosis and Wernicke encephalopathy from thiamine deficiency or pulmonary and skeletal development concerns related to inadequate stores of Vitamin A and D. In this review, we will discuss the current parenteral shortages and the possible impact on a population of very low birth weight infants. This review will also present a case study of a neonate who was impacted by these current shortages.

Cord blood 25-hydroxyvitamin D3 and allergic disease during infancy

OBJECTIVE

There has been growing interest in vitamin D insufficiency as a predisposing factor for allergy development based on immunoregulatory properties and epidemiological studies. The aim of this study was to investigate the association between vitamin D exposure in utero and allergic outcomes in the first year of life.

METHODS

Cord blood (CB) vitamin D was measured in 231 high-risk infants from an Australian prospective birth cohort. CB 25-hydroxyvitamin D(3) (25[OH]D(3)) concentration was analyzed in relation to maternal vitamin D intake and the development of infant eczema, allergen sensitization, and immunoglobulin E-mediated food allergy.

RESULTS

Maternal intake of supplemental vitamin D was significantly correlated with CB 25(OH)D(3) concentration (ρ = 0.244, P = .003), whereas dietary vitamin D did not influence CB levels. There was significant seasonal variation in CB 25(OH)D(3) concentration suggesting that sunlight exposure was an important determinant. Lower CB vitamin D status was observed in infants that developed eczema (P = .018), and eczema was significantly more likely in those with concentrations <50 nmol/L in comparison with those with concentrations ≥ 75 nmol/L (odds ratio 2.66; 95% confidence interval 1.24-5.72; P = .012). This association remained significant after adjustment for multiple confounding factors. The associations between CB 25(OH)D(3) concentration and allergen sensitization, immunoglobulin E-mediated food allergy, and eczema severity (SCORing Atopic Dermatitis) were not significant.

CONCLUSIONS

Reduced vitamin D status in pregnancy may be a risk factor for the development of eczema in the first year of life, reinforcing the need to explore the role of vitamin D exposure during development for disease prevention.

Vitamin D deficiency in critically ill children

OBJECTIVE

Vitamin D influences cardiovascular and immune function. We aimed to establish the prevalence of vitamin D deficiency in critically ill children and identify factors influencing admission 25-hydroxy vitamin D (25(OH)D) levels. We hypothesized that levels would be lower with increased illness severity and in children with serious infections.

METHODS

Participants were 511 severely or critically ill children admitted to the PICU from November 2009 to November 2010. Blood was collected near PICU admission and analyzed for 25(OH)D concentration by using Diasorin radioimmunoassay.

RESULTS

We enrolled 511 of 818 (62.5%) eligible children. The median 25(OH)D level was 22.5 ng/mL; 40.1% were 25(OH)D deficient (level <20 ng/mL). In multivariate analysis, age and race were associated with 25(OH)D deficiency; summer season, vitamin D supplementation, and formula intake were protective; 25(OH)D levels were not lower in the 238 children (46.6%) admitted with a life-threatening infection, unless they had septic shock (n = 51, 10.0%) (median 25(OH)D level 19.2 ng/mL; P = .0008). After adjusting for factors associated with deficiency, lower levels were associated with higher admission day illness severity (odds ratio 1.19 for a 1-quartile increase in Pediatric Risk of Mortality III score per 5 ng/mL decrease in 25(OH)D, 95% confidence interval 1.10-1.28; P < .0001).

CONCLUSIONS

We found a high rate of vitamin D deficiency in critically ill children. Given the roles of vitamin D in bone development and immunity, we recommend screening of those critically ill children with risk factors for vitamin D deficiency and implementation of effective repletion strategies.

Heightened attention to supplementation is needed to improve the vitamin D status of breastfeeding mothers and infants when sunshine exposure is restricted

Although exclusively breastfed infants are at increased risk of vitamin D (vit D) deficiency if vit D supplementation is lacking and sun exposure is limited, assessment of both risk factors in the first year of life is lacking. We evaluated the contribution of vit D intake and sunlight exposure to vit D status in 120 healthy, breastfeeding mother-infant dyads, who were followed up for 1 year. Vitamin D intake and skin sunlight exposure were evaluated using questionnaires. Serum 25-hydroxyvitamin D, parathyroid hormone (PTH) and alkaline phosphatase levels were determined post-natally in mothers at 4 weeks and in infants at 4, 26 and 52 weeks. Vitamin D supplementation was low (<20%) and sunlight exposure was common (93%) in study infants. At 4 weeks, 17% of mothers were vit D deficient (<50 nmol L(-1)) and 49% were insufficient (50-<75 nmol L(-1)), while 18% of infants were severely vit D deficient (<25 nmol L(-1)) and 77% were deficient (<50 nmol L(-1)). At 26 weeks, winter/spring birth season and shorter duration of months of exclusive breastfeeding were protective of vit D deficiency in infants. Vitamin D deficiency in infants decreased to 12% at 52 weeks with sunlight exposure. Serum PTH levels were significantly higher in severely vit D deficient than sufficient infants. Vitamin D deficiency was widespread in early post-partum breastfeeding mothers and infants, and declined to one in eight infants at 52 weeks due mostly to sunshine exposure. When sunlight exposure is limited or restricted, intensified vit D supplementation of breastfeeding mothers and infants is needed to improve vit D status.