Supplementation of Prenatal Vitamin D to Prevent Children's Stunting: A Literature Review

Background

Stunting is a common nutritional problem in children. Many risk factors contributing to stunting are identified in the literature. Vitamin D supplementation during pregnancy is useful for preventing impairment of fetal bone growth in the womb. However, lack of review in exploring supplementation of prenatal vitamin D is related to stunting in children.

Purpose

This study aims to identify the effectiveness of prenatal vitamin D supplementation in preventing stunting.

Methods

A literature review was conducted using PubMed, CINAHL, ScienceDirect, and Cochrane Library. Inclusion criteria were a randomized controlled trial study, published between 2011-2023, a full-text article for pregnant women and an independent variable supplement vitamin D to prevent children's stunting. The keywords used in English were "children OR child" AND "pregnant women" AND "preventive stunting" AND "vitamin D". Study quality was assessed using the Joanna Briggs Institute (JBI) appraisal tool.

Results

From the results of the study selection of 511 articles, 11 articles met the inclusion and eligibility criteria for study analysis. Four studies indicated that the administration of vitamin D did not influence the length of the neonate's body or the Length for Age Z-Score (LAZ), used as an indicator of stunting. However, seven articles demonstrated that providing vitamin D supplements to pregnant women impacted various aspects of anthropometry, including the length of the neonate's body. Our findings show that the dosage used of vitamin D in pregnancy varied between 1400-60,000 per week. Overall, results of this study analysis show that the intervention of prenatal vitamin D supplementation has an impact on the prevention of stunting.

Conclusion

This literature review highlighted the benefits of maternal vitamin D during pregnancy and for the children's growth. Prenatal vitamin D supplementation is needed to prevent stunting.

Validity and reliability of a semi-quantitative food frequency questionnaire for assessing dietary vitamin D and calcium intakes in Iranian childbearing age women

This study aimed to examine the validity and reliability of a semi-quantitative food frequency questionnaire (FFQ) designed to estimate dietary vitamin D and Calcium (Ca) intakes in a sample of Iranian childbearing age women. An 87-item FFQ was developed and 84 healthy childbearing age women completed it. FFQ was validated by comparing its results with the 24-h dietary recall (24-h recall) and serum 25-hydroxyvitamin D (S-25(OH)D) as the references methods. The FFQ was completed for the second time after 4 weeks to assess the reliability of the questionnaire. Data were analyzed using spearman’s correlation, cross-classification analysis, Bland–Altman plots, the weighted κ, intraclass classification, and the method of triads. Spearman’s correlations between vitamin D and Ca intakes by the FFQ and 24-h recalls and between vitamin D intakes and S-25(OH)D were significant (r: 0.706, r: 0.959, and r: 0.682, respectively, all, P < 0.001). Cross-classification for vitamin D and Ca between two dietary methods and for vitamin D intake of FFQ and S-25(OH)D demonstrated that most of the quartiles were categorized into the same or adjacent quartiles. The Bland Altman plots for these nutrients also demonstrated good agreement. For vitamin D, the validity coefficients (VCs) calculated by the method of the triad for three methods were in the range of 0.808–0.843. The weighted κ for agreement of vitamin D and Ca by FFQ1 and FFQ2 were 0.18 and 0.638, respectively. The findings indicated that the developed FFQ has acceptable validity for estimating vitamin D and Ca. Its reliability for Ca was stronger than vitamin D.

Vitamin D-Related Risk Factors for Maternal Morbidity and Mortality during Pregnancy: Systematic Review and Meta-Analysis

Vitamin D deficiency (serum 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL in serum) is a common health condition among pregnant women, especially in high-risk groups. Evidence has connected vitamin D levels with many health-related problems during pregnancy, including gestational diabetes and preeclampsia. Because of vitamin D’s effect on both mother and fetus, we systematically review the association between 25(OH)D level and its health effects. From a total of 143 studies, 43 came from PubMed, 4 from Cochrane, and 96 from EMBASE. After screening, we identified 38 studies as candidates for inclusion. Ultimately, we limited this review to 23 articles originating from 12 countries, written in English or Spanish, and conducted between 2010 and 2022. We conducted this review according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and evaluated the quality and strength of the evidence by using the Navigation Guide Systematic Review Methodology (SING). These systematic reviews summarize findings that support vitamin D’s role in reducing risks of multiple outcomes and the possible contribution of adequate vitamin D levels to a healthy pregnancy.

Knowledge, attitude, performance, and determinant factors of Vitamin D deficiency prevention behaviours among Iranian pregnant women

BACKGROUND

Pregnancy is a high-risk period for vitamin D (Vit D) deficiency, and there is a direct relationship between Vit D deficiency during this period and maternal and fetal complications. Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant women concerning the adoption of behaviors to prevent Vit D deficiency and identify the determinant factors of such behaviors.

METHODS

In this cross-sectional study, 185 pregnant women with a mean age of 27.52 ± 5.9 years were selected from the Health Centers in Tabriz, Iran, using the stratified random sampling between 2018 September 23 and 2019 June 21. Data were collected using a researcher-made questionnaires comprising demographic information, knowledge, attitude, and practice of pregnant women towards Vit D deficiency. The chi-square test and Fisher's exact test were used to determine the relationship between the demographics of pregnant women and their knowledge and attitude. Moreover, the general linear model test was used to determine the predictors of performance. The p-value< 0.05 was considered to be significant in this study.

RESULTS

The findings showed that 85.6% of pregnant women were well aware of the importance and role of Vit D in pregnancy. In addition, 76.7 and 75% of the participants had good knowledge of getting enough Vit D from sunlight and preventing Vit D deficiency in pregnancy, respectively. Moreover, 91.7% of the pregnant women believed that Vit D has a vital role in maternal and fetal health, and 61.1% showed a high level of perceived self-efficiency in preventing Vit D deficiency. In addition, 67.2% of women regarded the unpleasant taste and price of Vit D rich foods, such as seafood, as barriers to get Vit D, and 91.7% mentioned the lack of public places specific to women and living in apartments as barriers to getting enough Vit D from sunlight. According to the results, 57.8 and 79.4% of pregnant women performed at a moderate level in getting Vit D from food and sunlight, respectively. In general, educational attainment (Pvalue = 0.02, B = 0.56), pregnancy age (Pvalue = 0.04, B = -0.26), parity (Pvalue = 0.03, B = -0.45), and perceived self-efficacy of mothers (Pvalue < 0.001, B = 0.340) were the determinant factors of getting Vit D from food and sunlight as behaviours to prevent Vit D deficiency in pregnancy.

CONCLUSION

The findings of the current study revealed that despite the good knowledge of women about the Vit D deficiency during pregnancy, their performance was moderate. The unpleasant taste and high price of seafood were barriers to using them, and the lack of public places specific to women and living in apartments, were barriers to using sunlight. The most important determinant of preventive behaviours was perceived self-efficacy. Developing an awareness program to promote best practices in pregnant women is essential to prevent vitamin D deficiency.