ESPEYB16 2. Antenatal and Neonatal Endocrinology Vitamin D Supplementation in Pregnancy and Fetal and Infant Growth (1 abstracts)
2.17. Vitamin D supplementation in pregnancy and lactation and infant growth
Roth DE , Morris SK , Zlotkin S , Gernand AD , Ahmed T , Shanta SS , Papp E , Korsiak J , Shi J , Islam MM , Jahan I , Keya FK , Willan AR , Weksberg R , Mohsin M , Rahman QS , Shah PS , Murphy KE , Stimec J , Pell LG , Qamar H & Al Mahmud A
To read the full abstract: N Engl J Med. 2018 Aug 9;379(6):535–546.
This study tested whether vitamin D supplementation from mid pregnancy to delivery or 6 months post-partum had an effect on length-for-age z scores at 1 year or on other anthropometric measures from birth to 1 year.
Bangladesh is a resource poor country where approximately 30% of newborns are small for gestational age, and the growth of 36% of children younger than 5 years of age is stunted (height-for-age z score, <−2). Vitamin D deficiency or insufficiency is thought to be common among pregnant women especially in Bangladesh and supplementation with vitamin D is given frequently to women of reproductive age. Vitamin D supplementation of 4000 IU/d for pregnant women is safe and most effective in achieving sufficiency in all women and their neonates regardless of race. Some previous studies have shown that prenatal vitamin D supplementation increased infant linear growth (Roth DE et al., Brooke OG et al.). However, these previous studies were small, each involving fewer than 135 participants, and included postnatal growth as a post hoc outcome, and the between-group differences may have been due to chance. A meta-analysis of six trials of prenatal, multiple-micronutrient supplementation that included relatively low doses of vitamin D (200–400 IU per day) in low- and middle-income countries showed no effect on height at 2–8.5 years of age (Devakumar D et al.).
The findings of this large randomized, double-blind, placebo-controlled trial conducted in Bangladesh reports that vitamin D supplementation from mid pregnancy to delivery or 6 months post-partum had no significant effect on length-for-age z scores at 1 year or on other anthropometric measures from birth to 1 year. Similarly, vitamin D supplementation had no significant effect on numerous clinical outcomes during pregnancy or infancy. Vitamin D supplementation had no effect on length-for-age z scores at 1 year of age despite normalizing the maternal and infant serum concentrations of 25-hydroxyvitamin D, parathyroid hormone levels, and calcium and the urinary calcium: creatinine ratio.
Currently, the World Health Organization (WHO) does not recommend routine vitamin D supplementation during pregnancy. The findings of this study support that recommendation even in populations where vitamin D deficiency is relatively common.
References: Roth DE, Perumal N, Al Mahmud A, Baqui AH. Maternal vitamin D3 supplementation during the third trimester of pregnancy: effects on infant growth in a longitudinal follow-up study in Bangladesh. J Pediatr 2013; 163(6): 1605–1611.e3.
Brooke OG, Butters F, Wood C. Intrauterine vitamin D nutrition and postnatal growth in Asian infants. Br Med J (Clin Res Ed) 1981; 283: 1024.
Devakumar D, Fall CH, Sachdev HS, et al. Maternal antenatal multiple micronutrient supplementation for long-term health benefits in children: a systematic review and meta-analysis. BMC Med 2016; 14: 90.
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ESPE Yearbook of Paediatric Endocrinology
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