Vitamin D During Pregnancy and Infant Growth: A Long Shot

Abstract

Research Article| December 01 2018 Vitamin D During Pregnancy and Infant Growth: A Long Shot AAP Grand Rounds (2018) 40 (6): 69. https://doi.org/10.1542/gr.40-6-69 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Vitamin D During Pregnancy and Infant Growth: A Long Shot. AAP Grand Rounds December 2018; 40 (6): 69. https://doi.org/10.1542/gr.40-6-69 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Source: Roth DE, Morris SK, Zlotkin S, et al. Vitamin D supplementation in pregnancy and lactation and infant growth. N Engl J Med. 2018; 379(6): 535– 546; doi: https://doi.org/10.1056/NEJMoa1800927Google Scholar Investigators from multiple institutions conducted a randomized controlled trial to determine the efficacy of maternal vitamin D supplementation (VDS) on infant growth in regions where vitamin D deficiency is common. Participants were healthy pregnant women living in Bangladesh who were 17–24 weeks’ gestation. At enrollment, participants were randomized to 1 of 5 groups, based on receipt of (a) a placebo tablet through the prenatal period and for 26 weeks postpartum, (b) prenatal VDS only at 4,200 IU/week, (c) prenatal VDS only at 16,800 IU/week, (d) prenatal VDS only at 28,000 IU/week, and (e) prenatal VDS at 28,000 IU/week and postpartum VDS at 28,000 IU/week for 26 weeks. All tablets were identical in taste and appearance, and they were administered under direct observation when possible. Demographic data and maternal serum 25-hydroxyvitamin D concentrations were collected at baseline, with vitamin D deficiency defined as 25-hydroxyvitamin D concentrations <30 nmol/L. The primary outcome was infant length-for-age z score at 1 year of age, defined as the mean of 2 independent measurements performed by trained study personnel plotted on WHO child growth standards. Secondary outcomes included confirmed maternal hypercalcemia, defined as a serum calcium concentration of >2.6 mmol/L on a repeat specimen or >2.8 mmol/L on a single specimen at enrollment through 6 months postpartum. Other secondary outcomes included other infant anthropomorphic measures at 1 year of age, infant serum 25-hydroxyvitamin D concentrations at 3, 6, and 12 months of age, and maternal serum 25-hydroxyvitamin D concentrations at delivery and 3 and 6 months postpartum. Investigators used t-tests and compared outcomes across groups using an intention-to-treat analysis. There were 1,300 participants enrolled and randomized to the 5 groups. Baseline characteristics, including baseline maternal 25-hydroxyvitamin D levels, were not significantly different across groups. Overall, 64% of participants were vitamin D deficient at baseline. There was no significant difference in infant length-for-age z scores at 1 year across the 5 groups (P=0.23). There were also no significant differences in other infant anthropomorphic measures at 1 year of age across treatment groups. There was a significant, dose-dependent effect in maternal and infant 25-hydroxyvitamin D concentrations, with infants and mothers in the fifth group having the highest concentrations. There was confirmed maternal hypercalcemia in 0.7% of participants, but frequencies did not differ significantly by group. The investigators conclude that maternal VDS does not improve infant growth in a population with widespread vitamin D deficiency. Dr Chung has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Vitamin D deficiency is a global health problem; some countries in the Middle East and South Asia have vitamin D deficiency prevalence rates... You do not currently have access to this content.