Vitamin D, and Maternal and Child Health

Abstract

Vitamin D has important roles in calcium metabolism and in the prevention of rickets and osteomalacia; low levels of 25-hydroxyvitamin D are common in the general population and amongst pregnant women. Whilst there is a wealth of observational evidence linking vitamin D deficiency to a wide range of disease outcomes, there are currently few high-quality randomised controlled trials to confirm any causal associations, although many are currently in progress. Furthermore, currently, the vast majority of published guidelines recommend standard supplemental vitamin D doses for children and pregnant women, yet there is increasing recognition that individual characteristics and genetic factors may influence the response to supplementation. As such, future research needs to concentrate on documenting definite beneficial clinical outcomes of vitamin D supplementation, and establishing personalised dosing schedules and demonstrating effective approaches to optimising initiation and adherence.

Keywords: Bone mineral density; Pregnancy; Rickets; Supplementation; Vitamin D.

Fig. 1

Seasonal variation in maternal serum 25-hydroxyvitamin D status in early and late pregnancy in an observational cohort of women in Southampton, UK (50.9°N). From Moon et al. [15]

Fig. 2

Neonatal whole-body bone mineral content (BMC), bone area and bone mineral density (BMD) by intervention group and season of birth in the MAVIDOS trial. Data are shown as mean and 95% confidence interval. Winter is December to February, spring is March to May, summer is June to August and autumn is September to November. From Cooper et al. [12]

Fig. 3

Offspring fat mass measured by dual-energy X-ray absorptiometry grouped by maternal serum 25(OH)D concentration at 34 weeks of gestation in the Southampton Women’s Survey. Displayed as mean (95% CI). From Crozier et al. [124]

Fig. 4

Proportion of women achieving vitamin D replete status [25(OH)D > 50 nmol/l] in late pregnancy stratified by randomisation to placebo or 1000 IU/day cholecalciferol and season of delivery. Winter was defined as December–May. Using data reported in Moon et al. [139]

Fig. 5

Independent determinants of maternal 25(OH)D at 34 weeks of gestation in women randomised to 1000 IU/day cholecalciferol. Shown as change in 25(OH)D per unit predictor (β and 95% confidence interval). From Moon et al. [139]