Clinical Nutrition, Available online 17 December 2014, doi:10.1016/j.clnu.2014.12.006
Colin R. Paterson, paterson at btinternet.com Dr a, , , David Ayoub b c.s.
a Formerly Department of Medicine, University of Dundee Dundee Scotland
b Clinical Radiologists SC, Springfield, Illinois, USA
- We describe 25 infants with objective evidence of rickets in the first two weeks after birth.
- In 24 of these there was good evidence of vitamin D deficiency in the mothers.
- We conclude that maternal deficiency may lead to overt bone disease from before birth.
- Maternal deficiency probably also leads to impaired bone quality in postnatal life.
- We emphasise the importance of ensuring adequate vitamin D nutrition in pregnancy.
Background and aims
We wished to review all published reports of congenital rickets to identify the causes and characteristics.
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.
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. .
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.
- Post-mortem analysis of children in London Hospital – only 1 child had adequate level of vitamin D – July 2014
- Rickets in England – huge recent increase – Feb 2014
- Mongolian women have the lowest levels of vitamin D in the world – Sept 2013 Mongolia has the highest rate of Rickets
- Rickets reduced 60X - lessons learned by Turkey 2011
Turkey gave vitamin D to the infants -the study on this page hints that giving Vitamin D to the mothers might be better
- Overview of Rickets and vitamin D contains the following summary
Vitamin D deficiency is the cause of most rickets
Rate of rickets is usually < 0.1% of births, unless dark skin or breastfed
Rate of rickets has greatly increased with the drop in vitamin D levels during the past 40 years
400 IU can prevent/treat most rickets (Turkey gave vitamin D to EVERY child)
More than 400 IU may be needed
A low serum level of vitamin D does not indicate rickets
Rate of rickets in some countries varies from 10% to 70% (typically poor health overall)
Rickets was identified 400 years ago and treatments were determined 100 years ago
Rickets is strongly associated with severe breathing problems (weak ribs)
Bowed legs is not the primary indication of rickets (3 other indications of rickets are seen more often)
Vitamin D and Rickets consensus took 80 years
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