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 Aug 30. pii: S0022-3476(13)00938-4. doi: 10.1016/j.jpeds.2013.07.030
Roth DE, Perumal N, Al Mahmud A, Baqui AH.
Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: To estimate the effects of prenatal vitamin D supplementation on infant growth in Dhaka, Bangladesh.
STUDY DESIGN: Longitudinal follow-up of infants born at term or late preterm (≥34 weeks) to participants in a randomized double-blind trial of maternal third-trimester vitamin D3 (35 000 IU/wk; vitamin D ) vs placebo. Anthropometry was performed at birth, 1, 2, 4, 6, 9, and 12 months of age. The primary analysis (n = 145 overall; n = 134 at 1 year) was a comparison of mean length-for-age z-score (LAZ) based on World Health Organization standards.
RESULTS: LAZ was similar between groups at birth, but 0.44 (95% CI, 0.06-0.82) higher in vitamin D vs placebo at 1 year, corresponding to a sex-adjusted increase of 1.1 cm (95% CI, 0.06-2.0).
Mean change in LAZ from birth to 1 month was significantly greater in vitamin D (0.53 per month) vs placebo (0.19 per month; P = .004); but there was no significant divergence thereafter.
In longitudinal (repeated-measures) analysis, average LAZ during infancy was 0.41 higher in vitamin D vs placebo (95% CI, 0.11-0.71, P = .01).
Stunting was less common in vitamin D (17% of infants were ever stunted) vs placebo (31%; P = .049).
Other anthropometric indices were similar between groups.
CONCLUSIONS: Maternal vitamin D3 supplementation (35 000 IU/wk) during the third trimester of pregnancy enhanced early postnatal linear growth in a cohort of infants in Bangladesh.
- Had used a loading dose initially to restore vitamin D levels: suggest >300,000 IU over a month
The 35,000 IU per month used by the study may not have even restored vitamin D levels after 3 months
- Had started the prenatal dose earlier
- Had continued the vitamin D dose after birth (breast milk has very little vitamin D)
- Overview Pregnancy and vitamin D which has the following summary
IU Cumulative Benefit Blood level Cofactors Calcium $*/month 200 Better bones for mom
with 600 mg of Calcium
6 ng/ml increase Not needed No effect $0.10 400 Less Rickets (but not zero with 400 IU)
3X less adolescent Schizophrenia
Fewer child seizures
20-30 ng/ml Not needed No effect $0.20 2000 2X More likely to get pregnant naturally/IVF
2X Fewer dental problems with pregnancy
8X less diabetes
4X fewer C-sections (>37 ng)
4X less preeclampsia (40 ng vs 10 ng)
5X less child asthma
2X fewer language problems age 5
42 ng/ml Desirable < 750 mg $1 4000 2X fewer pregnancy complications
2X fewer pre-term births
49 ng/ml Should have
< 750 mg $3 6000 Probable: larger benefits for above items
Just enough D for breastfed infant
More maternal and infant weight
< 750 mg $4