Effects of Pre-Natal Vitamin D Supplementation with Partial Correction of Vitamin D Deficiency on Early Life Healthcare Utilisation: A Randomised Controlled Trial.
PLoS One. 2015 Dec 23;10(12):e0145303. doi: 10.1371/journal.pone.0145303. eCollection 2015.
180 women given single dose of 200,000 IU of vitamin D at 27 weeks gestation
Extensive detail on health care costs. Costs are in UK £
ROI = Return on Investment
Cost differences were not statistically significant after “correcting” for ethnicity
Note: They “corrected” for lower levels of vitamin D in darker skinned women
Probably far more cost effective (>1000 times?) if gave periodic doses to mother AND infant
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- Healthy pregnancies need lots of vitamin D
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Healthy pregnancies need lots of vitamin D has the following summaryProblem
Reduces Evidence 0. Chance of not conceiving 3.4 times Observe 1. Miscarriage 2.5 times Observe 2. Pre-eclampsia 3.6 times RCT 3. Gestational Diabetes 3 times RCT 4. Good 2nd trimester sleep quality 3.5 times Observe 5. Premature birth 2 times RCT 6. C-section - unplanned 1.6 times Observe Stillbirth - OMEGA-3 4 times RCT - Omega-3 7. Depression AFTER pregnancy 1.4 times RCT 8. Small for Gestational Age 1.6 times meta-analysis 9. Infant height, weight, head size
within normal limits
RCT 10. Childhood Wheezing 1.3 times RCT 11. Additional child is Autistic 4 times Intervention 12.Young adult Multiple Sclerosis 1.9 times Observe 13. Preeclampsia in young adult 3.5 times RCT 14. Good motor skills @ age 3 1.4 times Observe 15. Childhood Mite allergy 5 times RCT 16. Childhood Respiratory Tract visits 2.5 times RCT
RCT = Randomized Controlled Trial
Griffiths M1, Goldring S1, Griffiths C2, Shaheen SO2, Martineau A2, Cross L2, Robinson S3, Warner JO1, Devine A2, Boyle RJ1.
1Department of Paediatrics, Imperial College London, London, United Kingdom.
2Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, London, United Kingdom.
3Department of Endocrinology, Imperial College London, London, United Kingdom.
A portion of Table 6
Some observational studies have suggested that higher prenatal Vitamin D intake may be associated with improved health outcomes in childhood. However there have been mixed results in this area with some negative studies, especially for effects on atopic and respiratory outcomes. We examined the effect of prenatal Vitamin D on healthcare utilisation in the first three years of life.
In an ethnically stratified randomised controlled trial conducted at St Mary's Hospital London, 180 women at 27 weeks gestation were allocated to no Vitamin D, 800 IU ergocalciferol daily until delivery, or a single oral bolus of 200,000 IU cholecalciferol. Participants were randomised in blocks of 15 using computer-generated numbers and investigators were blinded to group assignment. Supplementation increased maternal and cord blood 25(OH) vitamin D concentrations, but levels remained lower than current recommendations. Primary health economic outcome was overall cost of unscheduled healthcare utilisation in the first three years of life as documented in the child's electronic health record. Secondary outcomes included cost attributable to: primary and secondary healthcare visits, respiratory and atopic complaints, cost in years 1, 2 and 3 of life and cost and frequency of prescribed medication. All costs were calculated as pounds sterling. Differences between groups were analysed using unpaired t-test or Mann-Whitney U test, and analysis of variance for adjusted analyses.
We assessed 99/180 (55%) complete electronic health records, control (n = 31), daily (n = 36) and bolus (n = 32). We found no difference in total healthcare utilisation costs between the control and daily (mean difference in costs in pounds sterling 1.02, 95%CI -1.60, 1.65; adjusted 1.07, 95%CI -1.62, 1.86) or control and bolus groups (mean difference -1.58, 95%CI -2.63, 1.06; adjusted -1.40, 95%CI -2.45, 1.24). There were no adverse effects of supplementation reported during the trial.
We found no evidence that prenatal vitamin D supplementation from 27 weeks gestation to delivery, at doses which failed to completely correct maternal vitamin D deficiency, influence overall healthcare utilisation in children in the first 3 years.
TRIAL REGISTRATION: Controlled-Trials.com ISRCTN68645785.
PMID: 26698303 PMCID: PMC4689556 DOI: 10.1371/journal.pone.0145303Vitamin D once during pregnancy reduced infant health care costs (300 times ROI) – RCT Dec 2015
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