N Engl J Med. 2018 Aug 9 : 10.1056/NEJMoa1800927.
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Notional chart for Vitamin D supplementation for levels < 30 nanograms
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Daniel E. Roth, M.D., Ph.D., Shaun K. Morris, M.D., Ph.D., Stanley Zlotkin, M.D., Ph.D., Alison D. Gernand, Ph.D., Tahmeed Ahmed, MBBS, Ph.D., Shaila Sharmeen Shanta, MBBS, Eszter Papp, Ph.D., Jill Korsiak, M.Sc., Joy Shi, M.Sc., M. Munirul Islam, MBBS, Ph.D., Ishrat Jahan, MBBS, MPH, Farhana Khanam Keya, MBBS, Andrew R. Willan, Ph.D., Rosanna Weksberg, M.D., Minhazul Mohsin, MBBS, Qazi Sadeq-ur Rahman, M.Sc., Prakesh S. Shah, M.D., Kellie E. Murphy, M.D., Jennifer Stimec, M.D., Lisa G. Pell, Ph.D., Huma Qamar, B.Sc., and Abdullah Al Mahmud, MSS, MMSc.
Causes of early infant growth restriction remain incompletely understood. Where vitamin D deficiency is common, vitamin D supplementation during pregnancy and lactation may improve fetal-infant growth and other birth outcomes.
We conducted a randomized, double-blind, placebo-controlled trial of maternal vitamin D supplementation from 17-24 weeks gestation until birth or 6 months postpartum. Participants were randomly allocated to five vitamin D and/or placebo supplementation groups: (A) 0 IU/week, (B) 4200 IU/week, (C) 16800 IU/week, or (D) 28000 IU/week in pregnancy, all with 0 IU/week postpartum; or, (E) 28000 IU/week in prenatal and postpartum periods. The primary outcome was length-for-age z-score at one year of age according to World Health Organization child growth standards.
Among 1164 infants assessed at one year of age (90% of 1300 pregnancies), there were no differences across groups in length-for-age z-scores (mean ±standard deviation): A: -0.93 ±1.05, B: -1.11 ±1.12, C: -0.97 ±0.97, D: -1.06 ±1.07, E: -0.94 ±1.00 (p=0.23). Groups were similar with respect to other anthropometric measures, birth outcomes, and morbidity. Vitamin D had dose- dependent effects on maternal and infant serum 25-hydroxyvitamin D and calcium, maternal urinary calcium excretion, and maternal parathyroid hormone concentrations. No clinical adverse events were attributed to the vitamin D intervention.
In a population with widespread prenatal vitamin D deficiency and fetal/infant growth restriction, maternal vitamin D supplementation from mid-pregnancy until birth or 6 months postpartum does not influence fetal or infant growth, and has no beneficial or harmful effects on numerous other birth and infant outcomes.Weekly Vitamin D to mother after birth much better than daily - RCT Aug 2018
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