Vitamin D supplementation during pregnancy and infancy reduces primary care antibiotic use for acute illnesses during infancy
Grant CC (1,2), Stewart A (3), Scragg R (3), Milne (1), Rowden J (1), Ekeroma A (4,5), Wall C (6), Mitchell E (1), Kaur S (1), Waymouth E (1), Trenholme A (5), Crane J (8), Camargo CA Jr (9,10).
1. Paediatrics: Child 8 Youth Health, University of Auckland, Auckland U42, NZ.
2. General Paediatrics, Starship Children's Hospital, Auckland 1023, NZ.
3. Epidemiology 8 Biostatistics, University of Auckland, Auckland 1072, NZ. "
4. Obstetrics 8 Gynaecology, University of Auckland, Auckland 1142, NZ.
5. Women 8 Children's Health, Middlemore Hospital, Auckland 2025, NZ.
6. Nutrition, University of Auckland, Auckland 1142, NZ.
7. Te Kupenga Hauora Maori, University of Auckland, Auckland 1072, NZ.
8. Medicine, University of Otago, Wellington 6021, NZ.
9. Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
10. Harvard Medical School, Boston, MA 02115, USA.
Background: Antibiotic prescribing in primary care is one of the most important drivers of antibiotic resistance. Strategies to reduce antibiotic prescribing are a current focus of health care quality improvement. We aimed to determine whether vitamin supplementation during pregnancy and infancy reduces antibiotic prescribing for acute illnesses during infancy.
Methods: We performed a randomised, double-blind, placebo-controlled trial in Auckland, New Zealand (latitude 36oS). Pregnant mothers, from enrollment at 27 weeks gestation to birth, and then their infants, from birth to age 6 months, were assigned to receive placebo or one of two dosages of daily of oral vitamin D3.
The enrolled woman/infant pairs were randomised to: placebo/placebo, 1000IU/400IU, or 2000IU/800IU. Serum 25-hydroxyvitamin D (25(0H)D) concentration was measured at enrollment, 36 weeks gestation, on cord blood samples, and at 2,4 and 6 months of age. We audited the primary care records of enrolled infants to a median age of 18 months, identified all acute visits and determined whether oral antibiotics were prescribed at each visit. Study investigators, parents and all treating physicians remained blinded to group allocation until after completion of the primary care audit.
Results: 260 pregnant women were randomised to placebo (n=87), lower dose (n=87) or higher dose (n=86) vitamin D. In comparison with placebo, serum 25(0H)D concentrations were higher during pregnancy and infancy in both the lower and higher dose vitamin D groups. During infancy, mean serum 25(0H)D was greater in the higher than the lower dose group at 2, 4 and 6 months of age. Primary care data, collected to a median (25th-75th centile) age of 18 (14 to 21) months, were available on 238 (92%) of the children. At least one acute primary care visit was made by 232 (98%) of the children with the median (25th, 75th centile) number of acute visits being 8 (4,13). Vitamin D supplementation did not affect the proportion making any acute visits (placebo 98%, lower dose 100%, higher dose 95%, p = 0.12), nor the median number of acute visits (placebo 8, lower dose 8, higher dose 8, p = 0.43). In comparison with placebo, the proportion of children prescribed antibiotics at any acute primary care visit did not differ for the lower dose vitamin D group (85% vs. 77%, p = 0.24) but was smaller in the higher dose group (85% vs 71%, p = 0.04). The number of acute visits at which an antibiotic was prescribed did not differ between groups (placebo 2, lower dose 2, higher dose 3, p = 0.50)
Conclusions: Vitamin D supplementation at 2000 lU/day -from 27 weeks gestation until birth and then at 800 lU/day from birth to age 6 months may reduce the proportion of children prescribed antibiotics at acute primary care visits during the first 18 months of life.
Grant CC, Stewart AW, Scragg R, Milne T, Rowden J, Ekeroma A, Wall C, Mitchell EA, Crengle S, Trenholme A, Crane J, Camargo CA Jr. vitamin D during pregnancy and infancy and infant serum 25-hydroxyvitamin D concentration. Pediatrics 2013; in press.
In VitaminDWiki 800 IU vitamin D for infant and 2000 IU for mother is good, not great – RCT Dec 2013 which has the following chart
Poster Presented at Vitamin D conference in England - April 23-25 2014
- Five times less mite allergy when vitamin D added in mid pregnancy and to infant – RCT April 2016
same cohort and authors - links to lots of other studies
Studies in both categories of Antibiotics and Pregnancy are listed here:
- Vaginal microbiome varies with race, vitamin D level, preterm birth, etc. - March 2019
- Antibiotics during pregnancy may cause childhood health problems – Feb 2019
- Gut Microbiome is important during pregnancy – Dec 2014
- 1.8X increased risk of Obesity if antibiotics were used during pregnancy – Nov 2014
- 2000 IU vitamin D during pregnancy and 800 IU to infant resulted in less use of antibiotics – RCT April 2014