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Reminder – 400 IU is enough only when infant already had a good level of vitamin D – Nov 2012

Vitamin D in the maternal-fetal-neonatal interface:

Clinical implications and requirements for supplementation.

J Matern Fetal Neonatal Med. 2012 Nov 6.
Marshall I, Mehta R, Petrova A.
Department of Pediatrics, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903.

Identification of the current evidence regarding the pathophysiological and clinical facets of vitamin D in the maternal-fetal-neonatal interface is of value because of the significance of the vitamin D endocrine system in human health and high prevalence of vitamin D deficiency in mothers and their infants.

Although many questions have still not been answered by the existing literature, we found evidence that:

(i) during pregnancy vitamin D participates in fetal skeletal mineralization and growth,
(ii) neonatal vitamin D level are dependent on the maternal vitamin D status at delivery,
(iii) a vitamin D sufficient status at birth may decrease the risk for the development of asthma and type 1 diabetes mellitus in later life,
(iv) recommendations for maintaining serum 25-hydroxyvitamin D [25(OH)D] levels >32 ng/mL to avoid secondary hyperparathyroidism in adults has not been applied to mothers and their infants,
(v) American Academy of Pediatrics recommended supplementation of 400 IU of vitamin D per day is sufficient only for infants who are born with normal vitamin D levels,
(vii) supplementation of lactating mothers with high doses of vitamin D (4,000 IU /d) allows the achievement of optimal 25(OH)D concentrations (>32 ng/mL)
in the maternal and infant serum without any risk of hypervitaminosis D in the mother.

We believe that inconsistency in the recognition of sufficient levels of vitamin D in mothers and their infants affects the identification of adequate doses for vitamin D supplementation during pregnancy, lactation, and infancy.

PMID: 23131182
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Reminder – 400 IU is enough only when infant already had a good level of vitamin D – Nov 2012

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- Group is giving only 200 IU of Vitamin D to 70 million women and children to prevent Rickets 16% of exclusively breastfed infants so low on vitamin D that they had rickets – June 2010 Breastfed without vitamin D supplements – a problem for NZ infants Jan 2013 Preemies have low vitamin D levels yet only get 400 IU – July 2013 Some preemies needed more than 400 IU of vitamin D – July 2013 Infants again said to need more than 400 IU of vitamin D – Sept 2012 Only about 10 percent of breastfed infants get even the minimum recommended vitamin D – April 2010 UK Milk producer sets vitamin D day, yet UK milk rarely has vitamin D – March 31 2013

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