Effect of calcium plus vitamin D supplementation during pregnancy in Brazilian adolescent mothers:
a randomized, placebo-controlled trial
Am J Clin Nutr July 2013 ajcn.056275
Maria Eduarda L Diogenes, Flávia F Bezerra, Elaine P Rezende, Marcia Fernanda Taveira, Isabel Pinhal, and Carmen M Donangelo
From the Laboratório de Bioquímica Nutricional e de Alimentos, Instituto de Química (MELD and CMD) and the Maternidade Escola (IP), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; the Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil (FFB, EPR, and MFT); and the Escuela de Nutrición, Universidad de la República, Montevideo, Uruguay (CMD).[
↵2 Supported by the Conselho Nacional de Desenvolvimento Científico e Tecnológico [grant 471872/2008-3 (to CMD) and a doctoral fellowship (to MELD)] and the Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (grant E-26/102.759/2008; to CMD), Brazil.
↵3 Address correspondence to CM Donangelo, Escuela de Nutrición, Universidad de la República, Paysandú 843, Montevideo 11100, Uruguay. E-mail: cmdonangelo at fmed.edu.uy.
Background: Pregnancy and lactation in adolescents with habitually low calcium intake may adversely affect maternal bone mass.
Objective: We investigated the effect of calcium plus vitamin D supplementation during pregnancy on bone mass during lactation in Brazilian adolescent mothers with low-calcium diets (∼600 mg/d).
Design: Pregnant adolescents (14–19 y) randomly received daily calcium (600 mg) plus vitamin D3 (200 IU) (n = 30) or a placebo (n = 26) from 26 wk of pregnancy (baseline) until parturition. The bone mineral content (BMC), bone area (BA), and bone mineral density (BMD) at the total body, lumbar spine, and hip (total and femoral neck) were evaluated by using dual-energy X-ray absorptiometry at 5 and 20 wk postpartum. Serum hormones and 25-hydroxyvitamin D [25(OH)D] were measured. Group comparisons were adjusted for significant covariates.
Results: The mean serum 25(OH)D concentration was 59 nmol/L at baseline. Compared with the placebo, 25(OH)D tended to be 14–15 nmol/L higher postpartum in the supplemented group (P = 0.08). Total body and hip BMC and BMD decreased over time (P ≤ 0.005) in both groups with a group × time interaction at the femoral neck (P < 0.04). Supplemented mothers had higher lumbar spine BA (6.7%; P = 0.002) and lumbar spine BMC (7.9%, P = 0.08) than did mothers who consumed the placebo at 5 wk postpartum. At 20 wk postpartum, differences between groups were more evident, with higher lumbar spine BMC (13.9%), lumbar spine BA (6.2%), and lumbar spine BMD (10.6%) in the supplemented group (P ≤ 0.008).
Conclusions: Calcium plus vitamin D supplementation during pregnancy of adolescents with low calcium intake results in higher lumbar spine bone mass and a reduced rate of femoral neck bone loss during lactation. Additional studies are required to determine whether bone effects are temporary or long-lasting. This trial was registered at clinicaltrials.gov as NCT01732328.
Received December 7, 2012. Accepted April 16, 2013.
- Those moms must have been extremely vitamin D deficient for such a low dose to have been of any benefit
Just a 6 ng/ml increase in vitamin D level over the placebo (no indication in abstract of actual level)
- Had not thought that such a low a dose of vitamin D could be of ANY benefit during pregnancy.
- Happy to see that it at least benefited moms bones.
- Doubt that 200 IU would have had much of any benefit in other health aspects to mom or infant
- Overview Pregnancy and vitamin D 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|