Implications of maternal vitamin D deficiency for the fetus, the neonate and the young infant
Table 3: Possible major outcomes related to vitamin D deficiency at different life stages
Life stage | Outcome | ||||
Preconception | Unsuccessful in vitro fertilization | ||||
Pregnancy | Reduced activation of innate immunity in the placenta | ||||
Increased risk of gestational diabetes and preeclampsia | |||||
Delay in fetal lung development and surfactant production | |||||
Delay in fetal bone development | |||||
Perinatal | Increased risk of cesarean delivery | ||||
Reduced body size and shape at birth | |||||
Poor skeletal mineralization and bone defects at birth | |||||
Childhood | Lower bone mineral content with skeletal deformities and increased risk of fracture | ||||
Growth retardation | |||||
Rickets | |||||
Increased risk of respiratory tract infections | |||||
Increased risk of wheezing and asthma | |||||
Increased risk of type 1 diabetes | |||||
Increased risk of central nervous system disorders |
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 cofactors | < 750 mg | $3 |
6000 | Probable: larger benefits for above items Just enough D for breastfed infant More maternal and infant weight | Should have cofactors | < 750 mg | $4 |
Healthy pregnancies need lots of vitamin D has the following summary
Problem | 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
Eur J Nutr DOI 10.1007/s00394-012-0476-4
Nicola Principi • Sonia Bianchini • Elena Baggi • Susanna Esposito
Background It has recently been demonstrated that vitamin D (VD) deficiency during pregnancy and lactation can give rise to problems in mothers and their children.
Aim To discuss the implications of VD deficiency during pregnancy and the best VD supplementation to use in order to avoid risks for the mother and child.
Methods PubMed was used to select all of the clinical studies published in the last 15 years concerning VD deficiency in pregnant women and its impact on the fetuses, neonates and infants, as well as the use of VD supplementation during pregnancy.
Results Several studies have suggested that VD deficiency is associated with possible major outcomes in the preconception period, during pregnancy, perinatally and in childhood. A 25(OH)D concentration of >32 and <50-60 ng/mL seems to be associated with the lowest risk of disease, and the administration of 2,000 IU/day to pregnant and breastfeeding women seems to maintain adequate 25(OH)D levels. However, not all the experts agree with these conclusions because some of them do not think that VD deficiency can really cause extraskeletal manifestations and consider that the traditionally suggested 400-600 IU/day can be enough to permit an adequate bone development.
Conclusions Despite an increasing amount of data seems to suggest that pregnant women need a greater amount of VD than recommended in the past, further studies are needed to determine how much VD has to be given to assure a regular evolution of the pregnancy and an adequate development of the fetus and the young child.