Maternal Vitamin D Status: Implications for the Development of Infantile Nutritional Rickets

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Cause and epidemiology of infantile nutritional rickets

The clinical picture of nutritional rickets was first described by Whistler (1645) and Glisson (1650), who reported that the disease rarely occurred before 6 months of age and was most prevalent between 6 months and 2.5 years of age.6 Although the classic features of vitamin D deficiency rickets are most commonly seen during this period, studies have shown that symptomatic vitamin D deficiency can develop early in infancy.7, 8, 9, 10, 11, 12 In Turkey, for example, in a 2-year period, 42

Vitamin D and calcium homeostasis in the mother-infant pair during pregnancy and lactation

Major changes in maternal calcium homeostasis take place during pregnancy and lactation, as the mother must provide enough calcium for fetal development during pregnancy and to meet breast milk calcium concentrations during lactation. In the nonpregnant and nonlactating woman, vitamin D sufficiency is essential to maintain normal calcium and bone homeostasis. However, during pregnancy and lactation, the vitamin D endocrine system probably plays little role in the physiologic alterations in

Consequences of vitamin D deficiency in mother-infant pairs

Besides the increased incidence of infantile rickets, neonatal hypocalcaemia, and the rare entity of congenital rickets, there is new evidence to suggest that there may be other consequences of maternal and infant vitamin D deficiency on the growing infant, child, and adolescent.

Intrauterine programming is important for neonatal and adult health, including bone health, and is determined by among other factors, adequate maternal nutritional and mineral homeostasis and the fetal hormonal milieu.69

Recommendations for the prevention of vitamin D deficiency in mother and child

Vitamin D deficiency in the neonate and infant can be prevented by supplementing all at-risk pregnant and lactating women with vitamin D, by exposing pregnant and lactating women and their infants to sufficient sunlight, or by supplementing exclusively breastfed infants with vitamin D.

There are obstacles to the implementation of each of these preventive strategies. The lack of adequate training of physicians in a supposedly rickets-free era coupled with the lack of adequate recommendations

Summary

The mother is the major source of circulating 25-OHD concentrations in the young infant. Thus maternal vitamin D status is an important factor in determining the vitamin D status of the infant and their risk of developing vitamin D deficiency and infantile nutritional rickets. As a result, breastfed infants of mothers with vitamin D deficiency who are unsupplemented and who receive little sunlight exposure are at high risk of developing vitamin D deficiency or rickets. Despite food

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References (97)

  • M.F. Holick

    The vitamin D epidemic and its health consequences

    J Nutr

    (2005)
  • M.A. Strand et al.

    Doing the month: rickets and post-partum convalescence in rural China

    Midwifery

    (2009)
  • A. Sachan et al.

    High prevalence of vitamin D deficiency among pregnant women and their newborns in northern India

    Am J Clin Nutr

    (2005)
  • N. Bishop et al.

    Metabolic bone disease of prematurity

  • A.D. Rothberg et al.

    Maternal-infant vitamin D relationships during breast-feeding

    J Pediatr

    (1982)
  • L.M. Bodnar et al.

    High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates

    J Nutr

    (2007)
  • N. Andiran et al.

    Risk factors for vitamin D deficiency in breast-fed newborns and their mothers

    Nutrition

    (2002)
  • C.S. Kovacs

    Vitamin D in pregnancy and lactation: maternal, fetal, and neonatal outcomes from human and animal studies

    Am J Clin Nutr

    (2008)
  • J.K. Bass et al.

    Calcium nutrition and metabolism during infancy

    Nutrition

    (2006)
  • F.R. Greer et al.

    Mineral homeostasis during lactation- relationship to serum 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D, parathyroid hormone and calcitonin

    Am J Clin Nutr

    (1982)
  • J.J. Steichen et al.

    Osteopenia of prematurity: the cause and possible treatment

    J Pediatr

    (1980)
  • B.L. Salle et al.

    Perinatal metabolism of vitamin D

    Am J Clin Nutr

    (2000)
  • A.R. Fleischman et al.

    Maternal and fetal serum 1,25-dihydroxyvitamin D levels at term

    J Pediatr

    (1980)
  • L.S. Hillman et al.

    Human perinatal vitamin D metabolism. I. 25-hydroxyvitamin D in maternal and cord blood

    J Pediatr

    (1974)
  • J.M. Gertner et al.

    Fetomaternal vitamin D relationships at term

    J Pediatr

    (1980)
  • L.E. Reeve et al.

    Vitamin D of human milk: identification of biologically active forms

    Am J Clin Nutr

    (1982)
  • R.P. Heaney et al.

    25-Hydroxylation of vitamin D3: relation to circulating vitamin D3 under various input conditions

    Am J Clin Nutr

    (2008)
  • F.R. Greer et al.

    Effects of maternal ultraviolet B irradiation on vitamin D content of human milk

    J Pediatr

    (1984)
  • B.W. Hollis et al.

    Vitamin D and its metabolites in human and bovine milk

    J Nutr

    (1981)
  • R.P. Heaney et al.

    Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol

    Am J Clin Nutr

    (2003)
  • L.A. Armas et al.

    Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color

    J Am Acad Dermatol

    (2007)
  • A. Dawodu et al.

    Hypovitaminosis D and vitamin D deficiency in exclusively breast-feeding infants and their mothers in summer: a justification for vitamin D supplementation of breast-feeding infants

    J Pediatr

    (2003)
  • B.L. Specker et al.

    Vitamin D in infancy and childhood: factors determining vitamin D status

    Adv Pediatr

    (1986)
  • M.K. Javaid et al.

    Prenatal and childhood influences on osteoporosis

    Best Pract Res Clin Endocrinol Metab

    (2002)
  • C. Mathieu et al.

    The coming of age of 1,25-dihydroxyvitamin D(3) analogs as immunomodulatory agents

    Trends Mol Med

    (2002)
  • R. Namgung et al.

    Bone in the pregnant mother and newborn at birth

    Clin Chim Acta

    (2003)
  • J.A. Pasco et al.

    Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity

    Med Hypotheses

    (2008)
  • M.K. Javaid et al.

    Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study

    Lancet

    (2006)
  • T.O. Scholl et al.

    Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight

    Early Hum Dev

    (2009)
  • J. Wohlfahrt et al.

    Secular and seasonal variation of length and weight at birth

    Lancet

    (1998)
  • B.D. Gessner et al.

    25-Hydroxyvitamin D levels among healthy children in Alaska

    J Pediatr

    (2003)
  • S. Datta et al.

    Vitamin D deficiency in pregnant women from a non-European ethnic minority population–an interventional study

    BJOG

    (2002)
  • L.Y. Matsuoka et al.

    Sunscreens suppress cutaneous vitamin D3 synthesis

    J Clin Endocrinol Metab

    (1987)
  • S.A. Taha et al.

    25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates

    Pediatr Res

    (1984)
  • K.S. Agarwal et al.

    The impact of atmospheric pollution on vitamin D status of infants and toddlers in Delhi, India

    Arch Dis Child

    (2002)
  • P.M. Dunn

    Francis Glisson (1597-1677) and the “discovery” of rickets

    Arch Dis Child Fetal Neonatal Ed

    (1998)
  • S. Balasubramanian et al.

    Hypocalcemia due to vitamin D deficiency in exclusively breastfed infants

    Indian Pediatr

    (2006)
  • S.S. Beck-Nielsen et al.

    Incidence and prevalence of nutritional and hereditary rickets in southern Denmark

    Eur J Endocrinol

    (2009)
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