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Published in: BMC Pediatrics 1/2016

Open Access 01-12-2016 | Research article

Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome

Authors: Ian Marshall, Rajeev Mehta, Charletta Ayers, Smita Dhumal, Anna Petrova

Published in: BMC Pediatrics | Issue 1/2016

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Abstract

Background

Occurrence and consequence of cord blood (CB) vitamin D insufficiency/deficiency has not been adequately explored despite rising concern regarding this topic in pediatrics. This study was designed to determine the rate, maternal risk factors, and clinical outcomes in infants in association with vitamin D insufficient/deficient status at birth.

Methods

American Academy of Pediatrics (AAP) defined levels (ng/mL) were utilized to categorize the vitamin D status in CB samples as deficient (5–15), insufficient (16–20), and sufficient (21–100). We used descriptive statistics and multiple regression models to identify the rate and factors associated with vitamin D deficiency/insufficiency and related outcomes in the enrolled mother-infant pairs.

Results

This prospective study was conducted at a single center on postpartum women and their infants. Vitamin D deficiency and insufficiency was recorded in 38.9 and 29.8% respectively of the 265 CB samples. Deficient CB vitamin D levels in infants were associated with maternal Black, Hispanic, or Asian race/ethnicity, younger age, and increased number of pregnancies. The likelihood for infants to be born with an insufficient vitamin D level increases with younger maternal age and the number of pregnancies as well as Asian ethnicity. We did not find an association between the vitamin D status at birth and pre-discharge clinical characteristics of the neonates.

Conclusions

The likelihood for an infant to be born with vitamin D deficiency/insufficiency is relatively high and is related mainly to younger maternal age, gravidity, and non-White race/ethnicity. Our findings raise a question regarding the adequacy of the AAP recommended vitamin D supplementation requirements without knowing the infant’s vitamin D status at birth.
Literature
1.
go back to reference Dawodu A, Wagner CL. Prevention of vitamin D deficiency in mothers and infants worldwide - a paradigm shift. Paediatr Int Child Health. 2012;32:3–13.CrossRefPubMedPubMedCentral Dawodu A, Wagner CL. Prevention of vitamin D deficiency in mothers and infants worldwide - a paradigm shift. Paediatr Int Child Health. 2012;32:3–13.CrossRefPubMedPubMedCentral
2.
go back to reference Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease [review]. Am J Clin Nutr. 2004;80(6 Suppl):1678S–88S.PubMed Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease [review]. Am J Clin Nutr. 2004;80(6 Suppl):1678S–88S.PubMed
3.
go back to reference Mylott BM, Kump T, Bolton ML, Greenbaum LA. Rickets in the Dairy State. WMJ. 2004;103:84–7.PubMed Mylott BM, Kump T, Bolton ML, Greenbaum LA. Rickets in the Dairy State. WMJ. 2004;103:84–7.PubMed
4.
go back to reference Belderbos ME, Houben ML, Wilbrink B, Lentjes E, Bloemen EM, Kimpen JL, Rovers M, Bont L. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics. 2011;127:e1513–1520.CrossRefPubMed Belderbos ME, Houben ML, Wilbrink B, Lentjes E, Bloemen EM, Kimpen JL, Rovers M, Bont L. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics. 2011;127:e1513–1520.CrossRefPubMed
5.
go back to reference Baïz N, Dargent-Molina P, Wark JD, Souberbielle JC, Annesi-Maesano I, EDEN Mother-Child Cohort Study Group. Cord serum 25-hydroxyvitamin D and risk of early childhood transient wheezing and atopic dermatitis. J Allergy Clin Immunol. 2014;133:147–53.CrossRefPubMed Baïz N, Dargent-Molina P, Wark JD, Souberbielle JC, Annesi-Maesano I, EDEN Mother-Child Cohort Study Group. Cord serum 25-hydroxyvitamin D and risk of early childhood transient wheezing and atopic dermatitis. J Allergy Clin Immunol. 2014;133:147–53.CrossRefPubMed
6.
go back to reference Hypponen E, Laara E, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358:1500–3.CrossRefPubMed Hypponen E, Laara E, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358:1500–3.CrossRefPubMed
8.
go back to reference Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142–52.CrossRefPubMed Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008;122:1142–52.CrossRefPubMed
9.
go back to reference Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122:398–417.CrossRefPubMed Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122:398–417.CrossRefPubMed
10.
go back to reference Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.CrossRefPubMed Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011;96:1911–30.CrossRefPubMed
11.
go back to reference Eldjerou LK, Cogle CR, Rosenau EH, Lu X, Bennett CA, Sugrue MW, Hoyne J, Lambert A, Ashley L, Sazama K, Fields G, Wingard JR, Zubair AC. Vitamin D effect on umbilical cord blood characteristics: a comparison between African Americans and Caucasians. Transfusion. 2015;55:1766–71.CrossRefPubMed Eldjerou LK, Cogle CR, Rosenau EH, Lu X, Bennett CA, Sugrue MW, Hoyne J, Lambert A, Ashley L, Sazama K, Fields G, Wingard JR, Zubair AC. Vitamin D effect on umbilical cord blood characteristics: a comparison between African Americans and Caucasians. Transfusion. 2015;55:1766–71.CrossRefPubMed
12.
go back to reference Jacquemyn Y, Ajaji M, Karepouan N. Vitamin D levels in maternal serum and umbilical cord blood in a multi-ethnic population in Antwerp, Belgium. Facts Views Vis Obgyn. 2013;5:3–5.PubMedPubMedCentral Jacquemyn Y, Ajaji M, Karepouan N. Vitamin D levels in maternal serum and umbilical cord blood in a multi-ethnic population in Antwerp, Belgium. Facts Views Vis Obgyn. 2013;5:3–5.PubMedPubMedCentral
13.
go back to reference Cadario F, Savastio S, Pozzi E, Capelli A, Dondi E, Gatto M, Zaffaroni M, Bona G. Vitamin D status in cord blood and newborns: ethnic differences. Ital J Pediatr. 2013;4:35–9.CrossRef Cadario F, Savastio S, Pozzi E, Capelli A, Dondi E, Gatto M, Zaffaroni M, Bona G. Vitamin D status in cord blood and newborns: ethnic differences. Ital J Pediatr. 2013;4:35–9.CrossRef
14.
go back to reference Bodnar LM, Simhan HN, Powers RW, 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;137:447–52.PubMedPubMedCentral Bodnar LM, Simhan HN, Powers RW, 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;137:447–52.PubMedPubMedCentral
15.
go back to reference Vinkhuyzen AA, Eyles DW, Burne TH, Blanken LM, Kruithof CJ, Verhulst F, Jaddoe VW, Tiemeier H, McGrath JJ. Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: The Generation R Study. J Steroid Biochem Mol Biol. 2015. doi:10.1016/j.jsbmb.2015.09.018.PubMed Vinkhuyzen AA, Eyles DW, Burne TH, Blanken LM, Kruithof CJ, Verhulst F, Jaddoe VW, Tiemeier H, McGrath JJ. Prevalence and predictors of vitamin D deficiency based on maternal mid-gestation and neonatal cord bloods: The Generation R Study. J Steroid Biochem Mol Biol. 2015. doi:10.​1016/​j.​jsbmb.​2015.​09.​018.PubMed
16.
go back to reference Bowyer L, Catling-Paull C, Diamond T, et al. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol. 2009;70:372–7.CrossRef Bowyer L, Catling-Paull C, Diamond T, et al. Vitamin D, PTH and calcium levels in pregnant women and their neonates. Clin Endocrinol. 2009;70:372–7.CrossRef
17.
go back to reference Halm BM, Lai JF, Pagano I, Cooney W, Soon RA, Franke AA. Vitamin D deficiency in cord plasma from multiethnic subjects living in the tropics. J Am Coll Nutr. 2013;32:215–23.CrossRefPubMedPubMedCentral Halm BM, Lai JF, Pagano I, Cooney W, Soon RA, Franke AA. Vitamin D deficiency in cord plasma from multiethnic subjects living in the tropics. J Am Coll Nutr. 2013;32:215–23.CrossRefPubMedPubMedCentral
18.
go back to reference Lee JM, Smith JR, Philipp BL, et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila). 2007;46:42–4.CrossRef Lee JM, Smith JR, Philipp BL, et al. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila). 2007;46:42–4.CrossRef
20.
go back to reference Bailey D, Perumal N, Yazdanpanah M, Al Mahmud A, Baqui AH, Adeli K, Roth DE. Maternal-fetal-infant dynamics of the C3-epimer of 25-hydroxyvitamin D. Clin Biochem. 2014;47:816–22.CrossRefPubMed Bailey D, Perumal N, Yazdanpanah M, Al Mahmud A, Baqui AH, Adeli K, Roth DE. Maternal-fetal-infant dynamics of the C3-epimer of 25-hydroxyvitamin D. Clin Biochem. 2014;47:816–22.CrossRefPubMed
22.
go back to reference Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439–43.CrossRefPubMed Chapuy MC, Preziosi P, Maamer M, et al. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7:439–43.CrossRefPubMed
23.
go back to reference Heaney RP, Dowell MS, Hale CA, et al. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–6.CrossRefPubMed Heaney RP, Dowell MS, Hale CA, et al. Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr. 2003;22:142–6.CrossRefPubMed
24.
go back to reference Holick MF. Vitamin D, status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19:73–8.CrossRefPubMed Holick MF. Vitamin D, status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19:73–8.CrossRefPubMed
25.
go back to reference Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. 1982;1:74–6.CrossRefPubMed Clemens TL, Adams JS, Henderson SL, Holick MF. Increased skin pigment reduces the capacity of skin to synthesise vitamin D3. Lancet. 1982;1:74–6.CrossRefPubMed
26.
go back to reference Wolpowitz D, Gilchrest BA. The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol. 2006;54:301–17.CrossRefPubMed Wolpowitz D, Gilchrest BA. The vitamin D questions: how much do you need and how should you get it? J Am Acad Dermatol. 2006;54:301–17.CrossRefPubMed
27.
go back to reference Mostafa WZ, Hegazy RA. Vitamin D and the skin: Focus on a complex relationship: a review. Journal of Advanced Research. 2015;6:793–804.CrossRefPubMed Mostafa WZ, Hegazy RA. Vitamin D and the skin: Focus on a complex relationship: a review. Journal of Advanced Research. 2015;6:793–804.CrossRefPubMed
28.
go back to reference Sulaiman RA, Sharratt CL, Lee PW, Skinner A, Griffiths MJ, Webster C, Ford C, Anderson J, Gama R. Ethnic differences in umbilical cord blood vitamin D and parathyroid hormone–South Asians compared to whites born in the UK. J Matern Fetal Neonatal Med. 2010;23:1315–7.CrossRefPubMed Sulaiman RA, Sharratt CL, Lee PW, Skinner A, Griffiths MJ, Webster C, Ford C, Anderson J, Gama R. Ethnic differences in umbilical cord blood vitamin D and parathyroid hormone–South Asians compared to whites born in the UK. J Matern Fetal Neonatal Med. 2010;23:1315–7.CrossRefPubMed
29.
go back to reference Andersen LB, Abrahamsen B, Dalgård C, Kyhl HB, Beck-Nielsen SS, Frost-Nielsen M, Jørgensen JS, Barington T, Christesen HT. Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population-based cohort study. Clin Endocrinol (Oxf). 2013;79:333–41.CrossRef Andersen LB, Abrahamsen B, Dalgård C, Kyhl HB, Beck-Nielsen SS, Frost-Nielsen M, Jørgensen JS, Barington T, Christesen HT. Parity and tanned white skin as novel predictors of vitamin D status in early pregnancy: a population-based cohort study. Clin Endocrinol (Oxf). 2013;79:333–41.CrossRef
30.
go back to reference Vercruyssen J, Martin M, Jacquemyn Y. A pilot study on 25-hydroxyvitamin D status according to sun exposure in pregnant women in Antwerp, Belgium. Facts Views Vis Obgyn. 2010;2:127–30.PubMedPubMedCentral Vercruyssen J, Martin M, Jacquemyn Y. A pilot study on 25-hydroxyvitamin D status according to sun exposure in pregnant women in Antwerp, Belgium. Facts Views Vis Obgyn. 2010;2:127–30.PubMedPubMedCentral
31.
32.
go back to reference Skouroliakou M, Ntountaniotis D, Massara P, Koutri K. Investigation of multiple factors which may contribute to vitamin D levels of bedridden pregnant women and their preterm neonates. J Matern Fetal Neonatal Med. 2016;29:2596–601.PubMed Skouroliakou M, Ntountaniotis D, Massara P, Koutri K. Investigation of multiple factors which may contribute to vitamin D levels of bedridden pregnant women and their preterm neonates. J Matern Fetal Neonatal Med. 2016;29:2596–601.PubMed
33.
go back to reference Atkinson LR, Escobar GJ, Takayama JI, Newman TB. Phototherapy use in jaundiced newborns in a large managed care organization: Do clinicians adhere to the guideline? Pediatrics. 2003;111:e555–61.CrossRefPubMed Atkinson LR, Escobar GJ, Takayama JI, Newman TB. Phototherapy use in jaundiced newborns in a large managed care organization: Do clinicians adhere to the guideline? Pediatrics. 2003;111:e555–61.CrossRefPubMed
34.
go back to reference Mutlu M, Çayir A, Çayir Y, Özkan B, Aslan Y. Vitamin D and hyperbilirubinaemia in neonates. HK J Paediatr (New Series). 2013;18:77–8. Mutlu M, Çayir A, Çayir Y, Özkan B, Aslan Y. Vitamin D and hyperbilirubinaemia in neonates. HK J Paediatr (New Series). 2013;18:77–8.
35.
go back to reference Bodnar LM, Catov JM, Roberts JM, Simhan HN. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. J Nutr. 2007;137:2437–42.PubMedPubMedCentral Bodnar LM, Catov JM, Roberts JM, Simhan HN. Prepregnancy obesity predicts poor vitamin D status in mothers and their neonates. J Nutr. 2007;137:2437–42.PubMedPubMedCentral
36.
go back to reference Ortigosa Gómez S, García-Algar O, Mur Sierra A, Ferrer Costa R, Carrascosa Lezcano A, Yeste FD. Sociodemographic factors related to plasma concentrations of 25-OH vitamin D and PTH in cord blood. Rev Esp Salud Publica. 2015;89:75–83.CrossRefPubMed Ortigosa Gómez S, García-Algar O, Mur Sierra A, Ferrer Costa R, Carrascosa Lezcano A, Yeste FD. Sociodemographic factors related to plasma concentrations of 25-OH vitamin D and PTH in cord blood. Rev Esp Salud Publica. 2015;89:75–83.CrossRefPubMed
37.
go back to reference McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr. 2008;87:1097S–101S.PubMed McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D exposure from sunlight questionnaires? Am J Clin Nutr. 2008;87:1097S–101S.PubMed
38.
go back to reference Taylor JA, Geyer LJ, Feldman KW. Pediatrics. Use of supplemental vitamin d among infants breastfed for prolonged periods. Pediatrics. 2010;125:105–11.CrossRefPubMed Taylor JA, Geyer LJ, Feldman KW. Pediatrics. Use of supplemental vitamin d among infants breastfed for prolonged periods. Pediatrics. 2010;125:105–11.CrossRefPubMed
Metadata
Title
Prevalence and risk factors for vitamin D insufficiency and deficiency at birth and associated outcome
Authors
Ian Marshall
Rajeev Mehta
Charletta Ayers
Smita Dhumal
Anna Petrova
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2016
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-016-0741-4

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