High-dose Maternal Vitamin D Supplementation Can ReduceInfantile Rickets Risk

The impact of maternal vitamin D supplementation on preventing infantile rickets in low- and middle-income countries is unclear, especially where routine infant supplementation is lacking. A recent study investigated the effects of varying doses of maternal vitamin D on biochemical rickets risk in infants aged 6-12 monthsin Bangladesh.

This was a secondary analysis of a randomized, placebo-controlled trial wherein 1,300 pregnant women were randomized into five groups – placebo, or vitamin D at doses of 4200 IU/week, 16,800 IU/week, or 28,000 IU/week––from the second trimester to delivery plus placebo until 6 months postpartum; or 28,000 IU/week both prenatally and until 6 months postpartum. Biochemical rickets screening was conducted on 790 infants. Relative risks (RR) and 95% confidence intervals (CI) for biochemical rickets were calculated for each group versus placebo.

The results showed that 39 (4.9%)out of 790 infants had biochemical rickets. The highest prevalence was in the placebo group (7.8%). Infants whose mothers received 28,000 IU of vitamin D weekly––both prenatally and postpartum––had a significantly lower risk. However, prenatal supplementation alone (4200 IU, 16,800 IU, 28,000 IU weekly) showed no significant risk reduction compared to placebo.

Therefore, it was concluded that high-dose maternal vitamin D supplementation (28,000 IU/week) during the third trimester and up to six months postpartum significantly reduced the risk of infantile biochemical rickets. This strategy could be beneficial for other low- and middle-income countries with similar vitamin D deficiencies. Future research should explore different postpartum supplementation doses and include longer-term follow-ups with radiologic and clinical assessments.

Source:Lautatzis ME, Keya FK, Al Mahmud A,et al. Pediatrics. 2024 Jun 1;153(6):e2023063263.