ArticlesMaternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study
Introduction
In elderly people, vitamin D insufficiency is common1 and associated with an increased risk of fragility fracture;2, 3 furthermore, calcium and vitamin D supplementation of those at risk of insufficiency seems to reduce their risk of fracture.4 Vitamin D is also necessary for skeletal growth during infancy and childhood. In a retrospective cohort study, vitamin D supplementation of premature infants during the first year of life was associated with increased whole-body bone mass at age 12 years.5
Vitamin D insufficiency is common in otherwise healthy pregnant women6 and growing evidence shows that the risk of osteoporotic fracture in later life is increased by the action of adverse environmental stimuli during early development, including intrauterine life.7 Epidemiological studies have shown that weight at birth and in infancy predicts peak bone mass,7, 8 and bone mass in later life.9, 10 Poor intrauterine and childhood growth are associated with an approximate doubling of hip fracture risk six decades later;11 maternal body build, nutrition, smoking, and physical activity during pregnancy have also been shown to predict the bone mass of their offspring at birth.12 However, the relation between maternal vitamin D status during pregnancy and postnatal skeletal growth of their children has not yet been directly assessed. We therefore tested the hypothesis that maternal vitamin D insufficiency during pregnancy has persisting effects on childhood bone mass in a UK population-based cohort of otherwise healthy, term-born children.
Section snippets
Patients and procedures
The study sample was recruited from children born to 596 white women who had participated in a study of maternal nutrition and fetal growth at the Princess Anne Maternity Hospital, Southampton, UK, between 1991 and 1992.13 The mothers were older than 16 years and registered before 17 weeks' gestation at the antenatal clinic. During early (median 15·1 weeks [IQR 13·9–16·4]) and late (32·6 weeks [32·0–33·4]) pregnancy, the women completed a lifestyle questionnaire and were asked their smoking
Results
596 infants were included in the original cohort; 461 were still resident in the local area and were invited to attend. 270 mothers responded and 215 agreed to participate in the bone densitometry component of the follow-up survey. Of these participants, 160 had vitamin D measurements in late pregnancy and their children had both whole-body and lumbar-spine measurements recorded. Women who took part in the follow-up study had similar characteristics in most aspects to those in the remainder of
Discussion
Our results suggest that maternal vitamin D insufficiency (or deficiency) during late pregnancy is associated with a deficit in bone-mineral accrual in their children that persists to age 9 years. The deficit manifests as a reduction in both bone size and BMC without effects on childhood height or lean mass. The study also shows that the estimated concentration of ionised calcium of umbilical-venous blood is correlated with whole-body BMC of the child at age 9 years; this association can be
References (34)
- 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) - et al.
Prenatal and childhood influences on osteoporosis
Best Pract Res Clin Endocrinol Metab
(2002) - et al.
Redefining vitamin D insufficiency
Lancet
(1998) - et al.
Uncritical use of bone mineral density in absorptiometry may lead to size-related artefacts in the identification of bone mineral determinants
Am J Clin Nutr
(1994) Lower peak bone mass and its decline
Baillieres Best Pract Res Clin Endocrinol Metab
(2000)- et al.
Maternal protein deficiency affects mesenchymal stem cell activity in the developing offspring
Bone
(2003) - et al.
Neonatal factors predicting childhood height in preterm infants: evidence for a persisting effect of early metabolic bone disease?
J Pediatr
(2000) - et al.
High prevalence of hypovitaminosis D among free-living postmenopausal women referred to an osteoporosis outpatient clinic in northern Italy for initial screening
Osteoporosis Int
(1999) - et al.
Occult vitamin D deficiency in postmenopausal US women with acute hip fracture
JAMA
(1999) - et al.
Hip fracture in elderly men: the importance of subclinical vitamin D deficiency and hypogonadism
Med J Aust
(1998)
Vitamin D3 and calcium to prevent hip fractures in the elderly women
N Engl J Med
Vitamin D supplementation during infancy is associated with higher bone mineral mass in prepubertal girls
J Clin Endocrinol Metab
Childhood growth, physical activity, and peak bone mass in women
J Bone Miner Res
Intrauterine programming of adult body composition
J Clin Endocrinol Metab
Growth in infancy and bone mass in later life
Ann Rheum Dis
Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study
Osteoporosis Int
Neonatal bone mass: influence of parental birthweight, maternal smoking, body composition, and activity during pregnancy
J Bone Miner Res
Cited by (688)
Molecular pathways in placental-fetal development and disruption
2024, Molecular and Cellular EndocrinologyMaternal vitamin D intakes during pregnancy and child health outcome
2023, Journal of Steroid Biochemistry and Molecular BiologyThe national health program for vitamin D supplementation in a developing country
2023, Clinical Nutrition ESPENDisorders of Neonatal Mineral Metabolism and Metabolic Bone Disease
2023, Principles of NeonatologyThe role of vitamin D physiology in regulating calcium and bone metabolism in mother and child
2023, Feldman and Pike's Vitamin D: Volume One: Biochemistry, Physiology and Diagnostics
- ‡
Listed at end of report