Elsevier

The Lancet

Volume 367, Issue 9504, 7–13 January 2006, Pages 36-43
The Lancet

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

https://doi.org/10.1016/S0140-6736(06)67922-1Get rights and content

Summary

Background

Vitamin D insufficiency is common in women of childbearing age and increasing evidence suggests that the risk of osteoporotic fracture in adulthood could be determined partly by environmental factors during intrauterine and early postnatal life. We investigated the effect of maternal vitamin D status during pregnancy on childhood skeletal growth.

Methods

In a longitudinal study, we studied 198 children born in 1991–92 in a hospital in Southampton, UK; the body build, nutrition, and vitamin D status of their mothers had been characterised during pregnancy. The children were followed up at age 9 years to relate these maternal characteristics to their body size and bone mass.

Findings

49 (31%) mothers had insufficient and 28 (18%) had deficient circulating concentrations of 25(OH)-vitamin D during late pregnancy. Reduced concentration of 25(OH)-vitamin D in mothers during late pregnancy was associated with reduced whole-body (r=0·21, p=0·0088) and lumbar-spine (r=0·17, p=0·03) bone-mineral content in children at age 9 years. Both the estimated exposure to ultraviolet B radiation during late pregnancy and the maternal use of vitamin D supplements predicted maternal 25(OH)-vitamin D concentration (p<0·0001 and p=0·0110, respectively) and childhood bone mass (p=0·0267). Reduced concentration of umbilical-venous calcium also predicted reduced childhood bone mass (p=0·0286).

Interpretation

Maternal vitamin D insufficiency is common during pregnancy and is associated with reduced bone-mineral accrual in the offspring during childhood; this association is mediated partly through the concentration of umbilical venous calcium. Vitamin D supplementation of pregnant women, especially during winter months, could lead to longlasting reductions in the risk of osteoporotic fracture in their offspring.

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)

  • MC Chapuy et al.

    Vitamin D3 and calcium to prevent hip fractures in the elderly women

    N Engl J Med

    (1992)
  • SA Zamora et al.

    Vitamin D supplementation during infancy is associated with higher bone mineral mass in prepubertal girls

    J Clin Endocrinol Metab

    (1999)
  • C Cooper et al.

    Childhood growth, physical activity, and peak bone mass in women

    J Bone Miner Res

    (1995)
  • CR Gale et al.

    Intrauterine programming of adult body composition

    J Clin Endocrinol Metab

    (2001)
  • C Cooper et al.

    Growth in infancy and bone mass in later life

    Ann Rheum Dis

    (1997)
  • C Cooper et al.

    Maternal height, childhood growth and risk of hip fracture in later life: a longitudinal study

    Osteoporosis Int

    (2001)
  • K Godfrey et al.

    Neonatal bone mass: influence of parental birthweight, maternal smoking, body composition, and activity during pregnancy

    J Bone Miner Res

    (2001)
  • Cited by (688)

    • Maternal vitamin D intakes during pregnancy and child health outcome

      2023, Journal of Steroid Biochemistry and Molecular Biology
    • The 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
    View all citing articles on Scopus

    Listed at end of report

    View full text