Maternal Vitamin D Status and Its Effect on Vitamin D Levels in Early Infancy in a Tertiary Care Centre in Sri Lanka

Abstract

Epidemiologic studies from South Asian countries have reported vitamin D deficiency among all age groups. However, there is very little information on vitamin D levels, especially in the vulnerable populations (pregnant/breast feeding mother and infants) in Sri Lanka. More data on vitamin D status of such populations will be important for policy decisions to be made at a national level. Similarly, it will be valuable for healthcare programs in other countries (e.g., United States, Australia, Europe, and Canada) as Sri Lankans are a fast-growing migrant population to those countries. The purpose of this study was to investigate maternal vitamin D status and its effects on infants in a state sector tertiary care centre in Sri Lanka. This prospective cohort study was conducted on 140 healthy pregnant mothers in the third trimester (mean gestational age 39±1 weeks). Blood was collected for 25(OH)D and parathyroid hormone (PTH). Sun exposure and feeding patterns of the infants were recorded based on maternal reporting. Mean age of the infants at follow-up visit was 36±7 days. Vitamin D (25 (OH)D) deficiency (<25 nmol/L) was observed in 12% pregnant mothers, 5% lactating mothers, and 63% infants. Insufficiency (<50 nmol/L) was found in an additional 51% and 43% in pregnant and lactating mothers and 25% of infants. Mean 25(OH)D was higher in pregnant (46.4±17.5 nmol/L) and lactating (51.9±17.0 nmol/L) mothers than infants (28.1±13.7 nmol/L). Maternal vitamin D level during pregnancy was a significant risk factor (OR: 6.00, 95%CI: 1.522-23.655) for infant deficiency and insufficiency. Sun exposure of infants showed a significant positive correlation with vitamin D level (OR: 3.23, 95%CI: 1.19-8.68). In conclusion, the presence of Vitamin D deficiency/insufficiency is higher in infants compared to pregnant/lactating mothers. Low maternal 25(OH)D during pregnancy was a risk factor for deficiency in infants. Although majority of lactating mothers had sufficient vitamin D, most of their exclusively breastfed offspring were deficient.

Vitamin D Deficiency Rickets and COVID-19 Pandemic

“…Vitamin D supplementation is not routinely carried out in Sri Lanka despite reports of vitamin D deficiency among various age groups. A single-centre, hospital-based study in the Colombo district had reported vitamin D deficiency (<20 ng/ml) without clinical features of rickets or osteomalacia among pregnant (62.9%) and lactating women (49.5%) and in infants (88.6%) [11]. A recent study conducted in a community setting in the Colombo district among pregnant women in their third trimester Case Reports in Pediatrics (unpublished) showed 62.1% of subclinical deficiency.…”

Evaluation of the prevalence of vitamin d deficiency in pregnant women and its correlation with neonatal vitamin D levels

“…They further suggested the dose of 4000 IU per day, which is equal to the amount of vitamin D obtained by sun exposure. Low levels of maternal vitamin D have known to be a risk factor of Vitamin D deficiency/ insufficiency in infants and breastfeeding children [19].…”

Parathyroid hormone in Sri Lankan pregnant women: Vitamin D and other determinants

“…The registered pregnant women are followed up from the first trimester and referred to the local hospital for delivery [15]. The sample size was calculated, taking a ±5% margin of error, P of 63.4 [16], and a confidence level of 95%.…”