Shedding Light on Vitamin D Status and Its Complexities during Pregnancy, Infancy and Childhood: An Australian Perspective

Abstract

Ensuring that the entire Australian population is Vitamin D sufficient is challenging, given the wide range of latitudes spanned by the country, its multicultural population and highly urbanised lifestyle of the majority of its population. Specific issues related to the unique aspects of vitamin D metabolism during pregnancy and infancy further complicate how best to develop a universally safe and effective public health policy to ensure vitamin D adequacy for all. Furthermore, as Australia is considered a “sunny country”, it does not yet have a national vitamin D food supplementation policy. Rickets remains very uncommon in Australian infants and children, however it has been recognised for decades that infants of newly arrived immigrants remain particularly at risk. Yet vitamin D deficiency rickets is entirely preventable, with the caveat that when rickets occurs in the absence of preexisting risk factors and/or is poorly responsive to adequate treatment, consideration needs to be given to genetic forms of rickets.

Vitamin D-Binding Protein in Pregnancy and Reproductive Health

“…Immunomodulatory and anti-inflammatory properties of vitamin D have been demonstrated, particularly in conditions of chronic low-grade inflammation such as type 2 diabetes [7] and heart failure [8], as well as in autoimmune diseases including asthma [9]. Vitamin D requirements are increased during pregnancy to adapt to heightened physiological demands in the mother, including driving the formation of the fetal skeleton and maintaining an environment of tolerance to paternal and fetal tissue and their accompanying alloantigens [10,11].…”

Association between variants in vitamin D‐binding protein gene and vitamin D deficiency among pregnant women in china

“…49,50 For example, the vitamin D concentration was lower in some populations with less sunshine due to geographical environment. 51,52 In addition, higher 25(OH)D concentration during the summer compared with lower 25(OH)D concentration during the winter further proves the importance of sun exposure. 53,54 As expected, sunshine duration was strongly associated with (Table S6).…”

“…Studies have proved that there was a significant relationship between the sunshine duration and 25(OH)D concentration 49,50 . For example, the vitamin D concentration was lower in some populations with less sunshine due to geographical environment 51,52 . In addition, higher 25(OH)D concentration during the summer compared with lower 25(OH)D concentration during the winter further proves the importance of sun exposure 53,54 .…”

Comment on Di Marco, N., Kaufman, J., Rodda, C.P. Shedding Light on Vitamin D Status and Its Complexities during Pregnancy, Infancy and Childhood: An Australian Perspective. Int. J. Environ. Res. Public Health 2019, 16 (4), 538, doi:10.3390/ijerph16040538

“…In their report on the roles of vitamin D status during early life development in Australia, Di Marco et al suggest that the use of cod liver oil can no longer be recommended due to its high retinol content (quoted at 4080 micrograms (12,240 IU)/tablespoonful), according to data from the USA (accessed 9 February 2019) [1]; however, most countries sell preparations that have been purified and deodorized, with removal of both toxins and fat-soluble vitamins before vitamin A and D replacement at permissible levels [2] (e.g., containing retinol at 400 micrograms (1200 IU)/capsule (Boots maxi strength cod liver oil) or 800 micrograms (2400 IU)/capsule (Club VITS) in the UK). Commonly used Australian preparations provide reasonable amounts of vitamin A (e.g., 300 micrograms (1000 IU)/capsule from Blackmores, or 187.5 micrograms (~560.IU)/capsule) [3].…”