Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age. A possible preventive effect of low-dose fish oil on early delivery and pre-eclampsia: indications from a 50-year-old controlled trial. Vitamin D Status of HIV-Infected Women and Its Association with HIV Disease Progression, Anemia, and Mortality Effect of calcium and vitamin D supplementation on toxaemia of pregnancy. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. Effect of vitamin D supplementation during pregnancy on foetal growth. Maternal vitamin D status during pregnancy and child outcomes Vitamin D3 induces expression of human cathelicidin antimicrobial peptide 18 in newborns Vitamin D requirements during lactation: high-dose maternal supplementation as therapy to prevent hypovitaminosis D for both the mother and the nursing infant. Vitamin D supplements in pregnant Asian women: effects on calcium status and fetal growth. Maternal plasma 25-hydroxyvitamin D concentration and birthweight, growth and bone mineral accretion of Gambian infants Effects of vitamin D supplementation to children diagnosed with pneumonia in Kabul: a randomised controlled trial. High-dose vitamin D supplements are not associated with linear growth in a large Finnish cohort. The association of maternal diet and dietary supplement intake in pregnant New Zealand women with infant birthweight Vitamin D Supplementation in Pregnancy: A Controlled Trial of Two Methods A prospective study of micronutrient status in adolescent pregnancy. VITAMIN D SUPPLEMENTS ENHANCE WEIGHT GAIN AND NUTRITIONAL STATUS IN PREGNANT ASIANS Diet during pregnancy and risk of preeclampsia or gestational hypertension. Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Intrauterine vitamin D nutrition and postnatal growth in Asian infants.
BACKGROUND Vitamin D deficiency and asthma are common at higher latitudes . Although vitamin D has important immunologic effects , its relation with asthma is unknown . OBJECTIVE We hypothesized that a higher maternal intake of vitamin D during pregnancy is associated with a lower risk of  recurrent wheeze in children at 3 y of age . DESIGN The participants were 1194 mother-child pairs in Project Viva-a prospect i ve prebirth cohort study in Massachusetts . We assessed the maternal intake of vitamin D during pregnancy from a vali date d food-frequency question naire . The primary outcome was recurrent wheeze , ie , a positive asthma predictive index ( > or=2 wheezing attacks among children with a personal diagnosis of eczema or a parental history of asthma ) . RESULTS The mean ( + /-SD ) total vitamin D intake during pregnancy was 548 + /- 167 IU/d . By age 3 y , 186 children ( 16 % ) had recurrent wheeze . Compared with mothers in the lowest quartile of daily intake ( median : 356 IU ) , those in the highest quartile ( 724 IU ) had a lower risk of having a child with recurrent wheeze [ odds ratio ( OR ) : 0.39 ; 95 % CI : 0.25 , 0.62 ; P for trend < 0.001 ] . A 100-IU increase in vitamin D intake was associated with lower risk ( OR : 0.81 ; 95 % CI : 0.74 , 0.89 ) , regardless of whether vitamin D was from the diet ( OR : 0.81 ; 95 % CI : 0.69 , 0.96 ) or supplements ( OR : 0.82 ; 95 % CI : 0.73 , 0.92 ) . Adjustment for 12 potential confounders , including maternal intake of other dietary factors , did not change the results . CONCLUSION In the northeastern United States , a higher maternal intake of vitamin D during pregnancy may decrease the risk of recurrent wheeze in early childhood A preventive effect of dietary marine n-3 fatty acids on  early delivery  and toxaemia has recently been hypothesized . In only one published controlled trial fish oil has been given to pregnant women , namely in that conducted during 1938 - 9 in London by the People 's League of Health with a dietary supplement containing vitamins , minerals , and halibut liver oil . Although it was of high quality and its findings are hitherto unexplained , neglect and misinterpretation of the trial seem to occur commonly in review s. Of the 5644 women who were enrolled the 622 withdrawals were independent of treatment . Alternate allocation to treatment was used , producing two groups that were well balanced as to age and parity . The supplement was given from about week 20 . The control group did not receive any supplement . Reductions of 20.4 % ( 95 % confidence interval 9 - 30 % , P = 0.00083 ) and 31.5 % ( 95 % confidence interval 11 - 47 % , P = 0.0047 ) were seen in odds of delivering before 40 weeks of gestation and pre-eclampsia respectively . No significant effects were seen on perinatal mortality , average birth weight , deliveries after 40 weeks , hypertension in the absence of oedema and proteinuria , duration of labour , sepsis or breast-feeding occurrence . Later controlled trials with vitamins or minerals given in the same amounts as in this trial have largely failed to show convincing effects as seen here . A controlled trial assessing the isolated effects of fish oil in pregnancy is warranted Background Vitamin D has a potential role in slowing HIV disease progression and preventing mortality based on its extensive involvement in the immune system ; however , this relationship has not been examined in large studies or in re source -limited setting s. Methodology /Principal Findings Vitamin D levels were assessed in 884 HIV-infected pregnant women at enrollment in a trial of multivitamin supplementation ( not including vitamin D ) in Tanzania . Women were followed up for a median of 69.5 months , and information on hemoglobin levels , HIV disease progression , and mortality was recorded . Proportional hazard models and generalized estimating equations were used to assess the relationship of these outcomes with vitamin D status . Conclusions / Significance Low vitamin D status ( serum 25-hydroxyvitamin D<32ng/mL ) was significantly associated with progression to WHO HIV disease stage III or greater in multivariate models ( incidence rate ratio [ RR ] : 1.25 ; 95 % confidence intervals [ CI ] : 1.05 , 1.50 ) . No significant relationship was observed between vitamin D status and T-cell counts during follow-up . Women with low vitamin D status had 46 % higher risk of developing severe anemia during follow-up , compared to women with adequate vitamin D levels ( RR : 1.46 ; 95 % CI : 1.09 , 1.96 ) . Women in the highest vitamin D quintile had a 42 % lower risk of all-cause mortality , compared to the lowest quintile ( RR : 0.58 ; 95 % CI : 0.40 , 0.84 ) . Vitamin D status had a protective association with HIV disease progression , all-cause mortality , and development of anemia during follow-up in HIV-infected women . If confirmed in r and omized trials , vitamin D supplementation could represent a simple and inexpensive method to prolonging the time to initiation of antiretroviral therapy in HIV-infected patients , particularly in re source -limited setting To study the effect of calcium and vitamin D supplementation on the incidence of toxaemia of pregnancy , 200 r and omly selected pregnant women ( supplemented group ) , were put on calcium ( 375 mg/day ) and vitamin D ( 1,200 IU/day ) supplements at 20 - 24 weeks of pregnancy onwards . Another 200 pregnant women constituted the non-supplemented group . At 32 and 36 weeks of pregnancy the systolic and diastolic blood pressure of non-toxemic women was significantly lower in the supplemented group than in the non-supplemented group . However , the incidence of toxaemia in the supplemented group ( 6 % ) was not significantly different from that in the non-supplemented group ( 9 % ) BACKGROUND The cholecalciferol inputs required to achieve or maintain any given serum 25-hydroxycholecalciferol concentration are not known , particularly within ranges comparable to the probable physiologic supply of the vitamin . OBJECTIVES The objectives were to establish the quantitative relation between steady state cholecalciferol input and the result ing serum 25-hydroxycholecalciferol concentration and to estimate the proportion of the daily requirement during winter that is met by cholecalciferol reserves in body tissue stores . DESIGN Cholecalciferol was administered daily in controlled oral doses labeled at 0 , 25 , 125 , and 250 micro g cholecalciferol for approximately 20 wk during the winter to 67 men living in Omaha ( 41.2 degrees N latitude ) . The time course of serum 25-hydroxycholecalciferol concentration was measured at intervals over the course of treatment . RESULTS From a mean baseline value of 70.3 nmol/L , equilibrium concentrations of serum 25-hydroxycholecalciferol changed during the winter months in direct proportion to the dose , with a slope of approximately 0.70 nmol/L for each additional 1 micro g cholecalciferol input . The calculated oral input required to sustain the serum 25-hydroxycholecalciferol concentration present before the study ( ie , in the autumn ) was 12.5 micro g ( 500 IU)/d , whereas the total amount from all sources ( supplement , food , tissue stores ) needed to sustain the starting 25-hydroxycholecalciferol concentration was estimated at approximately 96 micro g ( approximately 3800 IU)/d . By difference , the tissue stores provided approximately 78 - 82 micro g/d . CONCLUSIONS Healthy men seem to use 3000 - 5000 IU cholecalciferol/d , apparently meeting > 80 % of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months . Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin The need , safety , and effectiveness of vitamin D supplementation during pregnancy remain controversial . In this r and omized , controlled trial , women with a singleton pregnancy at 12 to 16 weeks ' gestation received 400 , 2000 , or 4000 IU of vitamin D(3 ) per day until delivery . The primary outcome was maternal/neonatal circulating 25-hydroxyvitamin D [ 25(OH)D ] concentration at delivery , with secondary outcomes of a 25(OH)D concentration of 80 nmol/L or greater achieved and the 25(OH)D concentration required to achieve maximal 1,25-dihydroxyvitamin D(3 ) [ 1,25(OH)(2)D(3 ) ] production . Of the 494 women enrolled , 350 women continued until delivery : Mean 25(OH)D concentrations by group at delivery and 1 month before delivery were significantly different ( p < 0.0001 ) , and the percent who achieved sufficiency was significantly different by group , greatest in 4000-IU group ( p < 0.0001 ) . The relative risk ( RR ) for achieving a concentration of 80 nmol/L or greater within 1 month of delivery was significantly different between the 2000- and the 400-IU groups ( RR = 1.52 , 95 % CI 1.24 - 1.86 ) , the 4000- and the 400-IU groups ( RR = 1.60 , 95 % CI 1.32 - 1.95 ) but not between the 4000- and . 2000-IU groups ( RR = 1.06 , 95 % CI 0.93 - 1.19 ) . Circulating 25(OH)D had a direct influence on circulating 1,25(OH)(2)D(3 ) concentrations throughout pregnancy ( p < 0.0001 ) , with maximal production of 1,25(OH)(2)D(3 ) in all strata in the 4000-IU group . There were no differences between groups on any safety measure . Not a single adverse event was attributed to vitamin D supplementation or circulating 25(OH)D levels . It is concluded that vitamin D supplementation of 4000 IU/d for pregnant women is safe and most effective in achieving sufficiency in all women and their neonates regardless of race , whereas the current estimated average requirement is comparatively ineffective at achieving adequate circulating 25(OH)D concentrations , especially in African Americans Chez 100 femmes enceintes , l'administration de 2 doses de 600000 UI de vitamine D du 3eme trimestre a entraine une amelioration significative des parametres biochimiques maternels et du serum du cordon , du poids de naissance et de certaines autres mesures anthropometriques du nouveau-ne comparativement a 100 femmes enceintes ne recevant pas de Objective : To investigate whether exposure to high maternal concentrations of 25(OH)-vitamin D in pregnancy poses any risk to the child . Design : Prospect i ve study . Setting : Princess Anne Maternity Hospital , Southampton , UK.Subjects : A group of 596 pregnant women were recruited . A total of 466 ( 78 % ) children were examined at birth , 440 ( 74 % ) at age 9 months and 178 ( 30 % ) at age 9 years . Methods :  Maternal 25 (OH)-vitamin D concentrations  were measured in late pregnancy . Anthropometry of the child was recorded at birth , 9 months and 9 years . At 9 months , atopic eczema was assessed . At 9 years , children had an echocardiogram and a dual energy x-ray absorptiometry scan , blood pressure , arterial compliance and carotid intima-media thickness were measured and intelligence and psychological function assessed . Results : There were no associations between maternal 25(OH)-vitamin D concentrations and the child 's body size or measures of the child 's intelligence , psychological health or cardiovascular system . Children whose mothers had a 25(OH)-vitamin D concentration in pregnancy > 75 nmol/l had an increased risk of eczema on examination at 9 months ( OR 3.26 , 95 % CI 1.15–9.29 , P=0.025 ) and asthma at age 9 years ( OR 5.40 , 95 % CI , 1.09–26.65 , P=0.038 ) compared to children whose mothers had a concentration of < 30 nmol/l . Conclusion : Exposure to maternal concentrations of 25(OH)-vitamin D in pregnancy in excess of 75 nmol/l does not appear to influence the child 's intelligence , psychological health or cardiovascular system ; there could be an increased risk of atopic disorders , but this needs confirmation in other studies .Sponsorship : The study was supported by the Medical Research Council and WellChild ( previously known as Children Nationwide ) Bactericidal activities of neutrophils occur by two distinctive mechanisms that are oxygen-dependent and -independent . Human cathelicidin antimicrobial peptide 18 ( hCAP18 ) , also known as LL-37/FALL-39 , is a neutrophil-specific granule protein . We compared the content of hCAP18 and neutrophil gelatinase-associated lipocalin ( NGAL ) , another neutrophil-specific granule protein , in neutrophils of both neonates and adults by flow cytometry . The percentage as well as fluorescence intensity ratio of hCAP18 and NGAL expression in neonate neutrophils were significantly lower than in adults . Expression of hCAP18 in monocytes , however , was not significantly different between neonates and adults . Both hCAP18 and NGAL expression increased in an age-dependent fashion . Plasma concentration of these peptides measured by enzyme-linked immunosorbent assay was not significantly different between neonates and adults . Oral intake of 1α hydroxy vitamin D3 ( 1α(OH)D3 ) in rickets patients for 4 weeks significantly increased hCAP18 expression in neutrophils compared to age-matched healthy controls without 1α(OH)D3 , indicating the potential of vitamin D3 as a regulator of the innate immune response of neonates Scientific data pertaining to vitamin D supplementation during lactation are scarce . The daily recommended intake for vitamin D during lactation has been arbitrarily set at 400 IU/d ( 10 microg/d ) . This recommendation is irrelevant with respect to maintaining the nutritional vitamin D status of mothers and nursing infants , especially among darkly pigmented individuals . Our objective was to examine the effect of high-dose maternal vitamin D2 supplementation on the nutritional vitamin D status  of mothers and nursing infants . Fully lactating women ( n = 18 ) were enrolled at 1 mo after birth to 1 of 2 treatment arms , ie , 1600 IU vitamin D2 and 400 IU vitamin D3 ( prenatal vitamin ) or 3600 IU vitamin D2 and 400 IU vitamin D3 , for a 3-mo study period . High-dose ( 1600 or 3600 IU/d ) vitamin D2 supplementation for a period of 3 mo safely increased circulating 25-hydroxyvitamin D [ 25(OH)D ] concentrations for both groups . The antirachitic activity of milk from mothers receiving 2000 IU/d vitamin D increased by 34.2 IU/L , on average , whereas the activity in the 4000 IU/d group increased by 94.2 IU/L. Nursing infant circulating 25(OH)D2 concentrations reflected maternal intake and the amount contained in the milk . With limited sun exposure , an intake of 400 IU/d vitamin D would not sustain circulating 25(OH)D concentrations and thus would supply only limited amounts of vitamin D to nursing infants in breast milk . A maternal intake of 2000 IU/d vitamin D would elevate circulating 25(OH)D concentrations for both mothers and nursing infants , albeit with limited capacity , especially with respect to nursing infants . A maternal intake of 4000 IU/d could achieve substantial progress toward improving both maternal and neonatal nutritional vitamin D status In a double-blind trial of vitamin D supplements in pregnant Asian women calciferol ( ergocalciferol , 1000 IU/day ) was administered to 59 women and placebo to 67 controls during the last trimester . The two groups had similar distributions of maternal age , height , parity , number of vegetarians , countries of origin , and sex and gestation of the infants . At entry to the trial maternal serum 25-hydroxy vitamin D ( 25-OHD ) concentrations were low in both treatment and control groups and significantly lower in vegetarians than non-vegetarians . Mothers in the treatment group gained weight faster in the last trimester than those in the control group , and at term they and their infants all had adequate plasma 25-OHD concentrations , Mothers and infants in the control group , however , had low plasma concentrations of 25-OHD and calcium and raised plasma alkaline phosphatase ( bone isoenzyme ) activity . Five of these infants developed symptomatic hypocalcaemia . Almost twice as many infants in the control group were small for gestational age ( 29 % v 15 % ) , but there were no significant differences between the two groups of infants in antropometric measurements . Infants in the control group , however , had larger fontanelles , suggesting impaired ossification of the skull . Because of the benefits to mothers and infants in the treatment group and the absence of side effects , vitamin D supplements should be given to all pregnant Asian women in the United Kingdom Maternal vitamin D deficiency during pregnancy is a recognized risk factor for rickets and osteomalacia in infancy ( 1 ) . The circulating plasma concentration of 25-hydroxyvitamin D ( 25OHD ) , a long-lived metabolite of vitamin D , is used to judge vitamin D status ; values below 25 nmol/L are associated with an increased risk of rickets and osteomalacia ( 1 ) . There is evidence that a low maternal plasma 25OHD in pregnancy may influence the growth and bone mineral accrual of the offspring during foetal life , infancy and childhood . Positive associations have been reported between maternal  vitamin D  status in pregnancy and birthweight , birth length , length at 1 year and bone mineral accretion at 9 years ( 2–6 ) , although evidence is conflicting ( 7,8 ) . These relationships have been observed at concentrations of 25OHD higher than those associated with rickets and osteomalacia , and there are calls to raise the accepted lower threshold of vitamin D sufficiency for pregnant women , most recently to 80 nmol/L ( 9 ) . On a population basis , plasma 25OHD concentrations above 80 nmol/L are relatively uncommon in countries at temperate latitudes but are more common among people living in the tropics who have abundant skin sunshine exposure ( 10 ) . To contribute to the debate on the definition of vitamin D sufficiency in pregnancy , we have investigated the influence of maternal plasma 25OHD concentration on foetal and infant growth in a rural area of The Gambia , West Africa ( 13 ° N ) . In this region , there is tropical sunshine all year , the women are farmers who work out-of-doors for much of each day , and local female dress does not restrict regular sunshine exposure to the face , neck , shoulders , arms and feet , especially during farm work and gardening . The study was a secondary analysis of biochemical , anthropometric and bone data from a subset of 125 women and infants collected during a calcium supplementation study of blood pressure in pregnant Gambian women ( International Trial Registry : IS RCT N96502494 ) . No significant benefits for foetal and infant growth of maternal calcium supplementation were identified despite the low customary calcium intake in The Gambia ( 11 ) . The protocol , methods , maternal characteristics and infant data from the detailed study have been published ( 11 ) . Briefly , women from the rural villages of Keneba and M and uar , West Kiang , The Gambia were recruited at 20 weeks of pregnancy ( P20 ) and r and omized to a daily calcium supplement or a matching placebo tablet until parturition ( 1500 mg Ca as calcium carbonate and microcellulose-lactose , respectively ; Nycomed Pharma AS , Asker , Norway ) . Fasting , early morning blood was collected and anthropometry performed at P20 and 36 weeks of pregnancy ( P36 ) . The mean ( ± SD ) age , weight , height and dietary calcium intake of the women at P20 were 27.4 ± 7.5 years , 56.3 ± 6.7 kg , 1.61 ± 0.05 m and 356 ± 190 mg/day , respectively . The median parity ( range ) was 3 ( 0–10 ) . Infant birthweight was measured within 24 h of delivery . Weight , crown-heel length and head circumference were measured at 2 , 13 and 52 weeks postpartum . In addition , infant bone mineral content ( BMC ) , bone mineral density ( BMD ) and bone width ( BW ) or bone area ( BA ) , were measured by single photon absorptiometry of the midshaft radius ( Lunar SP2 , Lunar Corporation , Madison , WI , USA ) and , for a subset ( n = 44 , 47 and 52 at 2 , 13 and 52 weeks , respectively ) , by whole-body dual-energy X-ray absorptiometry ( Lunar DPX+ , software version 4.7b , Lunar Corporation ) . Plasma 25OHD was measured a using radioimmunometric assay ( Diasorin Ltd , Wokingham , Berks , UK ) , with assay performance monitored through the Vitamin D External Quality Assessment Scheme ( DEQAS ; Endocrine/Oncology Laboratory , Charing Cross Hospital , London , UK ) . The intra- and inter-assay coefficients of variation were 4 % and 100 ) ; possible trends in the data with p = 0.01–0.1 were noted . The analysis was conducted on 123 mother – infant pairs ; blood sample s from two subjects were not available . Mean ± SD 25OHD ( range ) was : P20 = 103 ± 25 ( 53–167 ) nmol/L ; P36 = 111 ± 27 ( 51–189 ) nmol/L. No subject had a 25OHD value < 50 nmol/L , 20 % and 16 % had 25OHD < 80 nmol/L , at P20 and P36 , respectively . There was a high degree of within-subject consistency in 25OHD at P20 and P36 ( 25OHDP36 = 33.2 + [ 0.79 ± 0.07] × 25OHDP20 , p ≤ 0.001 , R2 adjusted 51.5 % , n = 121 ) ; 11 % of women had 25OHD < 80 nmol/L at both P20 and P36 . The mean birthweight of the infants was 2.99 ± 0.36 kg . The infant anthropometric and bone measures during the first year are given in Table 1 . No significant relationships or trends in the data were observed between maternal 25OHD concentration using the values at P20 , P36 or the mean of the two and any of the following infant measures : birthweight , infant weight , length , head circumference , BMC , BW ( or BA ) , BMD and size-adjusted BMC of the midshaft radius and whole body at any time postpartum . This is illustrated in Figure 1 for birthweight as a function of maternal 25OHD concentration at P20 . Comparing the results for mothers with 25OHD above and below 80 nmol/L did not alter this finding . Table 1 Anthropometric and bone measures  of Gambian infants Figure 1 Lack of a significant relationship between infant birthweight and maternal vitamin D status at 20 weeks of pregnancy ( p = 0.8 ) . Multiple regression model included season , maternal height , weight , weight gain , supplement group and sex of the infant . No significant interaction between supplement group and maternal 25OHD concentration was observed for any infant variable . Trends in the data were observed in a few instances for a supplement group × 25OHD interaction among the bone measures but no consistent picture emerged and they were considered to have arisen by chance . We conclude that there is no evidence for an influence of vitamin D status during pregnancy on infant growth and bone mineral accrual in the conditions prevailing in The Gambia . The children in this study , as is common in this region of The Gambia ( 13 ) , were born small , grew well for the first months of life but experienced growth faltering during later infancy compared to Western children ( 11,14 ) , as demonstrated by their weight and length SDS . The 25OHD concentrations of the women were > 50 nmol/L in the second half of pregnancy , and no distinction could be drawn in infant outcomes between mothers with concentrations above or below 80 nmol/L. Thus , our study suggests that , for women with regular , adventitious UVB sunshine exposure and in situations where foetal and infant growth may be constrained by multiple factors , there would be no benefit for foetal and infant growth or bone mineral accrual in aim ing to increase the vitamin D status of individual mothers during pregnancy above 50 or 80 OBJECTIVES To determine whether ( i ) supplementation of oral 100,000 iu of vitamin D(3 ) ( cholecalciferol ) along with antibiotics will reduce the duration of illness in children with pneumonia ; ( ii ) supplementation will reduce the risk of repeat episodes . METHODS Double-blind individually r and omised placebo-controlled trial in an inner-city hospital in Kabul , of 453 children aged 1 - 36 months , diagnosed with non-severe or severe pneumonia at the outpatient clinic . Children with rickets , other concurrent severe diseases , very severe pneumonia or wheeze , were excluded . Children were given vitamin D(3 ) or placebo drops additional to routine pneumonia treatment . RESULTS Two hundred and twenty-four children received vitamin D(3 ; ) and 229 received placebo .  There was no significant difference in the mean number of days to recovery between the vitamin D(3 ) ( 4.74 days ; SD 2.22 ) and placebo arms ( 4.98 days ; SD 2.89 ; P = 0.17 ) . The risk of a repeat episode of pneumonia within 90 days of supplementation was lower in the intervention ( 92/204 ; 45 % ) than the placebo group [ 122/211 ; ( 58 % ; relative risk 0.78 ; 95 % CI 0.64 , 0.94 ; P = 0.01 ] . Children in the vitamin D(3 ) group survived longer without experiencing a repeat episode ( 72 days vs. 59 days ; HR 0.71 ; 95 % CI 0.53 - 0.95 ; P = 0.02 ) . CONCLUSION A single high-dose oral vitamin D(3 ) supplementation to young children along with antibiotic treatment for pneumonia could reduce the occurrence of repeat episodes of pneumonia High vitamin D intake in childhood has been suggested to have an adverse influence on linear growth . In Finl and , in the mid-1960s the official recommendation for infant vitamin D supplementation was 2000 IU/d ( 50 μg/d ) . We investigated whether high-dose vitamin D supplementation in infancy was associated with subsequent growth in height . We used data from a prospect i ve population -based birth cohort study including all children due to be born in the 2 northernmost provinces in Finl and in 1966 ( 12,058 live-births , coverage 96 % ) . Information on each participant 's  height was collected at birth and ages 1 , 14 , and 31 y , as were possible confounding factors ( data for analyses available from 10,060 singletons ) . Information on the frequency and dose of vitamin D supplementation was collected in 1967 when participants were 1 y of age . A weak association was found between frequency of vitamin D supplementation with greater height at age 1 y ( P = 0.005 ) , which was explained by birth characteristics and maternal and social factors ( adjusted P = 0.34 ) . Neither frequency nor dose of vitamin D supplementation was associated with height at 14 or 31 y ( P > 0.13 ) . To conclude , contrary to proposed evidence suggesting that vitamin D has a negative influence on growth rate at a dosage of ~2000 IU/d , supplementation at this level in the Northern Finl and Birth Cohort was not associated with reduced height at any age studied Objective : To investigate the association of infant birthweight  with maternal diet and supplement intake . Subjects/ Methods : Prospect i ve cohort study of 504 European and Polynesian urban and rural pregnant volunteers recruited from northern New Zeal and clinics . Subjects were visited in months 4 ( mth4 ) and 7 ( mth7 ) of pregnancy when height , weight and skinfolds were measured , question naires to determine personal details administered , and diet assessed by a 24-hour recall and 3-day food record . Results : After adjusting for confounders nutrients accounted for up to 5.0 % of the total variance in birthweight . Ethnicity was not a significant confounder . A quadratic relationship existed between birthweight and % total energy ( % TE ) from carbohydrate , fat and protein , most significantly with carbohydrate energy ( P=0.002 ) . Birthweight was greatest ( ∼3600 g ) when carbohydrate % TE was 48 % , fat 35 % and protein 17 % . Birthweight was reduced with high β-carotene intakes ( mth4 , P=0.009 ) and with both high retinol and β-carotene intakes in mth4 and 7 ( average ) . Birthweight was positively associated with increasing pantothenic acid/biotin ratios ( P=0.011 ) , magnesium ( P=0.000 ) and vitamin D ( P=0.015 ) intakes in mth4 ; with biotin ( P=0.040 ) and B12 intakes above the RDI ( P=0.006 ) in mth7 ; and with pantothenic acid intake in mth4&7 ( P=0.002 ) . Dietary supplement usage was associated with increased birthweight , most significantly iron supplementation ( P=0.006 ) . Conclusion : Birthweight was associated with the % TE from carbohydrate , fat and protein , and with β-carotene , retinol , vitamins D and B12 , pantothenic acid , biotin and magnesium intakes and iron supplementation . More research may be required on some dietary recommendations for pregnancy & NA ; A r and omized study was conducted to evaluate the effects of single‐dose and daily vitamin D supplementation in pregnant women during the last trimester of a winter pregnancy in the Northwest of France . The women were divided into three r and omized groups : one ( N = 21 ) was given a vitamin D2 supplement of 1000 IU/day during the last three months of pregnancy , one ( N = 27 ) was given a single oral dose of 5 mg at the seventh month of pregnancy , and one ( N = 29 ) acted as a control . Venous plasma sample s were obtained at delivery from the women and from cord blood , and levels of calcium , 25‐OHD , and 1,25(OH)2D were determined . No significant difference in plasma calcium concentration was found among the three groups , but within each group plasma calcium concentrations were higher in the cord sample s than in the respective maternal sample s. The levels of the two metabolites measured were consistently lower in the cord sample s than in the respective maternal sample s. Cord 25‐OHD concentrations correlated with those of maternal plasma . No significant modification of maternal calciuria or of the birth weight of term infants was observed . 25‐OHD concentrations were greater in maternal and cord plasma from treated mothers , but only a slight difference was observed between the supplemented groups . 1,25(OH)2D concentrations were not significantly different in the three groups . A single 5‐mg dose of vitamin D given orally at the seventh month of pregnancy provides effective prophylaxis in the authors ’ region . ( Obstet Gynecol 68:300 , 1986 BACKGROUND Adolescents are more likely than adults to consume energy-dense , micronutrient-poor diets and to experience adverse pregnancy outcomes . OBJECTIVES The objectives were to assess micronutrient intake  and  blood biomarkers  prospect ively in pregnant adolescents recruited to the About Teenage Eating ( ATE ) Study and to determine associations with pregnancy outcome . DESIGN Pregnant adolescents ( n = 500 ) were recruited from 2 UK inner city population s.  Dietary intake was assessed with three 24-h dietary recalls , and micronutrient status was assessed by measurement of third trimester blood biomarkers . Pregnancy outcomes included small-for-gestational age ( SGA ) birth and preterm delivery . RESULTS Median iron and folate intakes were lower than UK and US recommended amounts . Folate and vitamin B-12 status were lower in smokers , despite no differences in dietary intake . Serum folate was < 7.0 nmol/L in 12 % of subjects , and serum total homocysteine ( tHcy ) was elevated ( > 10 micromol/L ) in 20 % of subjects . Fifty-two percent of the subjects had iron deficiency anemia , and 30 % had serum 25-hydroxyvitamin D concentrations < 25 nmol/L. The incidence of SGA birth was higher in subjects with poorer folate status ( red blood cell folate , P = 0.003 ; serum folate , P = 0.02 ; tHcy , P = 0.01 ; simple regression ) and those with low folate intakes , regardless of the inclusion ( P = 0.021 ) or exclusion ( P = 0.049 ) of intake from supplements ( simple regression ) . Adjustment for confounding variables confirmed the independence of these associations . The risk of SGA birth was also higher in subjects with low food iron intake ( P = 0.049 ) , but not when intake included iron from supplements ( P = 0.21 ) . The risk of SGA birth was lower in subjects with iron deficiency anemia ( P = 0.002 ) . CONCLUSION Poor micronutrient intake and status increase the risk of SGA births in pregnant adolescents In a double blind trial of supplementary vitamin D ( 1000 iu daily ) administered in the last trimester of pregnancy to Asian women living in London , supplemented mothers gained weight faster ( 63.3 g/day ) than those in the control group ( 46.4 g/day ) , and at term had significantly higher plasma levels of retinol binding protein and thyroid binding prealbumin indicating better protein‐calorie nutrition . Maternal weight gain correlated with postpartum levels of both retinol binding protein and thyroid binding prealbumin . Almost twice as many infants in the unsupplemented group weighed under 2500 g at birth , and had significantly lower retinol binding protein levels than infants of supplemented mothers . The nutritional benefits of supplementation provide further support for the routine administration of vitamin D to all British Asians during pregnancy PURPOSE We sought to examine associations of first-trimester intake of calcium , n-3 and n-6 fatty acids , trans fatty acids , magnesium , folate , and vitamins C , D , and E with  preeclampsia ( PE ) and gestational hypertension ( GH ) . METHODS We studied associations of diet with PE or GH among 1718 women in the prospect i ve cohort study Project Viva , using logistic regression and adjusting for maternal age , prepregnancy body mass index , first trimester systolic blood pressure , race/ethnicity , education , and parity . We assessed first-trimester diet using a vali date d semiquantitative food frequency question naire . RESULTS A total of 59 ( 3 % ) women developed PE , and 119 developed ( 7 % ) GH . We found a somewhat-lower risk of PE associated with higher intake of the elongated n-3 fatty acids docosahexaenoic and eicosapentaenoic acids ( odds ratio [ OR ] 0.84 , 95 % confidence interval [ 95 % CI ] : 0.69 - 1.03 per 100 mg/day ) , fish ( OR 0.91 , 95 % CI 0.75 - 1.09 per serving/day ) , and the ratio of docosahexaenoic + eicosapentaenoic to arachadonic acid ( OR 0.82 , 95 % CI 0.66 - 1.01 ) . We did not observe a lower risk of GH or PE with a greater intake of calcium ; vitamin C , D , or E ; milk ; magnesium ; folate ; or with lower intake of n-6 or trans fatty acids . CONCLUSIONS Our results support a potential benefit for elongated n-3 fatty acids in preventing preeclampsia Osteoporotic fractures , falls and obesity are major health problems in developed nations . Evidence suggests that there are antenatal factors predisposing to these conditions . Data are emerging from Australia and elsewhere to suggest that maternal vitamin D status in pregnancy affects intrauterine skeletal mineralisation and skeletal growth together with muscle development and adiposity . Given that low levels of vitamin D have been documented in many urbanised population s , including those in countries with abundant sunlight , an important issue for public health is whether maternal vitamin D insufficiency during pregnancy has adverse effects on offspring health . The developing fetus may be exposed to low levels of vitamin D during critical phases of development as a result of maternal hypovitaminosis D. We hypothesise that this may have adverse effects on offspring musculoskeletal health and other aspects of body composition . Further research focused on the implication s of poor gestational vitamin D nutrition is warranted as these developmental effects are likely to have a sustained influence on health during childhood and in adult life . We suggest that there is a clear rationale for r and omised clinical trials to assess the potential benefits and harmful effects of vitamin D supplementation during pregnancy BACKGROUND Vitamin D is a strong immunomodulator and may protect against adverse pregnancy outcomes , mother-to-child transmission ( MTCT ) of  human immunodeficiency virus ( HIV )  , and child mortality . METHODS A total of 884 HIV-infected pregnant women who were participating in a vitamin supplementation trial in Tanzania were monitored to assess pregnancy outcomes and child mortality . The association of these outcomes with maternal vitamin D status at enrollment was examined in an observational analysis . RESULTS No association was observed between maternal vitamin D status and adverse pregnancy outcomes , including low birth weight and preterm birth . In multivariate models , a low maternal vitamin D level ( < 32 ng/mL ) was associated with a 50 % higher risk ( 95 % confidence interval [ CI ] , 2%-120 % ) of MTCT of HIV at 6 weeks , a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks ( 95 % CI , 1.08 - 3.82 ) , and a 46 % higher overall risk of HIV infection ( 95 % CI , 11%-91 % ) . Children born to women with a low vitamin D level had a 61 % higher risk of dying during follow-up ( 95 % CI , 25%-107 % ) . CONCLUSIONS If found to be efficacious in r and omized trials , vitamin D supplementation could prove to be an inexpensive method of reducing the burden of HIV infection and death among children , particularly in re source -limited setting BACKGROUND Vitamin D insufficiency is beginning to be recognized as a public health problem . It is plausible that some portion of the lower Vitamin D levels which characterize minority population s is related to diet . AIMS We examined and described total Vitamin D intake during pregnancy from the mean of three 24-hour recalls plus use of dietary supplements . STUDY DESIGN Prospect i ve cohort . SUBJECTS 2251 low income , minority gravidae from Camden , New Jersey , USA . OUTCOME MEASURES Differences in total Vitamin D intake by maternal ethnicity . BMI and other factors ( age , parity ) and associations of total Vitamin D intake with gestation duration and birth weight adjusted for gestation . RESULTS AND CONCLUSIONS Total Vitamin D intake was significantly lower for minority gravidae ( African American , and Hispanic , mainly Puerto Rican ) , for parous women , and for women with pregravid BMI s consistent with obesity or being overweight . After control for energy , other nutrients , and other potential confounding variables , total intake of Vitamin D was associated with increased infant birth weight ; gravidae below the current adequate intake ( < 5 microg/day or 200 IU ) had infants with significantly lower birth weights ( p<0.05 ) . Additional intake of Vitamin D may be of importance since higher intake is associated with increased birth weight in a population at risk of adverse pregnancy outcomes Reactive arthritis is common during infection with intestinal pathogens , including shigella , salmonella , yersinia , and campylobacter , ' but Cl difficile has not been specifically linked with arthritis to date . Two case reports have described arthritis with antibioticassociated diarrhoea but both were in the " pre-Cl difficile " era.2 The first was a case of migratory polyarthritis after clindamycin with histological pseudomembranous colitis in a 55-year-old man in whom all the large joints and two metacarpophalangeal joints were affected . ' Both the diarrhoea and arthritis settled within six days after treatment with steroids . The second case was a 23-year-old woman with ampicillin-associated colitis and a monoarthritis of the right knee which settled within 14 days with aspirin , the diarrhoea having resolved five days earlier.3 The present case was similar in that the diarrhoea pre date d the arthritis , which improved rapidly after resolution of the diarrhoea . This case , however , documents the presence of faecal Cl difficile and its toxin , now the accepted pathogen in most cases of pseudomembranous colitis and in many cases of nonspecific colitis and diarrhoea after antibiotics . In the absence of other causes for the acute arthritis this case possibly represents a true reactive arthritis to the presence of enteric Cl difficile infection , treatment with oral metronidazole result ing in rapid clearance of toxin and symptomatic
Vitamin D has well-defined classical functions related to calcium metabolism and bone health but also has non-classical effects that may influence other aspects of health .
There has been considerable recent interest in the role of vitamin D on outcomes related to pregnancy and young child health but few efforts have been made to systematic ally consoli date this evidence to inform the research and policy agenda for low-income countries .
A systematic review was undertaken to identify intervention and observational studies of vitamin D supplementation , intake or status ( 25-hydroxy-vitamin D ) during pregnancy on perinatal and infant health outcomes .