MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Osteoporos Int. 2023 Jul;34(7):1269-1279. doi: 10.1007/s00198-023-06751-5. Epub 2023 Apr 27.
Systematic review and meta-analysis of the effect of moderate- to high-dose vitamin D supplementation in pregnancy on offspring bone mineralisation found a positive effect of vitamin D supplementation on offspring bone mineral density (BMD) at age 4-6 years, with a smaller effect on bone mineral content.
A systematic review and meta-analysis was performed to assess the effect of pregnancy vitamin D supplementation on offspring bone mineral density (BMD) in childhood.
A literature search was conducted for published RCTs of antenatal vitamin D supplementation with assessment of offspring BMD or bone mineral content (BMC) by dual-energy X-ray absorptiometry (DXA) using MEDLINE and EMBASE up to 13th July 2022. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Study findings were grouped in two age groups of offspring assessment: neonatal period and early childhood (3-6 years). Random-effects meta-analysis of the effect on BMC/BMD at 3-6 years was performed using RevMan 5.4.1, yielding standardised mean difference (SMD) (95% CI).
Five RCTs were identified with offspring assessment of BMD or BMC; 3250 women were randomised within these studies. Risk of bias was low in 2 studies and "of concern" in 3. Supplementation regimes and the control used (3 studies used placebo and 2 used 400 IU/day cholecalciferol) varied, but in all studies the intervention increased maternal 25-hydroxvitamin D status compared to the control group. Two trials assessing BMD in the neonatal period (total n = 690) found no difference between groups, but meta-analysis was not performed as one trial represented 96.4% of those studied at this age. Three trials assessed offspring whole-body-less-head BMD at age 4-6 years. BMD was higher in children born to mothers supplemented with vitamin D [0.16 SD (95% confidence interval 0.05, 0.27), n = 1358] with a smaller effect on BMC [0.07 SD (95% CI - 0.04, 0.19), n = 1351].
There are few RCTs published to address this question, and these are inconsistent in methodology and findings. However, meta-analysis of three trials suggests moderate- to high-dose vitamin D supplementation in pregnancy might increase offspring BMD in early childhood, but further trials are required to confirm this finding. (Prospero CRD42021288682; no funding received).
系统评价和荟萃分析发现，妊娠中、高剂量维生素 D 补充对后代骨矿物质密度（BMD）的影响，妊娠维生素 D 补充对儿童期后代 BMD 的影响。
检索 MEDLINE 和 EMBASE 数据库中截至 2022 年 7 月 13 日发表的评估产前维生素 D 补充对双能 X 射线吸收法（DXA）评估的后代 BMD 或骨矿物质含量（BMC）的随机对照试验（RCT）。使用 Cochrane 偏倚风险 2 工具评估偏倚风险。将研究结果分为后代评估的两个年龄组：新生儿期和幼儿期（3-6 岁）。使用 RevMan 5.4.1 对 3-6 岁时 BMC/BMD 的影响进行随机效应荟萃分析，得出标准化均数差（SMD）（95%CI）。
确定了 5 项评估 BMD 或 BMC 的 RCT，其中 3250 名女性在这些研究中随机分组。2 项研究的偏倚风险较低，3 项研究的偏倚风险“值得关注”。补充方案和对照组（3 项研究使用安慰剂，2 项研究使用 400IU/天胆钙化醇）有所不同，但在所有研究中，与对照组相比，干预措施均增加了母体 25-羟维生素 D 状态。两项评估新生儿期 BMD 的试验（总 n=690）发现两组之间无差异，但由于一项试验代表了该年龄组研究的 96.4%，因此未进行荟萃分析。三项试验评估了 4-6 岁儿童的全身（不包括头部）BMD。与未接受维生素 D 补充的母亲所生的儿童相比，接受维生素 D 补充的母亲所生的儿童 BMD 更高[0.16 SD（95%置信区间 0.05，0.27），n=1358]，BMC 更高[0.07 SD（95%置信区间 0.04，0.19），n=1351]。
目前已有少数 RCT 发表来解决这一问题，但这些 RCT 在方法学和研究结果上存在差异。然而，三项试验的荟萃分析表明，妊娠中、高剂量维生素 D 补充可能会增加儿童早期的后代 BMD，但需要进一步的试验来证实这一发现。（Prospero CRD42021288682；无资金支持）。
