MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; Paediatric Endocrinology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Tremona Road, Southampton, United Kingdom.
MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, United Kingdom; MRC Versus Arthritis Centre for Musculoskeletal Health and Work, MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
Am J Clin Nutr. 2024 Nov;120(5):1134-1142. doi: 10.1016/j.ajcnut.2024.09.014. Epub 2024 Sep 19.
Findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial demonstrated a positive effect of gestational cholecalciferol supplementation on offspring bone mineral density (BMD) at age 4 y. Demonstrating the persistence of this effect is important to understanding whether maternal vitamin D supplementation could be a useful public health strategy to improving bone health.
We investigated whether gestational vitamin D supplementation increases offspring BMD at ages 6-7 y in an exploratory post-hoc analysis of an existing trial.
In the MAVIDOS randomized controlled trial, pregnant females <14 wk' gestation with a singleton pregnancy and serum 25-hydroxyvitamin D 25-100nmol/l at 3 United Kingdom hospitals (Southampton, Sheffield, and Oxford) were randomly assigned to either 1000 IU/d cholecalciferol or placebo from 14 to 17-wk gestation until delivery. Offspring born at term to participants recruited in Southampton were invited to the childhood follow-up at ages 4 and 6-7 y. The children had a dual-energy X-ray absorptiometry (DXA, Hologic discovery) scan of whole-body-less-head (WBLH) and lumbar spine, from which bone area, bone mineral content (BMC), BMD, and bone mineral apparent density (BMAD) were derived. Linear regression was used to compare the 2 groups adjusting for age, sex, height, weight, duration of consumption of human milk, and vitamin D use at 6-7 y.
A total of 454 children were followed up at ages 6-7 y, of whom 447 had a usable DXA scan. Gestational cholecalciferol supplementation resulted in higher WBLH BMC [0.15 SD, 95% confidence interval (CI): 0.04, 0.26], BMD (0.18 SD, 95% CI: 0.06, 0.31), BMAD (0.18 SD, 95% CI: 0.04, 0.32), and lean mass (0.09 SD, 95% CI: 0.00, 0.17) compared with placebo. The effect of pregnancy cholecalciferol on bone outcomes was similar at ages 4 and 6-7 y.
Supplementation with cholecalciferol 1000 IU/d during pregnancy resulted in greater offspring BMD and lean mass in mid-childhood compared with placebo in this exploratory post-hoc analysis. These findings suggest that pregnancy vitamin D supplementation may be an important population health strategy to improve bone health.
This trial was registered at the ISRCTN (https://doi.org/10.1186/ISRCTN82927713) as 82927713 and EUDRACT (https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-001716-23/results) as 2007-001716-23.
母体维生素 D 骨质疏松研究（MAVIDOS）试验的结果表明，妊娠期间补充胆钙化醇对后代 4 岁时的骨密度（BMD）有积极影响。证明这种效果的持久性对于理解母体维生素 D 补充是否可以成为改善骨骼健康的一种有用的公共卫生策略非常重要。
我们通过对现有试验进行探索性事后分析，调查妊娠期间补充维生素 D 是否会增加 6-7 岁时的后代 BMD。
在 MAVIDOS 随机对照试验中，在英国 3 家医院（南安普顿、谢菲尔德和牛津）招募的妊娠不到 14 周且血清 25-羟维生素 D 水平为 25-100nmol/l 的单胎妊娠女性，从 14 周到 17 周妊娠时被随机分配至 1000IU/d 胆钙化醇或安慰剂，直至分娩。在南安普顿招募的参与者所生的足月婴儿被邀请参加 4 岁和 6-7 岁时的儿童随访。儿童进行全身-头（WBLH）和腰椎的双能 X 射线吸收测定法（DXA，Hologic Discovery）扫描，从中得出骨面积、骨矿物质含量（BMC）、BMD 和骨矿物质表观密度（BMAD）。使用线性回归来比较 2 组，调整年龄、性别、身高、体重、人乳消耗时间和 6-7 岁时的维生素 D 使用情况。
共有 454 名儿童在 6-7 岁时接受了随访，其中 447 名儿童的 DXA 扫描结果可用。妊娠期间补充胆钙化醇导致 WBLH BMC 增加[0.15SD，95%置信区间（CI）：0.04，0.26]、BMD（0.18SD，95%CI：0.06，0.31）、BMAD（0.18SD，95%CI：0.04，0.32）和瘦体重（0.09SD，95%CI：0.00，0.17）增加，与安慰剂相比。妊娠胆钙化醇对骨骼结局的影响在 4 岁和 6-7 岁时相似。
在这项探索性事后分析中，与安慰剂相比，妊娠期间每天补充 1000IU 胆钙化醇可使后代在儿童中期的 BMD 和瘦体重增加。这些发现表明，妊娠期间补充维生素 D 可能是改善骨骼健康的一项重要的人群健康策略。
该试验在 ISRCTN（https://doi.org/10.1186/ISRCTN82927713）中注册为 82927713，在 EUDRACT（https://www.clinicaltrialsregister.eu/ctr-search/trial/2007-001716-23/results）中注册为 2007-001716-23。
