Prenatal and infant predictors of bone health: the influence of vitamin D

Vitamin D is essential for the health of pregnant women and their infants. Vitamin D insufficiency and deficiency during pregnancy are reflected in lower maternal weight gain and biochemical evidence of disturbed skeletal homeostasis in the infant, with, in extreme situations, reduced bone mineralization, radiologically evident rickets, and fractures. Populations at risk for vitamin D deficiency are those for which, for environmental, cultural, or medical reasons, exposure to sunlight is poor and the dietary intake of vitamin D is low. The infants born in such populations have low vitamin D stores and may receive little additional vitamin D if they are breast-fed without supplements for long periods. In the short term, lack of vitamin D supplementation in infancy leads to biochemical disturbances, reduced bone mineralization, slower growth, and eventual alterations in bone shape and increased risk of fracture, the hallmarks of rickets. In the longer term, lack of vitamin D supplementation may result in reduced bone size and mass during childhood and an increased risk of type 1 diabetes mellitus. Clear recommendations are needed regarding the intake of vitamin D during pregnancy and infancy. Such recommendations should be based on functional outcomes, rather than biochemical measurements, so that the medical problems resulting from the lack of this essential nutrient can be overcome.