Elsevier

Medical Hypotheses

Volume 71, Issue 2, August 2008, Pages 266-269
Medical Hypotheses

Maternal vitamin D in pregnancy may influence not only offspring bone mass but other aspects of musculoskeletal health and adiposity

https://doi.org/10.1016/j.mehy.2008.01.033Get rights and content

Summary

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 populations, 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 implications 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 randomised clinical trials to assess the potential benefits and harmful effects of vitamin D supplementation during pregnancy.

Section snippets

Vitamin D

Vitamin D status, measured as the circulating 25-hydroxyvitamin D (25OHD) level, is a key determinant of production of 1,25-dihydroxyvitamin D (1,25(OH)2D), the secosteroid hormone required for normal bone growth and mineralisation [1], and for increasing the number and size of muscle fibres [2].

Vitamin D does not naturally occur in the majority of unfortified foods [3]; hence, in many countries vitamin D is derived predominantly from sun exposure [4]. Personal sun exposure may have decreased

Musculoskeletal health

Extant literature suggests that the risk of osteoporosis and consequent fragility fractures in adult life might be programmed by environmental influences during gestation [12]. There are also data to suggest that maternal vitamin D status during pregnancy affects intrauterine skeletal mineralisation [13] and skeletal growth in children [14]. Maternal veiling in pregnancy, a surrogate for low vitamin D levels, has been associated with reduced bone mass among adolescent boys [15]. In a

Adiposity

There is evidence from two studies that adult body mass index and the prevalence of obesity vary as a function of month of birth [24], [25]. Greater adiposity was found for men and women born in winter–spring, possibly reflecting fetal exposure to low vitamin D during the second or third trimester of pregnancy.

Vitamin D deficiency is also emerging as a risk factor for the metabolic syndrome in adults [26]. The evidence supports an inverse relationship between serum 25OHD and components of the

Conclusion

There is an emerging body of evidence to suggest that intrauterine vitamin D insufficiency may also be associated with later development of autoimmune and cardiovascular diseases, type I diabetes, schizophrenia, seasonal affective disorder and some cancers [7], but we have focussed on the hypothesis that maternal vitamin D insufficiency during pregnancy affects bone mass and other aspects of musculoskeletal development and adiposity in the offspring. We emphasise that adequate maternal vitamin

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