A large study involving 3,000 newborns in the West Midlands of England revealed that one-third of all newborns and half of Black, Asian and Minority Ethnic (BAME) infants are vitamin D deficient.
The University of Birmingham and Birmingham Women's and Children's NHS Foundation Trust examined vitamin D levels in 3,000 dry blood samples. The samples, collected in the infants first week, were part of the national Newborn Blood Spot screening program. The blood was collected at the end of summer and winter to record vitamin D status at their highest and lowest levels.
The vitamin D levels were analyzed alongside ethnicity, gestational age, maternal age and also deprivation indices. The proportion of babies with deficient, insufficient and sufficient levels of vitamin D based on season of birth and ethnicity were evaluated.
The majority of newborn's were White British (59.1%) and born at term.
The study revealed vitamin D deficiency in 35% of the cohort and highlighted a significant seasonal difference. Over 52% of winter-born babies were vitamin D deficient compared to 18% of summer-born babies. Nearly a quarter of the babies tested were from areas with high levels of social deprivation.
"Vitamin D deficiency is common in all babies born in the UK, especially in winter months. The high proportion of dark-skinned infants with low vitamin D status, demonstrates potential failings of the UK's national antenatal supplementation programme in protecting these ethnic groups, who are well recognised to be at a high risk of vitamin D deficiency,” said Lead author Dr Suma Uday from the University of Birmingham and Birmingham Women's and Children's hospital.
Indeed, vitamin D status was much lower in babies of Black, Asian and mixed races as well as non-British White babies when compared to White British infants.
Overall, across both seasons nearly half of the babies from Asian and Black ethnic backgrounds were found to be deficient in vitamin D (47.7% and 47.4%, respectively) compared with 30.3% of White British babies. Across the entire multi-ethnic cohort, nearly 70% of the babies had a low vitamin D status, meaning that two thirds of the babies tested were either deficient or had insufficient levels.
“We need to work on improving the disconnect between provision and uptake of vitamins in high risk-groups like expectant mothers from BAME backgrounds,” added Uday.
Senior author Professor Wolfgang Högler from the University of Birmingham's Institute of Metabolism and Systems Research suggested they improve vitamin D supplementation programs by modeling them like immunization programs. Högler also recommended taking a page from Finland’s playbook: “Much easier and more effective would be food fortification with vitamin D — an approach that we have seen to be successful in other high latitude countries, such as Finland.”
“Almost 50% of babies of Black or Asian origin were deficient at birth, which explains their high risk of hypocalcaemic complications and rickets if left unsupplemented. Our findings call for an immediate review of the delivery of antenatal and infant vitamin D supplementation programmes and implementation of food fortification in the long term,” the authors said.
The sunshine vitamin
Vitamin D deficiency in newborns can lead to life-threatening complications such as seizures, serious heart conditions and, rarely, death in the first months of life. Starting in the womb, vitamin D is crucial for developing healthy bones and muscles, as it helps the body absorb calcium and phosphate. Vitamin D status also has long-lasting implications on neurocognitive development.
A recent study in the US found that a mother’s vitamin D level during pregnancy is associated with their children's IQ — suggesting that higher vitamin D levels in pregnancy may lead to greater childhood IQ scores.
The study also revealed significantly lower levels of vitamin D levels among Black pregnant women. About 46% of the mothers in the study were deficient in vitamin D during their pregnancy, and vitamin D levels were lower among Black women compared to White women.
While vitamin D deficiency is common among the general population and pregnant women, Black women are at a heightened risk.
While additional research is needed to determine the optimal levels of vitamin D in pregnancy, growing research is helping to develop nutritional recommendations for pregnant women. Experts agree nutritional supplementation and screening may be an impactful strategy for reducing health disparities, especially among Black women and those at high risk for vitamin D deficiency.
Source: Clinical Nutrition
Published online ahead of print, Dec 10, 2020 doi: https://doi.org/10.1016/j.clnu.2020.12.008
“Failure of national antenatal vitamin D supplementation programme puts dark skinned infants at highest risk: A newborn bloodspot screening study”
Authors: S. Uday et al.