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American Journal of Clinical Nutrition, Vol. 71, No. 5, 1317S-1324s, May 2000
© 2000 American Society for Clinical Nutrition


Supplements

Perinatal metabolism of vitamin D1,2,3

Bernard L Salle, Edgar E Delvin, Alexandre Lapillonne, Nicholas J Bishop and Francis H Glorieux

1 From the Department of Neonatology and Human's Nutrition Center, Hôpital Edouard Herriot, Lyon, France; the Laboratory of Biochemistry, Sainte Justine Hospital, Montréal; the Division of Child Health, University of Sheffield, Sheffield Children's Hospital, Sheffield, United Kingdom; and the Genetics Unit, Shriners Hospital for Children , Montréal.

During pregnancy, maternal serum concentrations of 25-hydroxyvitamin D, the circulating form of vitamin D, correlate with dietary vitamin D intake. Maternal serum concentrations of 1,25-dihydroxyvitamin D, the hormonal circulating and active form of vitamin D, are elevated during pregnancy; 1,25-dihydroxyvitamin D is synthesized mainly by the decidual cells of the placenta and allows for increased calcium absorption. The fetus is entirely dependent on the mother for its supply of 25-hydroxyvitamin D, which is believed to cross the placenta. Hypocalcemia and increased parathyroid hormone secretion induce synthesis of 1,25-dihydroxyvitamin D after birth in both full-term and preterm neonates. Nevertheless, serum concentrations of 25-hydroxyvitamin D are a rate-limiting factor in the synthesis of 1,25-dihydroxyvitamin D. In vitamin D–replete infants, circulating 1,25-dihydroxyvitamin D concentrations are higher than those observed in older infants. In countries where dairy products are not routinely supplemented with vitamin D, maternal vitamin D supplementation during pregnancy is necessary. However, there is no indication for the use of pharmacologic doses of vitamin D or its metabolites in the perinatal period.

Key Words: 25-Hydroxyvitamin D • 1,25-dihydroxyvitamin D • mineral metabolism • parathyroid hormone • pregnancy • preterm infant • term infant




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