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Maternal vitamin D status during pregnancy and bone mineral content in offspring

Maternal vitamin D status during pregnancy and bone mineral content in offspring
Maternal vitamin D status during pregnancy and bone mineral content in offspring
We were intrigued by the results from the Avon Longitudinal Study of Parents and Children (ALSPAC) reporting no association between maternal 25-hydroxyvitamin D (25[OH]D) concentration in pregnancy and offspring bone mass (June 22, p 2176).1 Interestingly, these results contradict findings (which apparently still stand) from the same group (ALSPAC), in which maternal gestational exposure to ultaviolet B light was positively related to offspring bone mass at 9·9 years; this led the investigators to suggest that gestational vitamin D exposure exerts a direct effect on offspring bone development.2 That result was consistent with our findings from Princess Anne Hospital, Southampton, UK, in which maternal gestational serum 25(OH)D positively associated with offspring bone mass at 9 years, even after adjustment for child's age at dual-energy x-ray absorptiometry.3 In their latest ALSPAC analysis,1 adjustment for age removed the relation the investigators identified earlier, due to substantial colinearity between maternal gestational ultaviolet B exposure and child's age at dual-energy x-ray absorptiometry. The authors infer that their original findings2 are not sustained and that the newer results1 provide evidence that maternal vitamin D is not associated with offspring bone mass. Crucially, regression analysis cannot distinguish what is truly cause or confounder; our conclusion would be that substantial uncertainty remains, with these data adding to the growing body of observational evidence. Irrespective of how this intra-cohort inconsistency is interpreted, further evidence is needed from well-conducted systematic reviews4 and randomised trials.5 Definitive evidence-based policy in this important clinical area must await such information.
0140-6736
766
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Javaid, M.K.
51d3310b-032e-4c15-83ac-b878bce090f3
Inskip, H.M.
5fb4470a-9379-49b2-a533-9da8e61058b7
Godfrey, K.M.
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Harvey, N.C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Javaid, M.K.
51d3310b-032e-4c15-83ac-b878bce090f3
Inskip, H.M.
5fb4470a-9379-49b2-a533-9da8e61058b7
Godfrey, K.M.
0931701e-fe2c-44b5-8f0d-ec5c7477a6fd
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6

Harvey, N.C., Javaid, M.K., Inskip, H.M., Godfrey, K.M. and Cooper, C. (2013) Maternal vitamin D status during pregnancy and bone mineral content in offspring. The Lancet, 382 (9894), 766. (doi:10.1016/S0140-6736(13)61827-9). (PMID:23993185)

Record type: Article

Abstract

We were intrigued by the results from the Avon Longitudinal Study of Parents and Children (ALSPAC) reporting no association between maternal 25-hydroxyvitamin D (25[OH]D) concentration in pregnancy and offspring bone mass (June 22, p 2176).1 Interestingly, these results contradict findings (which apparently still stand) from the same group (ALSPAC), in which maternal gestational exposure to ultaviolet B light was positively related to offspring bone mass at 9·9 years; this led the investigators to suggest that gestational vitamin D exposure exerts a direct effect on offspring bone development.2 That result was consistent with our findings from Princess Anne Hospital, Southampton, UK, in which maternal gestational serum 25(OH)D positively associated with offspring bone mass at 9 years, even after adjustment for child's age at dual-energy x-ray absorptiometry.3 In their latest ALSPAC analysis,1 adjustment for age removed the relation the investigators identified earlier, due to substantial colinearity between maternal gestational ultaviolet B exposure and child's age at dual-energy x-ray absorptiometry. The authors infer that their original findings2 are not sustained and that the newer results1 provide evidence that maternal vitamin D is not associated with offspring bone mass. Crucially, regression analysis cannot distinguish what is truly cause or confounder; our conclusion would be that substantial uncertainty remains, with these data adding to the growing body of observational evidence. Irrespective of how this intra-cohort inconsistency is interpreted, further evidence is needed from well-conducted systematic reviews4 and randomised trials.5 Definitive evidence-based policy in this important clinical area must await such information.

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Letter to Lancet - ALSPAC vit D short nh 2013-1.docx - Author's Original
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Published date: 31 August 2013
Organisations: Faculty of Medicine

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Local EPrints ID: 359343
URI: http://eprints.soton.ac.uk/id/eprint/359343
ISSN: 0140-6736
PURE UUID: 9f01728f-b371-45b3-9fc0-059d53ea37ef
ORCID for N.C. Harvey: ORCID iD orcid.org/0000-0002-8194-2512
ORCID for H.M. Inskip: ORCID iD orcid.org/0000-0001-8897-1749
ORCID for K.M. Godfrey: ORCID iD orcid.org/0000-0002-4643-0618
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 28 Oct 2013 15:19
Last modified: 03 Dec 2019 02:04

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Author: N.C. Harvey ORCID iD
Author: M.K. Javaid
Author: H.M. Inskip ORCID iD
Author: K.M. Godfrey ORCID iD
Author: C. Cooper ORCID iD

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