Evaluation of umbilical cord vitamin D level and maternal factors effective on it in three hospitals of Emam Reza, Ghaem & Omol Banin during 2013-2014

Document Type : Original Article


1 Associate Professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Professor, Department of Pediatric Endocrinology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Assistant Professor of Pediatrics Endocrinology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.


Introduction: Congenital rickets which is a nutritional rickets is caused by low levels of vitamin D during fetal period that its cause is lack of this vitamin in pregnant mother. This study was performed with the aim to evaluate cord vitamin D level and the factors effective on it in the sample of Iranian born neonates. 
Methods: This cross sectional study was performed on the pregnant women who had referred to three hospitals of Mashhad University of medical sciences for delivery. A sample of 5 cc cord blood of 190 newborns was prepared. Calcium, phosphor, vitamin D, and alkaline phosphates were measured in the neonate's cord blood sample. Data was analyzed by SPSS software (version 16), and Chi-square, Fisher exact, Kolmogronov-Smironov, paired t, Wilcoxon, Independent t, and Mann-Whitney tests. PResults: 15 mothers (7.9%) had underlying disease that 12 women had diabetes mellitus and 3 (1.6%) had preeclampsia. 77 mothers (40.5%) mentioned use of vitamin D. Severe vitamin D deficiency (vitamin D level less than 12 ng/ml) was observed in 63 mothers (33.2%) and moderate vitamin D deficiency (vitamin D level between 12-20 ng/ml) in 99 (52.1%), and normal vitamin D level in 28 (14.7%).
Conclusion: The results of present study confirm the relative high prevalence of vitamin D deficiency in pregnant mothers and insufficient sun light exposure and maternal skin type were its main risk factor.


  1. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics 2008; 122(2):398-417.
  2. Looker AC, Gunter EW. Hypovitaminosis D in medical inpatients. N Engl J Med 1998;339 (5):344– 345.
  3. Hollis BW, Wagner CL. Vitamin D deficiency during pregnancy: an ongoing epidemic. Am J Clin Nutr 2006;84 (2):273.
  4. Wagner CL, Greer FR. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 2008;122(5):1142-52.
  5. Nicolaidou P, Hatzistamatiou Z, Papadopoulou A, Kaleyias J, Floropoulou E, Lagona E, et al. Low vitamin D status in mother-newborn pairs in Greece. Calcif Tissue Int 2006;78(6):337-42.
  6. Cameron C, Dallaire F, Vézina C, Muckle G, Bruneau S, Ayotte P, et al. Neonatal vitamin A deficiency and its impact on acute respiratory infections among preschool Inuit children. Can J Public Health 2008;99(2):102-6.
  7. Alouf B, Grigalonis M. Incidental finding of vitamin-D deficient rickets in an otherwise healthy infant--a reappraisal of current vitamin-D supplementation guidelines. J Natl Med Assoc 2005;97(8):1170-3.
  8. Holick MF. Photosynthesis, metabolism, and biologic actions of vitamin D. In: Glorieux FH, editor. Rickets. Nestle Nutritional Workshop Series volume 21. New York: Raven Press; 1991.
  9. Vakili R, Eshraghi P, Ataei Nakhaei A, Vakili S, Khakshour A, Saeidi M. Congenital Rickets: Report of Four Cases. International Journal of Pediatrics 2014; 2(1): 101-103.
  10. Dawodu A1Kochiyil JAltaye N. Pilot study of sunlight exposure and vitamin D status in Arab women of childbearing age. East Mediterr Health J 2011 Jul;17(7):570-4.
  11. Paxton GA1, Teale GRNowson CAMason RSMcGrath JJThompson MJ. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: a position statement. Med J Aust 2013;198(3):142-3.
  12. Eichholzer M, Platz EA, Bienstock JL, Monsegue D, Akereyeni F, Hollis BW, et al. Racial variation in vitamin D cord blood concentration in white and black male neonates.Cancer Causes Control 2013;24(1):91-8.
  13. Kazemi ASharifi FJafari NMousavinasab N. High prevalence of vitamin D deficiency among pregnant women and their newborns in an Iranian population. J Womens Health (Larchmt)  2009 ;18(6):835-9.
  14. Hollis BW, Wagner CL. Assessment of dietary vitamin D requirements during pregnancy and lactation. Am J Clin Nutr 2004;79(5):717-26.
  15. Ebrahimi MKhashayar PKeshtkar AEtemad KDini MMohammadi Z et al. Prevalence of vitamin D deficiency among Iranian adolescents. J Pediatr Endocrinol Metab 2014; 27(7-8):595-602.
  16. Ergür AT, Berberoğlu M, Atasay B, Şıklar Z, Bilir P, Arsan S, et al. Vitamin D deficiency in Turkish mothers and their neonates and in women of reproductive age. J Clin Res Pediatr Endocrinol 2009;1(6):266-9.
  17. Sabour H, Hossein A, Maghbouli J, Larijani B. Effects of vitamin D and calcium intake on serum bone markers at delivery. Journal Reproduction & Infertility 2007;5(3): 135-141
  18. Adami SRomagnoli ECarnevale VScillitani AGiusti ARossini M.Guidelines on prevention and treatment of vitamin D deficiency. Italian Society for Osteoporosis, Mineral Metabolism and Bone Diseases (SIOMMMS)]. Reumatismo 2011;63(3):129-47. (Italian).
  19. Ward LM. Vitamin D deficiency in the 21st century: a persistent problem among Canadian infants and mothers. CMAJ 2005;172(6):769-70.
  20. Nair R1, Maseeh A. Vitamin D: The "sunshine" vitamin. J Pharmacol Pharmacother 2012 ;3(2):118-26.
  21. Mannion CA, Gray-Donald K, Koski KG. Association of low intake of milk and vitamin D during pregnancy with decreased birth weight. CMAJ 2006;174(9):1273-7.