1
|
Shekhawat DS, Singh K, Singh P, Vyas V, Varthya SB, Sharma P. Prenatal vitamin D levels and infant cognitive, motor, language and social-emotional development at 6 and 9 months of age. Nutr Neurosci 2024:1-10. [PMID: 38896552 DOI: 10.1080/1028415x.2024.2366649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
AIM Vitamin D is involved in several processes related to the development of neuronal and non-neuronal cells. There is a possible link between maternal vitamin D status in pregnancy and delayed neurocognitive development in the offspring. The aim of the study was to explore the association of maternal and cord blood vitamin D levels with infants' neurodevelopment at 6 and 9 months of age. METHODOLOGY A cohort study was conducted in western Rajasthan, India. Maternal and cord blood samples were collected at the time of delivery. Serum 25(OH)-vitamin D levels were measured in both. Infant neurodevelopment was assessed at 6 and 9 months of age in six domains namely cognitive, receptive language, expressive language, fine motor, gross motor and social-emotional using the Bayley Scale of Infant Development- III (BSID-III). RESULTS A total of 175 mother-child pairs were enrolled. Among the mothers taking part in this study, 7.3% had deficient and 59.09% had insufficient levels of serum 25(OH) vitamin D during the third trimester of their pregnancy. Maternal and cord blood serum 25-OH vitamin D levels were 18.86 ± 8.53 ng/mL and 17.39 ± 8.87 ng/mL, respectively, and there was a significant correlation (r = 0.9778, p = 0.000) between levels of vitamin D. Based on the repeated measures ANOVA, post hoc Tukey's HSD test, maternal vitamin D levels had a significant relationship (p = 0.047) to the cognitive development of infants at 6 months of age. Furthermore, cord serum vitamin D levels showed a significant association (p = 0.023 and p = 0.010) with the social-emotional development of the infant at the age of 6 and 9 months. CONCLUSION Maternal and cord serum 25-OH vitamin D deficiency was significantly associated with the cognitive and social-emotional development of infants.
Collapse
Affiliation(s)
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, India
| | - Varuna Vyas
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Shoban Babu Varthya
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Praveen Sharma
- Department of Biochemistry, All India Institute of Medical Sciences, Jodhpur, India
| |
Collapse
|
2
|
Deepa R, Schayck OCPV, Babu GR. Low levels of Vitamin D during pregnancy associated with gestational diabetes mellitus and low birth weight: results from the MAASTHI birth cohort. Front Nutr 2024; 11:1352617. [PMID: 38887504 PMCID: PMC11180835 DOI: 10.3389/fnut.2024.1352617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/26/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction India has a high prevalence of Vitamin D insufficiency among women of childbearing age. In this study, we aimed to evaluate the potential relationship between Vitamin D deficiency and gestational diabetes mellitus (GDM) and low birth weight (LBW) of newborns in the "Maternal antecedents of adiposity and studying the transgenerational role of hyperglycaemia and insulin" (MAASTHI) birth cohort. Methods A prospective cohort study involving 230 participants was conducted in public hospitals located in urban Bengaluru, India. Healthy pregnant women who visited these hospitals for antenatal care (ANC) and who were between 14 and 36 weeks of gestational age were recruited after obtaining their informed consent. An oral glucose tolerance test (OGTT) was administered between 24 and 36 weeks of pregnancy and blood samples were preserved at -80°C for Vitamin D analysis. Follow-up at birth included recording the child's birth weight. Results We found that 178 (77.4%) of the study participants were vitamin D deficient, 44 (19.1%) were diagnosed with GDM, and 64 (27.8%) gave birth to LBW babies. Women in the lowest quartile of serum Vitamin D levels had three times higher odds of developing GDM than women in the higher quartiles [OR = 3.22 (95% CI: 1.03, 10.07), p = 0.04] after adjusting for age, parity, socioeconomic status, season, and adiposity. For every one-unit increase in Vitamin D levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) decreased by nearly 18%. Furthermore, causal mediation analysis showed that a decrease in one unit of Vitamin D is associated with a decrease of 0.015 units of fasting blood sugar (FBS) and 0.019 units of postprandial blood sugar (PPBS) as it flows through the mediator variable insulin resistance. Vitamin D-deficient women were twice at risk of giving birth to LBW babies (OR 2.04, 95% CI 0.99, 4.19, p = 0.05). Discussions Low levels of Vitamin D during pregnancy are associated with a greater risk of pregnant women developing GDM and giving birth to LBW babies in urban Bengaluru.
Collapse
Affiliation(s)
- R. Deepa
- Indian Institute of Public Health—Bengaluru, Public Health Foundation of India, Bengaluru, India
| | - Onno C. P. Van Schayck
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Giridhara R. Babu
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| |
Collapse
|
3
|
Abdelmageed RM, Hussein SMM, Anamangadan SM, Abdullah RWM, Rauf L, AlFehaidi AS, Hamed E. Prospective cohort study of vitamin D deficiency in pregnancy: Prevalence and limited effectiveness of 1000 IU vitamin D supplementation. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231222404. [PMID: 38282449 PMCID: PMC10826388 DOI: 10.1177/17455057231222404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/04/2023] [Accepted: 12/07/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Vitamin D deficiency is highly prevalent worldwide among pregnant women. Although vitamin D supplementation is effective in improving vitamin D status, the safety and optimal dosing of vitamin D supplementation during pregnancy remain less well understood. OBJECTIVE This study aimed to investigate the prevalence of vitamin D deficiency among pregnant women and evaluate the effectiveness of vitamin D supplementation in improving vitamin D status during pregnancy. DESIGN This prospective cohort study assessed the impact of a 16-week daily vitamin D supplementation 1000 IU regimen on vitamin D status among pregnant women. METHODS A total of 365 pregnant women were recruited, and their baseline total circulating 25-hydroxy vitamin D concentrations were measured. Of these, 249 participants completed the study, which involved oral daily supplementation with 1000 IU of vitamin D and a repeat of total circulating 25-hydroxy vitamin D concentrations after 16 weeks. RESULTS The study found that 57.7% of the participants had vitamin D deficiency, consistent with the rates reported in other studies. However, vitamin D supplementation at a dose of 1000 IU had a small effect size and was not clinically significant. However, 67% of participants with vitamin D deficiency remained deficient; among participants initially with vitamin D insufficiency, 30% became deficient. Moreover, 26.5% of individuals with sufficient vitamin D status at 12 weeks showed insufficient levels by 28 weeks. CONCLUSION Vitamin D deficiency is widespread among pregnant women, and vitamin D supplementation at a daily dose of 1000 IU may not adequately address this problem. Although the study has limitations, its results align with previous research and may apply to other populations with a high prevalence of vitamin D deficiency during pregnancy. Further research is necessary to determine the most effective approach for addressing prenatal vitamin D deficiency.
Collapse
Affiliation(s)
| | | | | | | | - Lubna Rauf
- Qatar University Health Centre, Primary Health Care Corporation, Doha, Qatar
| | | | - Ehab Hamed
- Qatar University Health Centre, Primary Health Care Corporation, Doha, Qatar
| |
Collapse
|
4
|
Kondapalli AV, Kamanda-Kosseh M, Williams JM, Shiau S, Bucovsky M, Colon I, Shane E, Cohen A. Clinical characteristics of pregnancy and lactation associated osteoporosis: An online survey study. Osteoporos Int 2023; 34:1477-1489. [PMID: 37204454 DOI: 10.1007/s00198-023-06793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
Pregnancy and lactation associated osteoporosis is a rare and often severe osteoporosis presentation. Little information is available about etiology, clinical characteristics, risk factors and predictors of severity. Using an anonymized questionnaire, we defined clinical characteristics and potential risk factors for disease severity in PLO including primiparity, heparin exposure and celiac disease. PURPOSE Pregnancy and lactation associated osteoporosis (PLO) is a rare form of early-onset osteoporosis in which young women present with fractures, usually multiple vertebral fractures, during late pregnancy or lactation. Little information is available about etiology, clinical characteristics, risk factors and predictors of disease severity. METHODS PLO patients were recruited to complete an anonymized online questionnaire. Disease severity was defined as total number of fractures during or after the first pregnancy associated with a fracture(s). Analyses related disease severity to potential predictors including diseases/conditions or medication exposures. RESULTS 177 completed surveys were received between 5/29/2018 and 1/12/2022. Average age at initial PLO fracture event was 32 ± 5 years. The majority were primiparous with singleton pregnancy and 79% fractured during lactation. Subjects reported 4.7 ± 2.7 total PLO fractures, with 48% reporting ≥ 5 fractures. Vertebral fractures, reported by 164/177 responders (93%), were the most common fracture type. Conditions and medications most commonly reported included vitamin D deficiency, amenorrhea unrelated to pregnancy, nephrolithiasis, celiac disease (CD), oral steroid use, heparin products during pregnancy and progestin only contraceptive after pregnancy. CD and heparins exposure during pregnancy were significantly related to disease severity. CONCLUSION This is the largest study characterizing clinical features of PLO to date. The large number of participants and broad range of clinical and fracture characteristics queried has yielded novel information on the characteristics of PLO and potential risk factors for its severity, including primiparity, exposure to heparin and CD. These findings provide important preliminary data that can help target future mechanistic investigations.
Collapse
Affiliation(s)
- Ananya V Kondapalli
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - Mafo Kamanda-Kosseh
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - John M Williams
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - Ivelisse Colon
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - Elizabeth Shane
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA
| | - Adi Cohen
- Division of Endocrinology, Department of Medicine, College of Physicians & Surgeons, Columbia University Irving Medical Center, 180 Fort Washington Avenue, #904 , New York, NY, 10032, USA.
| |
Collapse
|
5
|
Nema J, Wadhwani N, Randhir K, Dangat K, Pisal H, Kadam V, Mehendale S, Wagh G, Kulkarni B, Sachdev HS, Fall C, Gupte S, Joshi S. Association of maternal vitamin D status with the risk of preeclampsia. Food Funct 2023; 14:4859-4865. [PMID: 37129568 DOI: 10.1039/d3fo00007a] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The aim of this study was to examine serum vitamin D concentrations from early pregnancy until delivery in women who did and did not develop preeclampsia. This longitudinal study was carried out in Pune, India. A total of 1154 women with singleton pregnancies were recruited in early pregnancy from two hospitals. Blood samples were collected and stored at four time points across gestation: V1 = 11-14 weeks, V2 = 18-22 weeks, V3 = 26-28 weeks and V4 = at delivery. 108 women who developed preeclampsia (PE) and 216 who did not develop PE (Non-PE) were randomly selected from the remainder. Serum 25-hydroxy vitamin D concentrations (25(OH)D) were estimated in their samples using commercially available ELISA kits. Independent t-tests were used to compare 25(OH)D between PE and non-PE groups. Logistic and linear regressions were used to examine associations of 25(OH)D with the risk of preeclampsia and birth outcomes, respectively, after adjusting for confounders. The mean (SD) 25(OH)D at V1 was 21.95 (19.64) in the Non-PE group and 17.76 (13.21) in the PE group. A decrease in the concentrations of vitamin D (ng ml-1) in mid-pregnancy (V2) and at delivery was associated with an increased risk of preeclampsia (0.31 [95% CI 0.11, 0.86], p = 0.024 and 0.24 [95% CI 0.08, 0.77], p = 0.016), respectively. Our finding of lower vitamin D concentrations in mid-pregnancy, before women developed clinical preeclampsia, suggests that vitamin D may have a role in its pathophysiology.
Collapse
Affiliation(s)
- Juhi Nema
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Nisha Wadhwani
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Karuna Randhir
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Kamini Dangat
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Hemlata Pisal
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Vrushali Kadam
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| | - Savita Mehendale
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune 411043, India
| | - Girija Wagh
- Department of Obstetrics and Gynaecology, Bharati Medical College and Hospital, Bharati Vidyapeeth (Deemed to be University), Pune 411043, India
| | - Bharati Kulkarni
- Division of Reproductive, Biology, Maternal and Child Health (RBMCH) and Nutrition, Indian Council of Medical Research (ICMR) - Headquarters, New Delhi 110029, India
| | - Harshpal Singh Sachdev
- Department of Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, India
| | - Caroline Fall
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Sanjay Gupte
- Gupte Hospital and Research Centre, Pune 411004, India
| | - Sadhana Joshi
- Mother and Child Health, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed to be University), Pune Satara Road, Pune 411043, India.
| |
Collapse
|
6
|
Suárez-Varela MM, Uçar N, Peraita-Costa I, Huertas MF, Soriano JM, Llopis-Morales A, Grant WB. Vitamin D-Related Risk Factors for Maternal Morbidity during Pregnancy: A Systematic Review. Nutrients 2022; 14:nu14153166. [PMID: 35956342 PMCID: PMC9370561 DOI: 10.3390/nu14153166] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Abstract
Vitamin D has well-defined classical functions related to metabolism and bone health but also has non-classical effects that may influence pregnancy. Maternal morbidity remains a significant health care concern worldwide, despite efforts to improve maternal health. Nutritional deficiencies of vitamin D during pregnancy are related to adverse pregnancy outcomes, but the evidence base is difficult to navigate. The primary purpose of this review is to map the evidence on the effects of deficiencies of vitamin D on pregnancy outcome and the dosage used in such studies. A systematic search was performed for studies on vitamin D status during pregnancy and maternal outcomes. A total of 50 studies came from PubMed, 15 studies came from Cochrane, and 150 studies came from Embase, for a total of 215 articles. After screening, 34 were identified as candidate studies for inclusion. Finally, 28 articles met the inclusion criteria, which originated from 15 countries. The studies included 14 original research studies and 13 review studies conducted between 2012 and 2021. This review was finally limited to the 14 original studies. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and the quality and strength of the evidence was evaluated using the Navigation Guide Systematic Review Methodology (SING). We found evidence that supports the idea that supplementary vitamin D for pregnant women is important for reducing the risk of gestational diabetes, hypertension, preeclampsia, early labor, and other complications. The data retrieved from this review are consistent with the hypothesis that adequate vitamin D levels might contribute to a healthy pregnancy.
Collapse
Affiliation(s)
- Maria Morales Suárez-Varela
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University de Valencia, Avenida Vicent Andres Estelles s/n, 46100 Valencia, Spain; (M.M.S.-V.); (N.U.); (I.P.-C.); (M.F.H.); (A.L.-M.)
- Biomedical Research Center Network on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Nazlı Uçar
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University de Valencia, Avenida Vicent Andres Estelles s/n, 46100 Valencia, Spain; (M.M.S.-V.); (N.U.); (I.P.-C.); (M.F.H.); (A.L.-M.)
| | - Isabel Peraita-Costa
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University de Valencia, Avenida Vicent Andres Estelles s/n, 46100 Valencia, Spain; (M.M.S.-V.); (N.U.); (I.P.-C.); (M.F.H.); (A.L.-M.)
- Biomedical Research Center Network on Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - María Flores Huertas
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University de Valencia, Avenida Vicent Andres Estelles s/n, 46100 Valencia, Spain; (M.M.S.-V.); (N.U.); (I.P.-C.); (M.F.H.); (A.L.-M.)
| | - Jose Miguel Soriano
- Unit of Nutrition and Bromatology, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine, Universitat de València, Avda. Vicente Andrés Estellés s/n, Burjassot, 46100 Valencia, Spain;
| | - Agustin Llopis-Morales
- Area of Preventive Medicine and Public Health, Department of Preventive Medicine and Public Health, Food Sciences, Toxicology and Legal Medicine, School of Pharmacy, University de Valencia, Avenida Vicent Andres Estelles s/n, 46100 Valencia, Spain; (M.M.S.-V.); (N.U.); (I.P.-C.); (M.F.H.); (A.L.-M.)
| | - William B. Grant
- Sunlight, Nutrition, and Health Research Center, P.O. Box 641603, San Francisco, CA 94164-1603, USA
- Correspondence:
| |
Collapse
|
7
|
Gowtham T, Venkatesh S, Palanisamy S, Rathod S. Impact of maternal hypovitaminosis D on birth and neonatal outcome - a prospective cohort study. J Matern Fetal Neonatal Med 2022; 35:9940-9947. [PMID: 35603468 DOI: 10.1080/14767058.2022.2077098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vitamin D deficiency in pregnant women is of special concern as mother is the only source of vitamin D for the developing fetus, and maternal hypovitaminosis D has been implicated in a number of maternal and neonatal adverse outcomes. The objective of this study was to assess the association of maternal circulating 25-hydroxy vitamin D3 [25(OH)D] concentration with cord blood 25(OH)D and adverse birth and neonatal outcomes. METHODS This prospective cohort study was conducted in Mahatma Gandhi Medical College and Research Institute (MGMCRI) from January 2020 to December 2020. 121 babies born to mothers with singleton pregnancy tested for serum 25(OH)D level on admission for safe confinement were included in the study and cord blood of the babies were sampled for 25(OH)D. Based on the maternal 25(OH)D level, babies were categorized as those born to mothers with sufficient vitamin D level and those born to mothers with hypovitaminosis D (deficient/insufficient) and primary and secondary outcome was compared between two groups. RESULTS Maternal and cord blood hypovitaminosis D was observed in 65% of mothers and 68.6% of babies, respectively. Maternal vitamin D level was the single most significant predictor of cord blood vitamin D level with five-fold increased risk of cord blood hypovitaminosis D in babies born to mothers with hypovitaminosis D. Birthweight (t = -2.219, p = .028) and preterm birth (aOR = 4.417, 95% CI: 1.03-18.9) was significantly associated with maternal hypovitaminosis D and a trend toward increased risk of LBW (aOR - 2.1, 95%CI: 0.6-7.3), SGA babies (aOR - 1.5, 95% CI: 0.5-4.7), perinatal depression (aOR - 1.5, 95% CI: 0.4-5.8) and neonatal hyperbilirubinemia (aOR = 2.68, 95%CI: 0.942-7.6) was observed. CONCLUSIONS Hypovitaminosis D in pregnant women is a significant health issue affecting both the mother and her baby. Safest dose for supplementation during pregnancy to prevent adverse perinatal outcome needs to be evaluated.
Collapse
Affiliation(s)
- Thirupathi Gowtham
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Soma Venkatesh
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Soundararajan Palanisamy
- Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Setu Rathod
- Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| |
Collapse
|
8
|
Indian Academy of Pediatrics Revised (2021) Guidelines on Prevention and Treatment of Vitamin D Deficiency and Rickets. Indian Pediatr 2021. [DOI: 10.1007/s13312-022-2448-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|