Maternal vitamin D supplementation during pregnancy and lactation to promote infant growth in Dhaka, Bangladesh (MDIG trial): study protocol for a randomized controlled trial

Daniel E Roth, Alison D Gernand, Shaun K Morris, Brendon Pezzack, M Munirul Islam, Michelle C Dimitris, Shaila S Shanta, Stanley H Zlotkin, Andrew R Willan, Tahmeed Ahmed, Prakesh S Shah, Kellie E Murphy, Rosanna Weksberg, Sanaa Choufani, Rashed Shah, Abdullah Al Mahmud, Daniel E Roth, Alison D Gernand, Shaun K Morris, Brendon Pezzack, M Munirul Islam, Michelle C Dimitris, Shaila S Shanta, Stanley H Zlotkin, Andrew R Willan, Tahmeed Ahmed, Prakesh S Shah, Kellie E Murphy, Rosanna Weksberg, Sanaa Choufani, Rashed Shah, Abdullah Al Mahmud

Abstract

Background: Vitamin D regulates bone mineral metabolism and skeletal development. Some observational studies have suggested that prenatal vitamin D deficiency increases the risk of adverse pregnancy and/or birth outcomes; however, there is scant evidence from controlled trials, leading the World Health Organization to advise against routine vitamin D supplementation in pregnancy. Importantly, little is known about the effect of maternal vitamin D status on infant linear growth in communities in South Asia where stunting is highly prevalent and maternal-infant vitamin D status is commonly suboptimal.

Methods/design: The Maternal Vitamin D for Infant Growth study is a randomized, placebo-controlled, dose-ranging trial of maternal vitamin D supplementation during pregnancy and lactation in Dhaka, Bangladesh. The primary aims are to estimate (1) the effect of maternal prenatal oral vitamin D3 supplementation (4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk, administered as weekly doses) versus placebo on infant length at 1 year of age and (2) the effect of maternal postpartum oral vitamin D3 supplementation (28,000 IU/wk) versus placebo on length at 1 year of age among infants born to women who received vitamin D 28,000 IU/wk during pregnancy. Generally healthy pregnant women (n = 1300) in the second trimester (17-24 weeks of gestation) are randomized to one of five parallel arms: placebo 4200 IU/wk, 16,800 IU/wk, or 28,000 IU/wk in the prenatal period and placebo in the postpartum period or 28,000 IU/wk in the prenatal period and 28,000 IU/wk in the postpartum period. Household- and clinic-based follow-up of mother-infant pairs is conducted weekly by trained personnel until 26 weeks postpartum and every 3 months thereafter. The primary trial outcome measure is length for age z-score at 1 year of age. Anthropometric measurements, clinical information, and biological specimens collected at scheduled intervals will enable the assessment of a range of maternal, perinatal, and infant outcomes.

Discussion: The role of vitamin D in maternal and infant health remains unresolved. This trial is expected to contribute unique insights into the effects of improving maternal-infant vitamin D status in a low-income setting where stunting and adverse perinatal outcomes represent significant public health burdens.

Trial registration: ClinicalTrials.gov identifier: NCT01924013. Registered on 13 August 2013.

Figures

Fig. 1
Fig. 1
Maternal Vitamin D for Infant Growth (MDIG) trial flow diagram. The allocated intervention in each group is shown as “prenatal intervention; postpartum intervention”

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