Despite the majority of Indian population receiving adequate sunlight throughout the year, the prevalence of vitamin D deficiency (VDD) in India is estimated to be between 40% and 90%, irrespective of age, gender, and geography [1]. It is also highly prevalent among pregnant women, lactating mothers, neonates, and/or exclusively breastfed infants [1]. Apart from skeletal manifestation, VDD has been reported to be associated with type 2 diabetes, cardiovascular dysfunction, and autoimmune diseases during later life [1-3].

Vitamin D levels of newborns are primarily dependent on maternal vitamin D levels; hence, infants born to vitamin D deficient mothers are at a higher risk of developing VDD at birth [4-6]. The objective of this study was to assess the prevalence of VDD among infants born at a single hospital to healthy mothers in Bengaluru, a cosmopolitan city in Southern India.

This study was approved by the management of out hospital. Written informed consent was obtained from the mothers of the participants. This study was performed for a duration of three months between March, 2018 and June, 2018 at Cloudnine Hospitals, Bengaluru, India. All full-term, healthy, singleton infants born during the study period were included. Preterm infants, low birthweight infants, and infants with congenital disorders, sepsis, and jaundice were excluded from the study.

At 36-48 h of life, a venous blood sample (0.5 mL) was drawn from each participant, and 25-OH vitamin D values were measured by Tandem Mass Spectroscopy (TMS). The vitamin D level was calculated by adding the measurements of vitamin D2 and vitamin D3 levels. To facilitate the comparison, we divided the measured values of vitamin D levels into three diagnostic categories, modified from the values suggested by Indian Academy of Pediatrics (IAP) [7]: Vitamin D deficiency, £10 ng/mL; vitamin D insufficiency, 10–20 ng/mL; and vitamin D sufficiency, ≥20 ng/mL.

Vitamin D status were compared using the Chi-square test. Statistical analysis was performed using Microsoft Excel (Microsoft Office 2016, Microsoft Corporation, USA). Statistical significance was considered at P<0.05.

A total of 920 children were born during the study period, of which 825 newborns were included in the study. In all, 786 (95.3%) participants had vitamin D2 levels of <1 ng/mL. The mean (SD) of D3 level and total vitamin D levels were 8.1 (7.6) ng/mL and 8.3 (7.9) ng/mL, respectively. Only 65 (7.9%) infants had normal vitamin D levels (Table I).

Table I Prevalence of Vitamin D Deficiency Among Newborns*

		Vitamin D status

		Male (n=444) 

		Female (n=366)

		Deficient (<10 ng/mL) 

		313 (70.5)

		258 (70.5)

		Insufficient (10-20 ng/mL)

		103 (23.2)

		73 (20)

		Sufficient (>20 ng/mL)

		28 (6.3)

		35 (9.6)

		*Gender details were missing for 15 newborns; all values in n (%).

This study provides the prevalence of VDD based on the blood samples drawn from newborns, and not from the cord blood [8,9]. Our findings are in line with previously published studies, suggesting a higher prevalence of VDD among Indian newborns [1,8,9]. Although data on maternal vitamin D levels was not collected, most mothers had received antenatal supplementation of vitamin D, suggesting that this was insufficient to prevent neonatal VDD. Additionally, initiatives related to public health including food fortification, public awareness, etc. may be warranted to reduce burden of VDD.

This study further highlights the need for vitamin D supplementation in neonates.

Acknowledgements: We thank BioQuest Solutions for data analysis and editorial services; Dr Shweta Kumar for her guidance in the manuscript development.

Contributors: RKK, HD, SVG, AN: Involved in all aspects of the conduct of the study and preparation of manuscript. All authors approved the final manuscript and are accountable for all aspects related to the study.

Funding: None; Competing Interests: None stated.

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