The effect of maternal vitamin D supplementation in the third trimester on the incidence of early-onset sepsis in their newborns

Background: Neonatal septicemia, also called neonatal sepsis, encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis, and urinary tract infection. Neonatal sepsis is one of the important causes of neonatal mortality, worldwide. It is estimated that 33% of the neonatal deaths are due to sepsis-related causes. As Vitamin D has a role in strengthening immunity and hence controlling infection, it would be pertinent to study its role in the prevention of neonatal sepsis. Deficiency in Vitamin D contributes to this deficit in immune system. Methods: This was a pilot randomized, double-blind, placebo-controlled trial, enrolling 112 antenatal mothers at the beginning of the third trimester of pregnancy. The blood sample for Vitamin D level was collected from mothers at the time of enrollment. Study group received sachet containing 1.2 lac units of oral Vitamin D once a month for three doses. Control group received glucose powder only, once a month for three doses. Allocation was done using opaque envelope method. At the time of delivery, umbilical cord blood sample for Vitamin D levels was collected. Those clinically symptomatic at birth or within 72 h of birth were admitted in the neonatal intensive care unit and evaluated. All infants were followed up in the neonatal follow-up clinic on a weekly basis till 1 month of age. Results: In the babies born to supplemented mothers, 1% of the newborns were Vitamin D deficient, 1% were insufficient, and 48% had sufficient Vitamin D as compared to the unsupplemented group where 4% were deficient, 16% were insufficient, and 30% had sufficient Vitamin D levels (P < 0.001). 96% of the neonates had sufficient Vitamin D levels in the supplemented group compared to only 60% in the unsupplemented group (P < 0.001). Vitamin D supplementation of mothers ensured adequate levels in 96% of their infants compared to 60% in the unsupplemented group. There were three preterm deliveries and two cases of probable early-onset sepsis (EOS) in unsupplemented mothers. There was one case of probable late-onset sepsis in newborn in both groups. All four neonates with sepsis had Vitamin D levels in the deficient or insufficient range. Cord blood levels were deficient in five neonates and one of them (20%) developed EOS; cord blood levels were insufficient in 17 neonates and one (5.88%) developed EOS. None of the newborns in the sufficient range developed EOS. EOS was significantly higher in Vitamin D-deficient/insufficient group compared to that in Vitamin D-sufficient group (P < 0.003).