Am J Perinatol 2015; 32(13): 1273-1276
DOI: 10.1055/s-0035-1554797
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Seasonal Variation in Solar Ultra Violet Radiation and Early Mortality in Extremely Preterm Infants

Ariel A. Salas
1   Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
,
Kelly A. Smith
2   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Mackenzie D. Rodgers
2   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Vivien Phillips
2   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
,
Namasivayam Ambalavanan
2   Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
Further Information

Publication History

15 February 2015

15 April 2015

Publication Date:
03 June 2015 (online)

Abstract

Background Vitamin D production during pregnancy promotes fetal lung development, a major determinant of infant survival after preterm birth. Because vitamin D synthesis in humans is regulated by solar ultraviolet B (UVB) radiation, we hypothesized that seasonal variation in solar UVB doses during fetal development would be associated with variation in neonatal mortality rates.

Methods This cohort study included infants born alive with gestational age (GA) between 23 and 28 weeks gestation admitted to a neonatal unit between 1996 and 2010. Three infant cohort groups were defined according to increasing intensities of solar UVB doses at 17 and 22 weeks gestation. The primary outcome was death during the first 28 days after birth.

Results Outcome data of 2,319 infants were analyzed. Mean birth weight was 830 ± 230 g and median gestational age was 26 weeks. Mortality rates were significantly different across groups (p = 0.04). High-intensity solar UVB doses were associated with lower mortality when compared with normal intensity solar UVB doses (hazard ratio: 0.70; 95% confidence interval: 0.54–0.91; p = 0.01).

Conclusion High-intensity solar UVB doses during fetal development seem to be associated with risk reduction of early mortality in preterm infants. Prospective studies are needed to validate these preliminary findings.

 
  • References

  • 1 Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357 (3) 266-281
  • 2 Engelsen O. The relationship between ultraviolet radiation exposure and vitamin D status. Nutrients 2010; 2 (5) 482-495
  • 3 Zosky GR, Hart PH, Whitehouse AJ , et al. Vitamin D deficiency at 16 to 20 weeks' gestation is associated with impaired lung function and asthma at 6 years of age. Ann Am Thorac Soc 2014; 11 (4) 571-577
  • 4 Zosky GR, Berry LJ, Elliot JG, James AL, Gorman S, Hart PH. Vitamin D deficiency causes deficits in lung function and alters lung structure. Am J Respir Crit Care Med 2011; 183 (10) 1336-1343
  • 5 Nguyen TM, Guillozo H, Marin L, Tordet C, Koite S, Garabedian M. Evidence for a vitamin D paracrine system regulating maturation of developing rat lung epithelium. Am J Physiol 1996; 271 (3 Pt 1) L392-L399
  • 6 Phokela SS, Peleg S, Moya FR, Alcorn JL. Regulation of human pulmonary surfactant protein gene expression by 1alpha,25-dihydroxyvitamin D3. Am J Physiol Lung Cell Mol Physiol 2005; 289 (4) L617-L626
  • 7 Bancalari E. Bronchopulmonary dysplasia. In: Laurent G, Shapiro S, , eds. Encyclopedia of Respiratory Medicine. Oxford: Elsevier; 2006: 303
  • 8 Ambalavanan N, Walsh M, Bobashev G , et al; NICHD Neonatal Research Network. Intercenter differences in bronchopulmonary dysplasia or death among very low birth weight infants. Pediatrics 2011; 127 (1) e106-e116
  • 9 Livesey J, Elder P, Ellis MJ, McKenzie R, Liley B, Florkowski C. Seasonal variation in vitamin D levels in the Canterbury, New Zealand population in relation to available UV radiation. N Z Med J 2007; 120 (1262) U2733
  • 10 Olds WJ, McKinley AR, Moore MR, Kimlin MG. In vitro model of vitamin D3 (cholecalciferol) synthesis by UV radiation: dose-response relationships. J Photochem Photobiol B 2008; 93 (2) 88-93
  • 11 Hart PH, Lucas RM, Walsh JP , et al. Vitamin D in fetal development: findings from a birth cohort study. Pediatrics 2015; 135 (1) e167-e173
  • 12 Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 1988; 67 (2) 373-378
  • 13 McKenzie RL, Liley JB, Björn LO. UV radiation: balancing risks and benefits. Photochem Photobiol 2009; 85 (1) 88-98
  • 14 Ozias MK, Kerling EH, Christifano DN, Scholtz SA, Colombo J, Carlson SE. Typical prenatal vitamin D supplement intake does not prevent decrease of plasma 25-hydroxyvitamin D at birth. J Am Coll Nutr 2014; 33 (5) 394-399
  • 15 Wagner CL, Baggerly C, McDonnell SL , et al. Post-hoc comparison of vitamin D status at three timepoints during pregnancy demonstrates lower risk of preterm birth with higher vitamin D closer to delivery. J Steroid Biochem Mol Biol 2015; 148: 256-260
  • 16 Chen YH, Fu L, Hao JH , et al. Maternal vitamin D deficiency during pregnancy elevates the risks of small for gestational age and low birth weight infants in Chinese population. J Clin Endocrinol Metab 2015; 100: 1912-1919
  • 17 McGrath JJ, Barnett AG, Eyles DW. The association between birth weight, season of birth and latitude. Ann Hum Biol 2005; 32 (5) 547-559
  • 18 Bodnar LM, Simhan HN. The prevalence of preterm birth and season of conception. Paediatr Perinat Epidemiol 2008; 22 (6) 538-545
  • 19 Darrow LA, Strickland MJ, Klein M , et al. Seasonality of birth and implications for temporal studies of preterm birth. Epidemiology 2009; 20 (5) 699-706
  • 20 Keller CA, Nugent RP. Seasonal patterns in perinatal mortality and preterm delivery. Am J Epidemiol 1983; 118 (5) 689-698
  • 21 Sidebotham P, Fraser J, Covington T , et al. Understanding why children die in high-income countries. Lancet 2014; 384 (9946) 915-927
  • 22 Ginde AA, Liu MC, Camargo Jr CA. Demographic differences and trends of vitamin D insufficiency in the US population, 1988–2004. Arch Intern Med 2009; 169 (6) 626-632
  • 23 Hollis BW, Johnson D, Hulsey TC, Ebeling M, Wagner CL. Vitamin D supplementation during pregnancy: double-blind, randomized clinical trial of safety and effectiveness. J Bone Miner Res 2011; 26 (10) 2341-2357
  • 24 Wei SQ. Vitamin D and pregnancy outcomes. Curr Opin Obstet Gynecol 2014; 26 (6) 438-447