Nursing mothers and children:
Vitamin D deficiency has also been associated with some complications such as poor fetal growth, rickets and neonatal eczema (41). Vitamin D status was assessed in parturient and gravidae in a tertiary care hospital in Karachi (42). Maternal and fetal vitamin D levels were estimated from blood and cord blood respectively. It found that 89% of the subjects were vitamin D deficient (<30 ng/mL) and vitamin D levels were found inversely correlated with maternal blood pressure.
Vitamin D deficiency was also found in the nursing mothers (85.1%) of South Punjab (43). According to the study, most of the mothers used to live in open houses with maximum chances of sun exposure (168.81 minutes/day). Despite of ample sun exposure, the reason of vitamin D deficiency could be clothing style of the females that is very common in the society.
Vitamin D deficiency was also found in healthy infants from 9 to 12 months of age in Rawalpindi (44). The radiological studies of wrists showed that 53.8% of infants had rickets with sub-optimal levels of vitamin D (<30 ng/mL).
The possible reasons of the vitamin D deficiency in pregnant women could be low sun exposure and less physical activity during pregnancy. Clothing style and cultural regulations (not to go outside during pregnancy), may play their role in this condition.
Another study revealed that 99.5% women and 97.3% neonates in Karachi while, 89% of women and 85% of neonates in rural areas of district Jehlum were found vitamin D deficient. (45) Similarly, another study revealed maternal vitamin D deficiency (<30ng/mL) during early pregnancy in 44% (out of 301) of the subjects visiting a tertiary care hospital in Karachi (46). A similar study reported 77% vitamin D deficiency from neonates to children (15 year of age) (47).
Nutritional rickets was observed in 74% children admitted in a health care center in Karachi with the symptoms of severe pneumonia (4). The rickets was more prevalent (79.8%) in age group between 2 to 12 months. Vitamin D status was not measured in this study, but it could be inferred that the children would have severe vitamin D deficiency.
Sub-clinical rickets was also observed in several areas of Pakistan. A study conducted in 189 children with 11 to 16 years of age showed 27% prevalence of sub-clinical rickets in Hazara district, KPK (48). Similarly in Kaghan Valley, 26 students were evaluated for sub-clinical rickets and all were found to have this condition along with vitamin D deficiency and high alkaline phosphatase levels (49).
An interventional study was conducted to evaluate the effect of two oral doses of 200000 IU of vitamin D in the malnourished children of 6 to 58 months age range (50). The results of this interventional clinical study showed significant improvements in the developmental indices in these children as compared with control group.