Who should receive vitamin D in pregnancy and infancy? We focus on risk identification, prevention strategies, and the clinical recognition of deficiency, including nutritional rickets. Vitamin D deficiency remains an important and preventable issue, particularly in at-risk populations. To explore this topic, we are joined by Professor Ben Wheeler, a Paediatric Endocrinologist and Paediatrician.

Practical clinical pearls:

· Universal infant supplementation works best

Provide vitamin D supplementation to all infants up to 12 months, regardless of feeding method, ethnicity, or perceived sun exposure, as risk-based approaches miss vulnerable babies.

· Maternal vitamin D status shapes infant health

Maternal deficiency during pregnancy directly affects neonatal vitamin D stores and future bone health, making antenatal supplementation an important prevention strategy.

· Sun exposure is not a reliable strategy in infancy

In New Zealand’s high-latitude environment, sun exposure alone is inconsistent and carries skin cancer risks, so daily supplementation is preferred for infants.

· Test selectively, supplement proactively

Routine vitamin D testing is usually unnecessary in asymptomatic women and infants; focus instead on guideline-based supplementation and prevention in at-risk populations.

· Recognise rickets early and act urgently

Consider vitamin D deficiency and nutritional rickets in infants with poor growth, delayed milestones, hypotonia, bone pain, or irritability. Hypocalcaemia and raised ALP are important clues, and suspected rickets requires urgent same-day paediatric discussion and possible hospital admission.

Bio:

Professor Ben Wheeler is a Paediatric Endocrinologist and Paediatrician working for the University of Otago and the Southern District Health Board.

His research focuses on access to and use of new technologies for children and young people affected by diabetes, as well as factors that impact on glycaemic control in diabetes. He also has a research interest in vitamin D and bone health during pregnancy, lactation, and infancy. He has a number of collaborations ongoing in these areas, and usually multiple clinical trials or studies running in these areas at any one time.

Resources:

https://static.info.content.health.nz/docs/health-pros/topics/maternity/national/companion-statement-vitamin-d-sun-exposure-pregnancy-infancy-nz.pdf

https://www.starship.org.nz/guidelines/vitamin-d-deficiency-investigation-and-management/

https://bpac.org.nz/2025/vitamind.aspx

Wheeler, Benjamin J et al. “A Brief History of Nutritional Rickets.” Frontiers in endocrinology (Lausanne) 10 (2019): 795. Web.

Simm, Peter J et al. “Editorial: Childhood Rickets—New Developments in Epidemiology, Prevention, and Treatment.” Frontiers in endocrinology (Lausanne) 11 (2020): 621734. Web.

Listen Here:

https://podcasts.apple.com/nz/podcast/sun-stores-and-supplementation-vitamin-d-in-pregnancy/id1845748299?i=1000769448088

https://open.spotify.com/episode/6UiuK9TgKYFg8A3xXNIwN3?si=8f5ae56c48f9434a