title: The effect of maternal vitamin D concentration on fetal bone.
abstract: BACKGROUND
  Vitamin D deficiency during pregnancy may be associated with suboptimal fetal growth, but direct evidence is lacking.
  
  
  OBJECTIVE
  The aim of the study was to validate a method for fetal femur volume (FV) measurement using three-dimensional ultrasound and to detect correlations between FV and maternal vitamin D concentration.
  
  
  METHODS
  A novel method for assessing FV consists of three ultrasound measurements-femur length, proximal metaphyseal diameter (PMD), and midshaft diameter-and a volume equation; this was validated by comparing ultrasound to computed tomography measurements in six pregnancies after mid-trimester termination. This method was then applied in a cohort of healthy pregnant women participating in the Southampton Women Survey. Fetal three-dimensional ultrasound and maternal 25-hydroxyvitamin D [25(OH)D] levels were performed at 34 wk; dual-energy x-ray absorptiometry of the newborn was performed shortly after birth. Univariate and multiple linear regression analyses were performed between maternal characteristics and fetal outcomes.
  
  
  METHODS
  We performed ultrasound measurements of the fetal femur.
  
  
  RESULTS
  In 357 pregnant participants, serum 25(OH)D correlated significantly with FV (P = 0.006; r = 0.147) and PMD (P = 0.001; r = 0.176); FV also demonstrated positive univariate correlations with maternal height (P < 0.001; r = 0.246), weight (P = 0.003; r = 0.160), triceps skinfold thickness (P = 0.013; r = 0.134), and a borderline negative effect from smoking (P = 0.061). On multiple regression, independent predictors of FV were the maternal height and triceps skinfold thickness; the effect of 25(OH)D on FV was attenuated, but it remained significant for PMD.
  
  
  CONCLUSIONS
  Using a novel method for assessing FV, independent predictors of femoral size were maternal height, adiposity, and serum vitamin D. Future trials should establish whether pregnancy supplementation with vitamin D is beneficial for the fetal skeleton, using FV and PMD as fetal outcome measures.
authors.affiliation: Nuffield Department of Obstetrics and Gynecology, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom. chrisioannou@doctors.org.uk
authors.forename: C
authors.initials: C
authors.lastname: Ioannou
authors.forename: M K
authors.initials: MK
authors.lastname: Javaid
authors.forename: P
authors.initials: P
authors.lastname: Mahon
authors.forename: M K
authors.initials: MK
authors.lastname: Yaqub
authors.forename: N C
authors.initials: NC
authors.lastname: Harvey
authors.forename: K M
authors.initials: KM
authors.lastname: Godfrey
authors.forename: J A
authors.initials: JA
authors.lastname: Noble
authors.forename: C
authors.initials: C
authors.lastname: Cooper
authors.forename: A T
authors.initials: AT
authors.lastname: Papageorghiou
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density / Q000502:physiology*; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging* / Q000378:metabolism; D047109:Fetal Development / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D