Table 16. The effect of maternal vitamin D status in gestation on offspring anthropometry and body composition – Observational studies.

First Author and year	Bias score	Study type	Study Details, age at which children were assessed and technique used	Offspring outcome assessed (units)	Confounders/ adjustments	Number of weeks gestation when maternal 25(OH)D3 was measured	Mean (SD) or median (IQR) maternal 25(OH)D concentration (nmol/l)	Mean (SD) offspring outcome according to maternal 25(OH)D category/Unadjusted correlation coefficient (r) or regression coefficient (B) (95% CI)			Adjusted correlation coefficient (r) or regression coefficient (B) (95% CI)			Conclusion
Weiler, 2005 86	3 (med)	Cross- sectional	Winnipeg, Canada Sample size for analysis=50 women Neonates delivered at term and assessed within 15 days of birth by DXA	Whole body fat (%)	Nil, but no significant difference in terms of offspring sex, season of birth, gestational age at birth in mothers with 25(OH)D >37.5 nmol/l compared with those with 25(OH)D <37.5 nmol/l Significant difference in race between the 2 groups (o=0.010	Within 48 hours of delivery	Overall mean not given Mean in adequate 25(OH)D group (>37.5 nmol/l, n=32)= 61.6 (24.7) Mean in the deficient group (<37.5 nmol/l, n=18)=28.6 (7.8)		Maternal 215(OH)D <37.5 nmol	Maternal 25(OH )D >37.5 nmol	Not given			No significant difference in offspring whole body fat in those with maternal 25(OH)<37.5 nmol/l compared to those with maternal 25(OH)D >37.5 nmol/l
								Mean (SD) neonatal whole body fat (%)	12.7 (4.1)	10.6 (4.1)
Morley, 2006 91	8 (low)	Cohort	Melbourne, Australia n=374 women (232 recruited in winter, 127 in summer) Neonates assessed between 12-72 h of age using calipers/encircling tape	Subscapular skinfold (mm) Triceps skinfold (mm) Suprailiac skin fold (mm) Mid upper-arm circumference (cm) Calf circumference (cm)	Sex, maternal height, whether first child, smoking, season of blood sample	11 weeks and 28-32 weeks	Winter recruitment, geometric mean at 11 wks=49.2; 26-32 wks=48.3 Summer recruitment geometric mean at 11 weeks=62.6; 26-32 wks=68.9		β (95% CI) for every Log2 increase in maternal 25(OH)D (i.e. doubling of 25(OH)D at 28-32 wks		Adjusted β (95% CI) for every Log2 increase in maternal 25(OH)D (i.e. doubling of 25(OH)D) at 28-32 weeks			A weak inverse association seen between maternal 25(OH)D and offspring subscapular and triceps skinfold thickness. No significant association seen with suprailiac skinfold thickness, mid upper arm circumference or calf circumference after adjustment for confounders
								Subscapular skinfold (mm)	−0.2 (−0.4, −0.02)		−0.2 (−0.4, −0.06)
								Triceps skinfold (mm)	−0.3 (−0.5, −0.02)		−0.1 (−0.4, 0.1)
								Suprailiac skin fold (mm)	−0.06 (−0.4, 0.1)		−0.06 (−0.4, 0.2)
								Mid upper arm circumference (cm)	0.08 (−0.07, 0.2)		0.1 (−0.06, 0.3)
								Calf circumferene (cm)	0.05 (−0.1, 0.2)		0 (−0.2, 0.2)
Gale, 2008 25	4 (med)	Cohort	Princess Anne Cohort, Southampton, UK Children assessed at birth n=466), 9 months (n=440) and 9 years (n=178) using measuring tape with DXA at 9 years only	Mid-upper arm circumference (cm) at birth and 9 months Fat mass (kg) Lean mass (kg) at 9 years	Adjusted for age of child at scan	Late pregnancy (median (IQR) 32.6 (32-33.4) weeks	50 (30-75.3) 50.4% had 25(OH)D >50nmol/k 28.3% had levels 27.5-50 nmol/l 21.1% had levels <27.5 nmol/l	P value for difference in offspring outcome according to quartile of maternal 25(OH)D			Not given			No significant association between maternal 25(OH)D concentration measured in late pregnancy and offspring’s mid upper arm circumference at birth and 9 months. At 9 years fat mass and lean mass tended to be lower in children born to mothers in the lowest of 25(OH)D distribution but no statistically significant linear trends seen.
									p value
								Mid-upper arm circumference at birth	0.080
								Mid-upper arm circumference at 9 months	0.581
								Fat mass at 9 years	0.090
								Lean mass at 9 years	0.090
Sayers, 2009 42	3 (med)	Cohort	ALSPAC, cohort, UK n=6955 women Children assessed at mean age 9.9 years by DXA	Lean mass (kg) fat mass (kg)	Nil	Not directly measured Ambient UVB measured during 98 days preceding birth	Not measured		β (95% CI) change in outcome per 1 SD increase in UVB	P value	Not given			Maternal UVB exposure in pregnancy is positively associated with offspring lean mass at age 9 years. No significant association seen with fat mass.
								Lean mass (kg)	163 (89, 237)	0.00002
								Fat mass (kg)	73.9 (−44.2, 191.9)	0.22
Krishnaveni, 2011 102	4 (med)	Cohort	Mysore Parthenon Study, Mysore, India Children assessed at 5 years (n=506) and 9.5 years (n=469) using measuring tape, calipers and bioimpedence	Arm muscle area (AMA; cm2) Subscapular skinfold, thickness (mm), Triceps skinfold thickness (mm), Waist circumference, Fat mass (kg), Percent body fat (%), Fat-free mass (kg), Percent fat-free mass (%)	Offspring sex and age, maternal BMI, gestational diabetes, socioeconomic score, parity and religion	28-32 weeks (at study entry)	39.0 (24-58) 67% of women had 25(OH)D <50 nmol/l (the authors definition of deficiency)	Not given			Comparing offspring of mothers with and without 25(OH)D deficiency (deficient=0, non-deficient=1)			At ages 5 and 9.5 years offspring born to women with 25(OH)D <50 nmol/l in late pregnancy had significantly reduced arm-muscle area in comparison to those children born to mothers without deficient. No significant difference seen in any of the other anthropometric or body composition measurements
												β	P Value
											5 yr
											AMA	0.4	0.01
											Subsca p	.004	0.86
											Triceps	0.01	0.55
											Waist	0.07	0.81
											Fat mass	−0.01	0.92
											%Fat	−0.4	0.48
											Fat-free mass	0.1	0.33
											%fat free mass	0.3	0.51
											9.5 yr
											AMA	0.7	0.02
											Subscap	−.009	0.80
											Triceps	.004	0.88
											Waist	0.3	0.62
											Fat mass	−0.07	0.77
											%Fat mass	−0.6	0.34
											Fat free mass	0.2	0.50
											%Fat free mass	0.6	0.33
Crozier, 2012 103	8 (low)	Cohort	Southampton Women’s Survey, UK Children assessed at birth (574), 4 years (565) and 6 years (447) using DXA	Fat mass (kg) Fat free mass (kg)	Offspring sex, gestation, age at measurement, length/ height, maternal educational attainment, smoking in pregnancy, pre-pregnancy BMI, maternal height, parity, social class, Institute of Medicine weight gain category, breastfeeding duration, vitamin D intake at 3 years, physical activity at 3 years	34 weeks	62 (43-89)	Outcome	Unadjusted β (95% CI)	P Value	Adjusted β (95% CI)	P value		Positive association between late pregnancy maternal 25(OH)D and offspring fat mass at birth after adjusting for confounders. Negative association late pregnancy maternal 25(OH)D and fat mass at 6 years after adjusting for confounders. No significant association seen at 4 years after adjustments for confounders.
								Birth fat mass (SD)	0.06 (−0.01, 0.12)	0.09	0.08 (0.02, 0.15)	0.02
								Birth fat-free mass (SD)	0.02 (−0.03, 0.07)	0.44	0.04 (−0.02, 0.09)	0.17
								4-y fat mass (SD)	−0.09 (−0.16, 0.02)	0.02	−0.01 (−0.08, 0.07)	0.81
								4-y fat-free mass (SD)	0.03 (−0.02, 0.08)	0.21	0.03 (−0.02, 0.08)	0.30
								6-y fat mass (SD)	−0.16 (−0.23, −0.08)	<0.001	−0.10 (−0.17, −0.02)	0.01
								6-y fat-free mass (SD)	0.01 (−0.04, 0.06)	0.65	0.02 (−0.03, 0.07)	0.43

DXA = Dual energy X-ray absorptiometry