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Differential low uptake of free vitamin D supplements in preterm infants: the Quebec experience
Insights
Vitamin D supplement uptake was low among preterm infants in Quebec, decreasing over time and varying by gestational age. Targeting interventions towards late preterm infants and younger mothers could improve vitamin D supplementation rates.
Area of Science:
- Neonatal Health
- Public Health Policy
- Nutritional Science
Background:
- Vitamin D is crucial for bone health in premature infants.
- Quebec's public health insurance (Régie de l'Assurance Maladie du Québec - RAMQ) provides free vitamin D supplements.
- Understanding supplement uptake is vital for optimizing infant nutrition.
Purpose of the Study:
- To assess vitamin D supplement acquisition by preterm infants through the RAMQ program.
- To analyze variations in supplement uptake based on gestational age.
- To identify factors influencing participation and adherence to vitamin D supplementation.
Main Methods:
- Retrospective cohort study of preterm infants (1998-2008) covered by RAMQ.
- Data linkage from the Quebec Pregnancy Cohort administrative database.
- Stratification by early (<34 weeks) and late gestational age; logistic regression for predictor analysis.
Main Results:
- 24.5% of 10,288 eligible preterm infants received vitamin D; uptake was higher in early preterms (37.4%) vs. late preterms (20.7%).
- Median supplement bottles obtained were 2 for early and 1 for late preterm infants.
- Program participation declined annually (OR=0.90/year), with higher uptake associated with older/educated mothers and pediatrician prescriptions.
Conclusions:
- Vitamin D supplement uptake by preterm infants was low and decreased over the first year post-discharge.
- Early preterm infants showed higher initial acquisition rates than late preterm infants.
- Intervention strategies should consider targeting late preterm infants and mothers with lower educational attainment to enhance vitamin D supplementation.
Background:
Vitamin D is essential for bone mineralization, particularly in premature infants. For nearly 20 years, Quebec has offered a program of free vitamin D supplements via its public medication insurance plan Régie de l'Assurance Maladie du Québec (RAMQ). The objective of this study is to evaluate the number of preterm infants that obtained at least one bottle (50 doses) of vitamin D supplement through this program and to determine if uptake varied by gestational age.
Methods:
This was a retrospective cohort study of preterm infants covered by RAMQ and born from 1998 to 2008; all infants had 1 year of follow-up data regarding supplement use. Data were extracted from the Quebec Pregnancy Cohort, a linked administrative database and were stratified by early (<34 weeks) or late gestational age premature infants. The number of infants obtaining supplements was the primary outcome and their characteristics were compared across gestational age groups. Predictors for participation (obtaining at least 1 bottle) or adherence (2 or more bottles) were identified via logistic regression (GEE).
Results:
10288 infants were eligible; the percentage exposed to vitamin D was 24.5% (37.4%- early; 20.7%-late preterm infants, p < 0.001). The median number of bottles obtained was 2 for early and 1 for late preterms. For all premature infants, there was an apparent geometric decline in the infants obtaining subsequent bottles of supplements over the 12 month period. Additionally, there was a significant decline in program participation over time (OR = 0.90/year, 95% CI: 0.89-0.90) regardless of gestational age. Older or more educated mothers were positive predictors for participation. A prescription from a pediatrician significantly increased the odds of obtaining the supplement.
Conclusion:
Early preterm infants were more likely to obtain the supplement post-discharge; uptake was low and decreased with time for both age categories. Specifically, targeting late preterm infants and young mothers with less education could improve vitamin D uptake.
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