ORIGINAL RESEARCH
Andrea J. Aul, MD; Philip R. Fischer, MD; Matthew R. Benson, MD; Sara S. Oberhelman-Eaton, MD; Kristin C. Mara, MS; Tom D. Thacher, MD
Corresponding Author: Andrea J. Aul, MD; Department of Pediatric and Adolescent Medicine - Mayo Clinic.Email: aul.andrea@mayo.eduDOI: 10.3122/jabfm.2022.220244R1Keywords: Breast Feeding, Dietary Supplements, Rickets, Vitamin DDates: Submitted: 07-17-2022; Revised: 09-24-2022; Accepted: 09-27-2022
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INTRODUCTION: Rates of infant vitamin D supplementation fall short of guideline recommendations. We explored this discrepancy from the clinician perspective as they advise and affect this important intervention to prevent rickets. We compared infant and high-dose maternal vitamin D supplementation prescribing attitudes and practices between infant-only clinicians (IC) and clinicians who care for mothers and infants (MIC).
METHODS: We surveyed clinicians in departments of family medicine, obstetrics/gynecology, primary care pediatrics, neonatology, newborn nursery, and members of vitamin D and rickets working groups and a social media group for lactation medicine providers about their perspectives and practices regarding vitamin D supplementation.
RESULTS: 360 clinician survey responses were analyzed. In current practice, IC were more likely than MIC to recommend vitamin D supplementation to exclusively (P<0.001) and partially breastfed infants (P=0.005). MIC were more likely than IC to discuss infant and high-dose maternal supplementation options and let the parents/caregivers choose (34.7%, 22.0%, P=0.009). If supplementing the mother with high-dose vitamin D or the infant directly each provided adequate vitamin D in the infant, MIC were more likely than IC to think that supplementation of the mother would be preferred by parents/caregivers (63.0%, 45.2%, P=0.003), improve adherence (66.5%, 49.4%, P=0.006), and promote breastfeeding (54.7%, 36.5%, P=0.001); they were also more likely to recommend supplementation of the mother (17.7%, 8.9%, P=0.04).
CONCLUSIONS: MIC are more likely than IC to embrace high-dose maternal vitamin D supplementation to provide adequate vitamin D for infants. This highlights an opportunity for further education of clinicians about this option.