Bone Abstracts

Over 80% of Quebec woman initiate breastfeeding, and rates of exclusive breastfeeding at 6 months doubled from 2003 (9.7%) to 2009 (19.0%). To prevent deficiency, current recommendations for these infants include 400 IU/day of vitamin D. For 20 years, Quebec has offered a program of free vitamin D supplements through its public medication insurance plan (RAMQ).

Objective: Program evaluation over the last decade.

Methods: This is a retrospective descriptive analysis of infants born between Jan 1998 and Dec 2008. All healthy term infants covered by RAMQ drug plan were eligible; ~30% of pregnant women and infants are covered. Data were extracted from the Quebec Pregnancy Registry linking three databases: RAMQ (diagnoses, medications, and SES), MedEcho (hospitalizations), and IQ20 (birthweight, SES). Multivariable logistic regression (GEE) examined predictors of participation.

Results: A total of 123 018 infants were eligible. Mean annual prevalence of vitamin D exposure was 17.9%±5.6. Median age at which the first bottle of supplements was obtained was 36 days (range=0–370). The majority (51.0%) obtained only one bottle of fifty doses (median=1, range=1–20). Significant predictors (P<0.05) were prescription by pediatrician (odds ratio (OR)=1.23, with 95% CI=1.19–1.27); increasing maternal age (OR=1.018/year, 95% CI=1.015–1.021); non-synthesizing season for vitamin D (OR=1.04, 95% CI=1.01–1.07); women living alone (OR=0.87, 95% CI=0.83–0.91), less education (OR 0.88, 95% CI=0.84–0.92) and rural residence (OR 0.94, 95% CI=0.91–0.98). There was also a decline in program participation over time (OR 0.89/year, 95% CI=0.88–0.90).

Conclusions: Program participation was low and decreased with time. Additional risks for rickets included long delay prior to filling the first prescription, failure to renew, younger mothers, mothers with less education, and care by a non-pediatrician. Overall, poor uptake suggests difficulty in administration of supplements, poor understanding of their potential benefits, or low acceptance of health professionals’ advice. New preventive strategies need to be developed to increase long-term vitamin D compliance.

Declaration of funding: Funded by Montreal Children’s Hospital-Research Institute and Gray Family Fund.