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Aim The aim of this study was to evaluate the uptake of a free vitamin D infant prescription programme and to determine the incidence of nutritional rickets. Methods This was a retrospective cohort study of infants from Quebec, Canada, involving term infants born between 1998 and 2008 and covered by the public insurance programme. Data were extracted from the Quebec Pregnancy Cohort. Predictors of programme participation were identified through logistic regression. Results A total of 123 018 infants were eligible, and the mean annual prevalence of supplemental vitamin D exposure was 17.9 ± 5.6%. The median age for obtaining the first bottle was 36 days and half only obtained one bottle of 50 doses. Mothers with higher socio-economic status, those who lived as a couple, older mothers or a prescription by a paediatrician significantly increased the odds of obtaining vitamin D. There was a decline in programme participation over time ( OR 0.89/year, 95% CI = 0.88-0.90). The incidence of rickets was 23.9 cases per 100 000 live births, with an annual increase of 1.12 cases/year (95% CI = 1.01-1.24). Conclusion Without educational measures, a free prescription programme for vitamin D failed to encourage participation or adherence. Moreover, participation decreased with time. New strategies, including educational support, need to be developed to increase vitamin D supplementation rates. [ABSTRACT FROM AUTHOR]

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Health policy in North America advocates that all breastfed infants receive a vitamin D supplement of 400 IU per day for the primary prevention of rickets. Despite this recommendation, rickets still occurs in Canada. It is not known whether vitamin D deficiency in the Canadian population is solely attributable to inadequacies in vitamin supplementation. Thus, the evaluation of current practices, including awareness and compliance with recommendations, is clearly needed. The objective of this study was to describe the vitamin D supplementation practices of mothers of newborns living in the Montreal area. This was a cross-sectional telephone survey of 343 mothers delivering a healthy term infant from December 2007 to May 2008 at the Royal Victoria Hospital (Montreal, Que.). Ninety percent of all mothers breastfed their infants during the first 6 months; 53% did so exclusively. Of mothers exclusively breastfeeding, 74% reported meeting the Health Canada recommendation. The main reason for not adhering to the recommendation was the assumption by mothers who began to feed fortified formula (400 IU·L-1) that supplementation was no longer necessary. Fifty percent of infants receiving mixed feedings without supplementation prior to 6 months did not achieve the recommended intake. Receiving advice about supplementation and the higher education of mothers were significant positive determinants of supplementation practices. This work identified infants consuming mixed feedings and those consuming only formula in the first 6 months as groups at high risk for not meeting the recommended 400 IU·day-1 of vitamin D. Therefore there may still be gaps in knowledge regarding vitamin D supplementation. D’après la politique nord-américaine en matière de santé, les nourrissons allaités au sein devraient consommer tous les jours 400 UI de vitamine D à titre de prévention primaire contre le rachitisme. Malgré cette recommandation, le rachitisme se manifeste encore au Canada. On ne sait pas si la carence en vitamine D dans la population canadienne est uniquement imputable à l’apport insuffisant de suppléments vitaminiques. Il est donc important d’évaluer les usages actuels et d’inclure les notions de sensibilisation et de conformité aux recommandations. Cette étude se propose de décrire les pratiques de supplémentation en vitamine D chez les mères de nouveau-nés vivant dans la région de Montréal. Cette étude transversale réalisée au moyen d’une enquête téléphonique s’adresse à 343 femmes ayant mis au monde un enfant à terme et en bonne santé à l’hôpital Royal Victoria (Montréal, Que.) entre les mois de décembre 2007 et mai 2008. Quatre-vingt dix pour cent des mères ont allaité leur enfant au cours des 6 premiers mois; 53 % l’ont fait de façon exclusive. Soixante-quatorze pour cent des femmes s’en tenant exclusivement à l’allaitement ont dit avoir suivi les recommandations de Santé Canada. La principale raison évoquée par les femmes ne se conformant pas à la recommandation est qu’après un certain temps ces femmes pensaient que ce n’était plus nécessaire. Cinquante pour cent des nourrissons recevant une alimentation mixte sans supplément au cours des six premiers mois n’ont pas eu l’apport recommandé. Avoir des conseils en matière de supplémentation et avoir fréquenté des établissements d’enseignement supérieur constituent des déterminants positifs signifiants en matière de pratiques de supplémentation. Cette enquête révèle que les nourrissons recevant une alimentation mixte ou ne consommant que des préparations enrichies au cours des six premiers mois constituent un groupe à haut risque, car il ne rencontre pas les recommandations stipulant un apport de 400 UI de vitamine D; ces nourrissons sont plus à risque que les enfants allaités au sein. Il semble donc y avoir un écart entre les connaissances et les comportements au sujet de la supplémentation en vitamine D. [ABSTRACT FROM AUTHOR]