Maternal deficiencies may be the cause of overt bone disease from before birth and impairment of bone quality after birth.[7][8] The primary cause of congenital rickets is vitamin D deficiency in the mother's blood, which the baby shares.[8] Vitamin D ensures that serum phosphate and calcium levels are sufficient to facilitate the mineralization of bone.[9] Congenital rickets may also be caused by other maternal diseases, including severe osteomalacia, untreated celiac disease, malabsorption, pre-eclampsia, and premature birth.[7] Rickets in children is similar to osteoporosis in the elderly, with brittle bones. Pre-natal care includes checking vitamin levels and ensuring that any deficiencies are supplemented.[10]
Also exclusively breast-fed infants may require rickets prevention by vitamin D supplementation or an increased exposure to sunlight.[11]
In sunny countries such as Nigeria, South Africa, and Bangladesh, there is sufficient endogenous vitamin D due to exposure to the sun. However, the disease occurs among older toddlers and children in these countries, which in these circumstances is attributed to low dietary calcium intakes due to a mainly cereal-based diet.[12]