Effect of Vitamin D3Supplementation During Pregnancy on Risk of Persistent Wheeze in the Offspring

医学 喘息 怀孕 后代 儿科 哮喘 维生素D与神经学 队列研究 随机对照试验 产科 内科学 遗传学 生物
作者
Bo Chawes,Klaus Bønnelykke,Jakob Stokholm,Nadja Hawwa Vissing,Elín Bjarnadóttir,Ann‐Marie Malby Schoos,Helene M. Wolsk,Tine Marie Pedersen,Rebecca Vinding,Sunna Thorsteinsdóttir,Lambang Arianto,Henrik Wegener Hallas,Lene Heickendorff,Susanne Brix,Morten Arendt Rasmussen,Hans Bisgaard
出处
期刊:JAMA [American Medical Association]
卷期号:315 (4): 353-353 被引量:289
标识
DOI:10.1001/jama.2015.18318
摘要

Importance

Observational studies have suggested that increased dietary vitamin D intake during pregnancy may protect against wheezing in the offspring, but the preventive effect of vitamin D supplementation to pregnant women is unknown.

Objective

To determine whether supplementation of vitamin D3during the third trimester of pregnancy reduces the risk of persistent wheeze in the offspring.

Design, Setting, and Participants

A double-blind, single-center, randomized clinical trial conducted within the Copenhagen Prospective Studies on Asthma in Childhood 2010 cohort. Enrollment began March 2009 with a goal of 708 participants, but due to delayed ethical approval, only 623 women were recruited at 24 weeks of pregnancy. Follow-up of the children (N = 581) was completed when the youngest child reached age 3 years in March 2014.

Interventions

Vitamin D3(2400 IU/d; n = 315) or matching placebo tablets (n = 308) from pregnancy week 24 to 1 week postpartum. All women received 400 IU/d of vitamin D3as part of usual pregnancy care.

Main Outcomes and Measures

Age at onset of persistent wheeze in the first 3 years of life. Secondary outcomes included number of episodes of troublesome lung symptoms, asthma, respiratory tract infections, and neonatal airway immunology. Adverse events were assessed.

Results

Of the 581 children, persistent wheeze was diagnosed during the first 3 years of life in 47 children (16%) in the vitamin D3group and 57 children (20%) in the control group . Vitamin D3supplementation was not associated with the risk of persistent wheeze (hazard ratio [HR], 0.76 [95% CI, 0.52-1.12],P = .16), but the number of episodes of troublesome lung symptoms was reduced (mean episodes [95% CI]: 5.9 [5.2-6.6] for the vitamin D3group vs 7.2 [6.4-8.1] for the control group; incidence risk ratio [IRR], 0.83 [95% CI, 0.71-0.97],P = .02), and the airway immune profile was up-regulated (principal component analysis,P = .04). There was no effect on additional end points, including asthma (32 children [12%] in the vitamin D3group vs 47 children [14%] in the control group; odds ratio, 0.82 [95% CI, 0.50-1.36],P = .45), and respiratory tract infections (upper, mean [95% CI]: 5.2 [4.8-5.5] in the vitamin D3group vs 5.3 [4.9-5.6] in the control group, IRR, 0.99 [95% CI, 0.90-1.09],P = .84; lower: 94 children [32%] in the vitamin D3group vs 95 children [33%] in the control group, HR, 0.96 [95% CI, 0.72-1.27],P = .76). Intrauterine death was observed in 1 fetus (0%) in the vitamin D3group vs 3 fetuses (1%) in the control group and congenital malformations in 17 neonates (5%) in the vitamin D3group vs 23 neonates (8%) in the control group.

Conclusions and Relevance

The use of 2800 IU/d of vitamin D3during the third trimester of pregnancy compared with 400 IU/d did not result in a statistically significant reduced risk of persistent wheeze in the offspring through age 3 years. However, interpretation of the study is limited by a wide CI that includes a clinically important protective effect.

Trial Registration

clinicaltrials.gov Identifier:NCT00856947
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