ESPEYB17 5. Bone, Growth Plate and Mineral Metabolism Advances in Clinical Practice (5 abstracts)
5.5. Six-year follow-up of a trial of antenatal vitamin D for asthma reduction
Litonjua AA , Carey VJ , Laranjo N , Stubbs BJ , Mirzakhani H , O’Connor GT , Sandel M , Beigelman A , Bacharier LB , Zeiger RS , Schatz M , Hollis BW & Weiss ST
Department of Pediatrics, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, NY, USA
To read the full abstract: N Engl J Med. 2020;382(6):525–533.
In brief: High dose vitamin D supplementation of 4400 IU compared with 400 IU during the prenatal period alone to mothers of offspring at risk for asthma did not influence the incidence of asthma and recurrent wheeze in children aged 6-years.
Commentary: Vitamin D deficiency has been implicated in the increasing prevalence of asthma and allergies in westernized societies. Because asthma and wheezing illnesses begin very early in life, studies of prenatal and early-life risk factors are crucial. These authors had previously reported a reduction in asthma and recurrent wheeze in 3-year-old children of pregnant women who had received a higher dose vitamin D supplementation of 4400 IU compared with 400 IU (average treatment time 25 weeks). However, the 6.1% reduction in incidence with higher dose supplementation was not statistically significant.
Here, the same authors followed the children to age 6 years to determine the course of asthma and recurrent wheeze. Throughout the study, investigators and participants remained unaware of the treatment assignments.
There was no effect of maternal vitamin D supplementation on asthma and recurrent wheeze in either an intention-to-treat analysis or an analysis with stratification according to the maternal 25-hydroxyvitamin D level during pregnancy. There was no effect of prenatal vitamin D supplementation on most of the prespecified secondary outcomes. This study found no effects of prenatal supplementation on spirometric indexes. Although there was a very small effect on airway resistance as measured by impulse oscillometry, this finding was of uncertain significance.
This study concluded that vitamin D supplementation during the prenatal period alone to mothers of offspring at risk for asthma did not influence the 6-year incidence of asthma and recurrent wheeze in the children. This study has number of limitations mainly in relation to lack of postnatal supplementation and enrolment of pregnant women in the trial was without regard to their initial vitamin D concentration. Nevertheless, it provides insight into the lack of benefit of antenatal exposure of high dose Vitamin D to prevent atopic disease in children.
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ESPE Yearbook of Paediatric Endocrinology
ISSN 1662-4009 (Online)
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