Journal Article

Prenatal vitamin D supplementation reduces risk of asthma/recurrent wheeze in early childhood: A combined analysis of two randomized controlled trials

Hollis, Bruce W., Bisgaard, Hans, Chawes, Bo L., Wolsk, Helene M., Weiss, Scott T., Waage, Johannes, Litonjua, Augusto A., Stokholm, Jakob, Bønnelykke, Klaus

2017

Overview

We recently published two independent randomized controlled trials of vitamin D supplementation during pregnancy, both indicating a >20% reduced risk of asthma/recurrent wheeze in the offspring by 3 years of age. However, neither reached statistical significance. To perform a combined analysis of the two trials and investigate whether maternal 25-hydroxy-vitamin D (25(OH)D) level at trial entry modified the intervention effect. VDAART (N = 806) and COPSAC2010. (N = 581) randomized pregnant women to daily high-dose vitamin D3 (4,000 IU/d and 2,400 IU/d, respectively) or placebo. All women also received a prenatal vitamin containing 400 IU/d vitamin D3. The primary outcome was asthma/recurrent wheeze from 0-3yrs. Secondary end-points were specific IgE, total IgE, eczema and lower respiratory tract infections (LRTI). We conducted random effects combined analyses of the treatment effect, individual patient data (IPD) meta-analyses, and analyses stratified by 25(OH)D level at study entry. The analysis showed a 25% reduced risk of asthma/recurrent wheeze at 0-3yrs: adjusted odds ratio (aOR) = 0.74 (95% CI, 0.57-0.96), p = 0.02. The effect was strongest among women with 25(OH)D level ≥30ng/ml at study entry: aOR = 0.54 (0.33-0.88), p = 0.01, whereas no significant effect was observed among women with 25(OH)D level <30ng/ml at study entry: aOR = 0.84 (0.62-1.15), p = 0.25. The IPD meta-analyses showed similar results. There was no effect on the secondary end-points. This combined analysis shows that vitamin D supplementation during pregnancy results in a significant reduced risk of asthma/recurrent wheeze in the offspring, especially among women with 25(OH)D level ≥ 30 ng/ml at randomization, where the risk was almost halved. Future studies should examine the possibility of raising 25(OH)D levels to at least 30 ng/ml early in pregnancy or using higher doses than used in our studies. COPSAC2010: ClinicalTrials.gov NCT00856947; VDAART: ClinicalTrials.gov NCT00920621.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Age / Allergies / Asthma / Asthma - prevention & control / Biology and Life Sciences / Care and treatment / Child, Preschool / Childhood / Children / Clinical trials / Data processing / Diabetes / Eczema / Female / Health aspects / Health risks / Hospitals / Humans / Immunoglobulin E / Medicine / Medicine and Health Sciences / Meta-analysis / Nutritional aspects / Offspring / Physical sciences / Placebos / Pregnancy / Prenatal Care / Prenatal experience / Progeny / Randomization / Randomized Controlled Trials as Topic / Recurrence / Research and Analysis Methods / Respiratory Sounds / Respiratory tract / Respiratory tract diseases / Risk / Risk reduction / Skin diseases / Studies / Supplementation / Supplements / Vitamin D / Vitamin D - administration & dosage / Vitamin D3 / Vitamin deficiency / Womens health