The Impact of Baseline 25-Hydroxyvitamin D Level and Gestational Age on Prenatal Vitamin D Supplementation to Prevent Offspring Asthma or Recurrent Wheezing

Research output: Contribution to journalJournal articleResearchpeer-review

  • Iskander LC Shadid
  • Nicklas Brustad
  • Mengdi Lu
  • Chawes, Bo Lund Krogsgaard
  • Hans Bisgaard
  • Robert S. Zeiger
  • George T. O'Connor
  • Leonard B. Bacharier
  • Henk Jan Guchelaar
  • Augusto A. Litonjua
  • Scott T. Weiss
  • Hooman Mirzakhani

Background: Prenatal vitamin D deficiency is associated with asthma or recurrent wheezing in offspring. However, evidence from randomized trials on the efficacy of vitamin D supplementation is inconclusive. Objectives: We aimed to examine the differential efficacy of prenatal vitamin D supplementation based on the maternal baseline vitamin D status and the starting time of supplementation to prevent early life asthma or recurrent wheezing. Methods: We conducted a secondary analysis of the Vitamin D Antenatal Asthma Reduction Trial (VDAART), a randomized double-blind trial of prenatal vitamin D supplementation initiated at 10–18 weeks (wks) of gestation (4400 IU of intervention/day compared with 400 IU of placebo/day) to prevent offspring asthma or recurrent wheezing by the age of 6 years. We assessed the effect of modification of supplementation by maternal baseline vitamin D status at enrollment and the timing of initiation of supplementation. Results: An inverse relationship was observed between maternal 25-hydroxyvitamin D (25(OH)D) levels at trial entry and 25(OH)D levels during late pregnancy (32–38 wks of gestation) in both supplementation arms (P < 0.001). Overall, supplementation efficacy was not dependent on the maternal baseline 25(OH)D status. However, a trend toward the reduction of asthma or recurrent wheezing was observed across the baseline groups in the intervention arm (P = 0.01), with the greatest reduction observed in the most severely vitamin D–deficient women (25(OH)D < 12 ng/mL; adjusted odds ratio [aOR] = 0.48; confidence interval [CI]: 0.17, 1.34). Gestational age at trial enrollment modified supplementation efficacy, showing a greater reduction of offspring asthma or recurrent wheezing with earlier intervention during pregnancy (aOR = 0.85; CI = 0.76, 0.95), particularly in women who were 9–12 wk pregnant (aOR = 0.45; CI = 0.24, 0.82). Conclusions: Pregnant women with severe vitamin D deficiency show the greatest 25(OH)D improvement because of supplementation. In these women, a vitamin D dose of 4400 IU might have a preventive role in the development of early life offspring asthma or recurrent wheezing. Gestational age is suggested to modify the efficacy of prenatal vitamin D supplementation, showing the highest beneficial effect if supplementation is started during the first trimester of pregnancy. This study is an ancillary analysis from the VDAART, which is registered in ClinicalTrials.gov as NCT00902621.

Original languageEnglish
Book seriesAmerican Journal of Clinical Nutrition
Volume117
Issue number6
Pages (from-to)1342-1352
Number of pages11
ISSN0002-9165
DOIs
Publication statusPublished - 2023

Bibliographical note

Funding Information:
RSZ reports grants from the NHLBI for the present work; other grants and personal fees from Merck & Co. MedImmune/AstraZeneca, Genentech/Novartis, and GSK; personal fees from Regeneron Pharmaceuticals, UpToDate, and DBV Technologies; and grants from ALK Pharma, Teva, and Quest. ML currently works at Vertex Pharmaceuticals. The remaining authors report no conflicts of interest.

Funding Information:
The Vitamin D Antenatal Asthma Reduction Trial (VDAART) was funded by the National Heart, Lung, and Blood Institute ( U03 HL091528 and R01 HL091528 , to STW and AAL, respectively). HM has received research support from NHLBI ( U03 HL091528 and 1 K01HL146977 01A1 ).

Funding Information:
The Vitamin D Antenatal Asthma Reduction Trial (VDAART) was funded by the National Heart, Lung, and Blood Institute (U03 HL091528 and R01 HL091528, to STW and AAL, respectively). HM has received research support from NHLBI (U03 HL091528 and 1 K01HL146977 01A1).

Publisher Copyright:
© 2023 American Society for Nutrition

    Research areas

  • 25(OH)D, childhood asthma, pregnancy, recurrent wheeze, vitamin D supplementation

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