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Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial.
J Allergy Clin Immunol. 2017 Nov; 140(5):1423-1429.e5.JA

Abstract

BACKGROUND

Nutrient trials differ from drug trials because participants have varying circulating levels at entry into the trial.

OBJECTIVE

We sought to study the effect of a vitamin D intervention in pregnancy between subjects of different races and the association between 25-hydroxyvitamin D3 (25[OH]D) levels in pregnancy and the risk of asthma/recurrent wheeze in offspring.

METHODS

The Vitamin D Antenatal Asthma Reduction Trial is a randomized trial of pregnant women at risk of having children with asthma randomized to 4400 international units/d vitamin D or placebo plus 400 international units/d vitamin D. Asthma and recurrent wheezing until age 3 years were recorded.

RESULTS

African American (AA) women (n = 312) had lower initial levels of 25(OH)D (mean [SD], 17.6 ng/mL [8.3 ng/mL]) compared with non-AA women (n = 400; 27.1 ng/mL [9.7 ng/mL], P < .001). No racial difference was found from vitamin D supplementation in pregnancy on asthma/recurrent wheezing in offspring (P for interaction = .77). Having an initial level of greater than 30 ng/mL and being randomized to the intervention group was associated with the lowest risk for asthma/recurrent wheeze by age 3 years compared with having an initial level of less than 20 ng/mL and receiving placebo (adjusted odds ratio, 0.42; 95% CI, 0.19-0.91).

CONCLUSIONS

We did not find differences between AA and non-AA mothers in the effect of maternal vitamin D supplementation and asthma/recurrent wheeze in offspring at 3 years. Maternal supplementation of vitamin D, particularly in mothers with initial 25(OH)D levels of greater than 30 ng/mL, reduced asthma/recurrent wheeze in the offspring through age 3 years, suggesting that higher vitamin D status beginning in early pregnancy is necessary for asthma/recurrent wheeze prevention in early life.

Authors+Show Affiliations

Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Mass.Department of Pediatrics, Boston Medical Center, Boston, Mass.Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.Department of Allergy and Research evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.Department of Allergy and Research evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: augusto.litonjua@channing.harvard.edu.

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

28285844

Citation

Wolsk, Helene M., et al. "Vitamin D Supplementation in Pregnancy, Prenatal 25(OH)D Levels, Race, and Subsequent Asthma or Recurrent Wheeze in Offspring: Secondary Analyses From the Vitamin D Antenatal Asthma Reduction Trial." The Journal of Allergy and Clinical Immunology, vol. 140, no. 5, 2017, pp. 1423-1429.e5.
Wolsk HM, Harshfield BJ, Laranjo N, et al. Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. J Allergy Clin Immunol. 2017;140(5):1423-1429.e5.
Wolsk, H. M., Harshfield, B. J., Laranjo, N., Carey, V. J., O'Connor, G., Sandel, M., Strunk, R. C., Bacharier, L. B., Zeiger, R. S., Schatz, M., Hollis, B. W., Weiss, S. T., & Litonjua, A. A. (2017). Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. The Journal of Allergy and Clinical Immunology, 140(5), 1423-e5. https://doi.org/10.1016/j.jaci.2017.01.013
Wolsk HM, et al. Vitamin D Supplementation in Pregnancy, Prenatal 25(OH)D Levels, Race, and Subsequent Asthma or Recurrent Wheeze in Offspring: Secondary Analyses From the Vitamin D Antenatal Asthma Reduction Trial. J Allergy Clin Immunol. 2017;140(5):1423-1429.e5. PubMed PMID: 28285844.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vitamin D supplementation in pregnancy, prenatal 25(OH)D levels, race, and subsequent asthma or recurrent wheeze in offspring: Secondary analyses from the Vitamin D Antenatal Asthma Reduction Trial. AU - Wolsk,Helene M, AU - Harshfield,Benjamin J, AU - Laranjo,Nancy, AU - Carey,Vincent J, AU - O'Connor,George, AU - Sandel,Megan, AU - Strunk,Robert C, AU - Bacharier,Leonard B, AU - Zeiger,Robert S, AU - Schatz,Michael, AU - Hollis,Bruce W, AU - Weiss,Scott T, AU - Litonjua,Augusto A, Y1 - 2017/03/09/ PY - 2016/07/26/received PY - 2016/12/12/revised PY - 2017/01/04/accepted PY - 2017/3/14/pubmed PY - 2017/11/29/medline PY - 2017/3/14/entrez KW - Vitamin D KW - allergy KW - asthma KW - prenatal KW - randomized controlled trial SP - 1423 EP - 1429.e5 JF - The Journal of allergy and clinical immunology JO - J Allergy Clin Immunol VL - 140 IS - 5 N2 - BACKGROUND: Nutrient trials differ from drug trials because participants have varying circulating levels at entry into the trial. OBJECTIVE: We sought to study the effect of a vitamin D intervention in pregnancy between subjects of different races and the association between 25-hydroxyvitamin D3 (25[OH]D) levels in pregnancy and the risk of asthma/recurrent wheeze in offspring. METHODS: The Vitamin D Antenatal Asthma Reduction Trial is a randomized trial of pregnant women at risk of having children with asthma randomized to 4400 international units/d vitamin D or placebo plus 400 international units/d vitamin D. Asthma and recurrent wheezing until age 3 years were recorded. RESULTS: African American (AA) women (n = 312) had lower initial levels of 25(OH)D (mean [SD], 17.6 ng/mL [8.3 ng/mL]) compared with non-AA women (n = 400; 27.1 ng/mL [9.7 ng/mL], P < .001). No racial difference was found from vitamin D supplementation in pregnancy on asthma/recurrent wheezing in offspring (P for interaction = .77). Having an initial level of greater than 30 ng/mL and being randomized to the intervention group was associated with the lowest risk for asthma/recurrent wheeze by age 3 years compared with having an initial level of less than 20 ng/mL and receiving placebo (adjusted odds ratio, 0.42; 95% CI, 0.19-0.91). CONCLUSIONS: We did not find differences between AA and non-AA mothers in the effect of maternal vitamin D supplementation and asthma/recurrent wheeze in offspring at 3 years. Maternal supplementation of vitamin D, particularly in mothers with initial 25(OH)D levels of greater than 30 ng/mL, reduced asthma/recurrent wheeze in the offspring through age 3 years, suggesting that higher vitamin D status beginning in early pregnancy is necessary for asthma/recurrent wheeze prevention in early life. SN - 1097-6825 UR - https://www.unboundmedicine.com/medline/citation/28285844/Vitamin_D_supplementation_in_pregnancy_prenatal_25_OH_D_levels_race_and_subsequent_asthma_or_recurrent_wheeze_in_offspring:_Secondary_analyses_from_the_Vitamin_D_Antenatal_Asthma_Reduction_Trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(17)30217-8 DB - PRIME DP - Unbound Medicine ER -