Revista»The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
Aims: To summarize the relationship between vitamin D and infant asthma or wheeze.Materials and methods: We used PubMed and Embase to search articles through July 2017 with selection criteria for relevant studies. Random-effect models were used to pool the results of included studies.Results: Ten articles with 14 independent reports of 2073 incident cases of asthma and 1875 cases of wheeze among 23 030 pairs of mother and child were included in our meta-analysis. Compared to those who did not take vitamin D, the mothers who had vitamin D supplementation during pregnancy stage could reduce the risk of asthma or wheeze in infants. The combined odds ratio of infant wheeze was 0.65 (95% CI = 0.54-0.79) and asthma was 0.78 (95% CI = 0.69-0.89). The results almost did not change in the subgroup analyses.Conclusions: It suggests that increasing maternal vitamin D intake during pregnancy might have a protective effect on suffering from wheeze and asthma for children.
BACKGROUND: In the past few years, growing evidence supports a preventive role of vitamin D supplementation during pregnancy for wheezing or asthma in offspring. However, the optimal dose of vitamin D intake is unclear. We conducted a meta-analysis to examine the linear and nonlinear dose-response pattern of vitamin D intake during pregnancy and asthma or wheezing in offspring.
QUESTIONS/PURPOSES: The purpose of this study was to answer the following question: Which dose of vitamin D is more effective in preventing wheezing in offspring?
METHOD: We identified relevant studies by searching PubMed, EMBASE and CENTRAL up to December 2017 and by hand-searching reference lists. Meta-analysis and subgroup analysis were performed. Fixed or random effects model linear trends analyses were conducted based on the heterogeneity test. Then, if the data did not show linear trends, we considered a nonlinear trend analysis instead.
RESULTS: A total of 6068 participants were included in the study. Our analysis showed an inverse relationship between the intake of vitamin D during pregnancy and the occurrence of wheezing in offspring (pooled OR = 0.68, 95% CI = 0.55-0.83, I2 = 24%, Z statistic = 3.64, p < 0.01). We found a nonlinear U-shaped association between vitamin D supplementation during pregnancy and asthma or wheezing in offspring, with the lowest risk at approximately 800 IU/d. Publication bias was shown in a funnel plot without Egger's test.
CONCLUSIONS: Vitamin D intake during pregnancy is inversely related to wheezing or asthma in offspring. Furthermore, the trend analysis indicates that offspring may benefit from approximately 800 IU/d vitamin D intake during pregnancy.
BACKGROUND: Vitamin D deficiency has been linked to an increased risk of asthma. This study aimed to quantify the effect of early life vitamin D status on asthma and wheeze later in life.
METHODS: PubMed, Embase, CINAHL, and CNKI databases, the Cochrane Central Register of Controlled Trials, and Google Scholar were searched up to July 2017. We included randomized controlled trials (RCTs) and cohort studies with vitamin D level in blood (maternal or cord or infant) or intake (maternal intake during pregnancy or infant intake) and asthma and/or wheeze. Two reviewers independently extracted data. Fixed- and random-effects models were used to summarize the risk estimates of comparisons between highest vs. lowest vitamin D categories.
RESULTS: Of the 1485 studies identified, three RCTs and 33 cohort studies were included. We did not include the RCTs (1619 participants) in the meta-analysis as the comparators and outcome definitions were heterogenous. Three RCTs reported a non-statistically significant effect of vitamin D supplementation during pregnancy on offspring wheeze/asthma at 3 years of age. Pooled estimates of cohort studies suggest no association between antenatal blood vitamin D levels or vitamin D intake and offspring asthma assessed either > 5 years or ≤ 5 years. The estimate for blood vitamin D remained unchanged when two studies assessing asthma in adulthood were excluded, but a significant inverse association emerged between vitamin D intake and childhood asthma. We found no association between antenatal vitamin D level and wheeze. On the other hand, vitamin D intake during pregnancy may have a protective effect against wheeze.
CONCLUSIONS: The pooled estimates from cohort studies show no association between antenatal blood vitamin D level and asthma/wheeze in later life. Whereas, the pooled estimates from cohort studies suggest that antenatal vitamin D intake may have an effect on childhood asthma > 5 years or childhood wheeze. The inconsistent results from studies assessing vitamin D either in blood or intake may be explained by previously reported non-linear association between blood vitamin D3 and childhood asthma. Further trials with enough power and longer follow-up time should be conducted to confirm the results.
BACKGROUND: There is uncertainty about the influence of diet during pregnancy and infancy on a child's immune development. We assessed whether variations in maternal or infant diet can influence risk of allergic or autoimmune disease.
METHODS AND FINDINGS: Two authors selected studies, extracted data, and assessed risk of bias. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. We searched Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Web of Science, Central Register of Controlled Trials (CENTRAL), and Literatura Latino Americana em Ciências da Saúde (LILACS) between January 1946 and July 2013 for observational studies and until December 2017 for intervention studies that evaluated the relationship between diet during pregnancy, lactation, or the first year of life and future risk of allergic or autoimmune disease. We identified 260 original studies (964,143 participants) of milk feeding, including 1 intervention trial of breastfeeding promotion, and 173 original studies (542,672 participants) of other maternal or infant dietary exposures, including 80 trials of maternal (n = 26), infant (n = 32), or combined (n = 22) interventions. Risk of bias was high in 125 (48%) milk feeding studies and 44 (25%) studies of other dietary exposures. Evidence from 19 intervention trials suggests that oral supplementation with nonpathogenic micro-organisms (probiotics) during late pregnancy and lactation may reduce risk of eczema (Risk Ratio [RR] 0.78; 95% CI 0.68-0.90; I2 = 61%; Absolute Risk Reduction 44 cases per 1,000; 95% CI 20-64), and 6 trials suggest that fish oil supplementation during pregnancy and lactation may reduce risk of allergic sensitisation to egg (RR 0.69, 95% CI 0.53-0.90; I2 = 15%; Absolute Risk Reduction 31 cases per 1,000; 95% CI 10-47). GRADE certainty of these findings was moderate. We found weaker support for the hypotheses that breastfeeding promotion reduces risk of eczema during infancy (1 intervention trial), that longer exclusive breastfeeding is associated with reduced type 1 diabetes mellitus (28 observational studies), and that probiotics reduce risk of allergic sensitisation to cow's milk (9 intervention trials), where GRADE certainty of findings was low. We did not find that other dietary exposures-including prebiotic supplements, maternal allergenic food avoidance, and vitamin, mineral, fruit, and vegetable intake-influence risk of allergic or autoimmune disease. For many dietary exposures, data were inconclusive or inconsistent, such that we were unable to exclude the possibility of important beneficial or harmful effects. In this comprehensive systematic review, we were not able to include more recent observational studies or verify data via direct contact with authors, and we did not evaluate measures of food diversity during infancy.
CONCLUSIONS: Our findings support a relationship between maternal diet and risk of immune-mediated diseases in the child. Maternal probiotic and fish oil supplementation may reduce risk of eczema and allergic sensitisation to food, respectively.
ANTECEDENTES: Hasta la fecha, no se ha llevado a cabo una revisión sistemática de las pruebas sobre la asociación entre la vitamina D y el desarrollo de enfermedades alérgicas. OBJETIVO: Revisar la eficacia y seguridad de la suplementación con vitamina D en comparación con la ausencia de suplementos en mujeres embarazadas, lactantes, lactantes y niños para la prevención de alergias. MÉTODOS: Se realizaron búsquedas en tres bases de datos hasta el 30 de enero de 2016, incluyendo estudios aleatorizados (ECA) y no aleatorios (NRS). Dos revisores extrajeron los datos de forma independiente y evaluaron la certeza en el cuerpo de evidencia usando el enfoque de Evaluación de Grados de Recomendaciones, Desarrollo y Evaluación (GRADE). RESULTADOS: Entre los 1932 artículos identificados, un ECA y cuatro NRS fueron elegibles. Una certeza muy baja en el conjunto de pruebas de los estudios examinados sugiere que la suplementación con vitamina D para mujeres embarazadas, lactantes y lactantes no puede disminuir el riesgo de desarrollar enfermedades alérgicas como la dermatitis atópica (en mujeres embarazadas), rinitis alérgica (en mujeres embarazadas, Asma y / o sibilancias (en mujeres embarazadas, lactantes y lactantes), o alergias alimentarias (en mujeres embarazadas). No se encontraron estudios de prevención primaria de enfermedades alérgicas en niños. CONCLUSIÓN: Se dispone de información limitada sobre la prevención primaria de las enfermedades alérgicas después de la suplementación con vitamina D y su posible impacto sigue siendo incierto. Este artículo está protegido por derechos de autor. Todos los derechos reservados.
Prenatal vitamin D status may influence offspring's respiratory and allergic outcomes; however, evidence is inconclusive. A systematic review and meta-analysis was conducted on the association between 25-hydroxyvitamin D [25(OH)D] levels in maternal blood in pregnancy or cord blood at birth with the risk of offspring's respiratory and allergic conditions. Two independent researchers conducted systematic searches for observational studies published until May 2017 using defined keywords on vitamin D and health outcomes, including respiratory tract infections (RTIs), wheeze, asthma, atopic eczema, allergic rhinitis, allergic sensitization, and lung function. Random-effects meta-analyses were conducted. A total of 34 from 547 retrieved articles were included. Increased prenatal exposure to 25(OH)D was inversely associated with risk of RTIs. Comparing the highest with the lowest category of 25(OH)D levels, the pooled odds ratio was 0.64 (95% CI 0.47, 0.87). A positive borderline association was found for lung function at school age (FEV1 z-score coefficient 0.07, 95% CI -0.01, 0.15). No associations were found for wheeze, asthma, atopic eczema, allergic rhinitis, and allergic sensitization. The introduction of public health measures to tackle vitamin D status in pregnancy may reduce the burden of RTIs in offspring. Current evidence does not support an impact on asthma and allergy. This article is protected by copyright. All rights reserved.
Objectives To estimate the effects of vitamin D supplementation during pregnancy on 11 maternal and 27 neonatal/infant outcomes; to determine frequencies at which trial outcome data were missing, unreported, or inconsistently reported; and to project the potential contributions of registered ongoing or planned trials.Design Systematic review and meta-analysis of randomised controlled trials; systematic review of registered but unpublished trials.Data sources Medline, Embase, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from inception to September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials.Eligibility criteria for study selection Trials of prenatal vitamin D supplementation with randomised allocation and control groups administered placebo, no vitamin D, or vitamin D ≤600 IU/day (or its equivalent), and published in a peer reviewed journal.Results 43 trials (8406 participants) were eligible for meta-analyses. Median sample size was 133 participants. Vitamin D increased maternal/cord serum concentration of 25-hydroxyvitamin D, but the dose-response effect was weak. Maternal clinical outcomes were rarely ascertained or reported, but available data did not provide evidence of benefits. Overall, vitamin D increased mean birth weight of 58.33 g (95% confidence interval 18.88 g to 97.78 g; 37 comparisons) and reduced the risk of small for gestational age births (risk ratio 0.60, 95% confidence interval 0.40 to 0.90; seven comparisons), but findings were not robust in sensitivity and subgroup analyses. There was no effect on preterm birth (1.0, 0.77 to 1.30; 15 comparisons). There was strong evidence that prenatal vitamin D reduced the risk of offspring wheeze by age 3 years (0.81, 0.67 to 0.98; two comparisons). For most outcomes, meta-analyses included data from a minority of trials. Only eight of 43 trials (19%) had an overall low risk of bias. Thirty five planned/ongoing randomised controlled trials could contribute 12 530 additional participants to future reviews.Conclusions Most trials on prenatal vitamin D published by September 2017 were small and of low quality. The evidence to date seems insufficient to guide clinical or policy recommendations. Future trials should be designed and powered to examine clinical endpoints, including maternal conditions related to pregnancy (such as pre-eclampsia), infant growth, and respiratory outcomes.Systematic review registration PROSPERO CRD42016051292.
Las infecciones del tracto respiratorio (ITR) son una causa común de morbilidad y mortalidad en niños pequeños y pueden asociarse con sibilancias. La vitamina D puede tener un papel protector contra la RTI. MATERIALES Y MÉTODOS: Se realizó una búsqueda sistemática de Pubmed, Embase y la biblioteca Cochrane. Los títulos y resúmenes fueron evaluados y los artículos seleccionados fueron revisados por dos autores. Se incluyeron ensayos controlados aleatorios (ECA) que investigaron el efecto de la suplementación de vitamina D durante el embarazo en RTI o sibilancias en niños de 5 años de edad o menos. Se incluyeron estudios observacionales sobre la asociación entre la 25-hidroxivitamina D sérica (25OHD) durante el embarazo, o al nacer, y RTIs y / o sibilancias. El protocolo se registró en PROSPERO (número de registro CRD42015019183). Resultados: De los cuatro ECA, uno mostró un efecto protector de una dosis diaria alta (2,000 UI) de vitamina D durante el embarazo en las visitas al médico RTI de la descendencia (p = 0,004, el ECA también incluyó 800UI / día suplemento hasta los seis meses) . El metanálisis de tres ECA mostró un riesgo relativo reducido (RR) para la sibilancia de la prole cuando las madres fueron suplementadas con vitamina D durante el embarazo (RR = 0,81 [IC del 95%: 0,68-0,97], p = 0,025). En tres de cuatro estudios de observación de calidad moderada y cinco de diez de calidad moderada, se observó una asociación inversa entre el embarazo y el cordón de 25OHD y el consiguiente sibilo y / o RTI. CONCLUSIÓN: La creciente evidencia apoya un papel preventivo de la vitamina D durante el embarazo en la sibilancia de la progenie y / o RTI. Los futuros estudios de intervención pueden necesitar superar las recomendaciones actuales de suplementos de vitamina D durante el embarazo para mostrar beneficios contra sibilancias o infecciones en la infancia.
SCOPE: Mounting evidence suggests that maternal vitamin D status during pregnancy may be associated with development of childhood asthma, but the results are still inconsistent. A dose-response meta-analysis was performed to quantitatively summarize evidence on the association of maternal vitamin D status during pregnancy with the risk of childhood asthma.
METHODS AND RESULTS: A systematic search was conducted to identify all studies assessing the association of maternal 25-hydroxyvitamin D (25(OH)D) during pregnancy with risk of childhood asthma. The fixed or random-effect model was selected based on the heterogeneity test among studies. Nonlinear dose-response relationship was assessed by restricted cubic spline model. Fifteen prospective studies with 12 758 participants and 1795 cases were included in the meta-analysis. The pooled relative risk of childhood asthma comparing the highest versus lowest category of maternal 25(OH)D levels was 0.87 (95% confidence interval, CI, 0.75-1.02). For dose-response analysis, evidence of a U-shaped relationship was found between maternal 25(OH)D levels and risk of childhood asthma (Pnonlinearity = 0.02), with the lowest risk at approximately 70 nmol/L of 25(OH)D.
CONCLUSION: This dose-response meta-analysis suggested a U-shaped relationship between maternal blood 25(OH)D levels and risk of childhood asthma. Further studies are needed to confirm the association.
Antecedentes: Las enfermedades alérgicas han experimentado un aumento en todo el mundo, con los niños que sufren la mayor carga. Por lo tanto, la prevención temprana de las enfermedades alérgicas es una prioridad de salud pública. OBJETIVO: Sintetizar la evidencia de ensayos controlados aleatorios (ECA) que evaluaron el efecto de las intervenciones vitamínicas durante el embarazo en el desarrollo de enfermedades alérgicas en la descendencia. MÉTODOS: Se realizaron búsquedas en CENTRAL, MEDLINE, SCOPUS, Registro Internacional de Ensayos Clínicos de la Organización Mundial de la Salud, tesis electrónicas y Web of Science. La calidad del estudio se evaluó utilizando la herramienta Cochrane de riesgo de sesgo. Los ECA incluidos tuvieron un mínimo de 1 mes de seguimiento postgestativo. RESULTADOS: Un total de 5 ECA cumplieron los criterios de inclusión, incluyendo 2456 niños que usaron vitaminas C + E (1 estudio), vitamina C (1 estudio) y vitamina D (3 estudios) en comparación con placebo / control. Se consideró que dos estudios tenían un alto riesgo de sesgo por sesgo de desempeño o una alta tasa de pérdida de seguimiento. Todos fueron clasificados como de bajo riesgo de sesgo por cegamiento de la evaluación de resultados. No realizamos metanálisis con estudios de vitamina C o vitamina C + E debido a la alta heterogeneidad entre los 2 estudios incluidos. Sin embargo, realizamos un metanálisis con ensayos de vitamina D (incluidos 1493 niños) y los resultados mostraron una asociación entre la ingesta prenatal de vitamina D y el riesgo de desarrollar sibilancias recurrentes en la progenie (riesgo relativo (RR), 0,812; IC del 95%, 0,67 - 0,98). CONCLUSIONES: La evidencia actual sugiere que la suplementación prenatal de vitamina D podría tener un efecto beneficioso sobre la sibilancia recurrente en niños. El seguimiento a largo plazo de estos estudios es necesario para determinar si este efecto observado es sostenido. No hay evidencia sobre el efecto de otras vitaminas para la prevención de los resultados respiratorios y / o alérgicos.
Aims: To summarize the relationship between vitamin D and infant asthma or wheeze.Materials and methods: We used PubMed and Embase to search articles through July 2017 with selection criteria for relevant studies. Random-effect models were used to pool the results of included studies.Results: Ten articles with 14 independent reports of 2073 incident cases of asthma and 1875 cases of wheeze among 23 030 pairs of mother and child were included in our meta-analysis. Compared to those who did not take vitamin D, the mothers who had vitamin D supplementation during pregnancy stage could reduce the risk of asthma or wheeze in infants. The combined odds ratio of infant wheeze was 0.65 (95% CI = 0.54-0.79) and asthma was 0.78 (95% CI = 0.69-0.89). The results almost did not change in the subgroup analyses.Conclusions: It suggests that increasing maternal vitamin D intake during pregnancy might have a protective effect on suffering from wheeze and asthma for children.
