Prenatal vitamin D supplementation to prevent childhood asthma: 15-year results from the Vitamin D Antenatal Asthma Reduction Trial (VDAART) - 05/02/24

Doi : 10.1016/j.jaci.2023.10.003

Scott T. Weiss, MD, MS ^a,^⁎ , Hooman Mirzakhani, MD, PhD, MMSc ^a, Vincent J. Carey, PhD ^a, George T. O’Connor, MD ^b, Robert S. Zeiger, MD ^c, Leonard B. Bacharier, MD ^d, Jeffrey Stokes, MD ^e, Augusto A. Litonjua, MD, MPH ^f
^a Department of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
^b Department of Medicine, Pulmonary Centre, Boston Medical Centre, Boston University, Boston, Mass
^c Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif
^d Department of Pediatrics, Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr Children’s Hospital at Vanderbilt, Nashville, Tenn
^e Department of Pediatrics, Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Washington University, St Louis, Mo
^f Department of Pediatrics Golisano Children’s Hospital, Pediatric Pulmonary Division, University of Rochester Medical School, Rochester, NY

^∗Corresponding author: Scott T. Weiss, MD, MS, Channing Division of Network Medicine, 181 Longwood Ave, Boston, MA 02115.Channing Division of Network Medicine181 Longwood AveBostonMA02115

Abstract

This article provides an overview of the findings obtained from the Vitamin D Antenatal Asthma Reduction Trial (VDAART) spanning a period of 15 years. The review covers various aspects, including the trial’s rationale, study design, and initial intent-to-treat analyses, as well as an explanation of why those analyses did not achieve statistical significance. Additionally, the article delves into the post hoc results obtained from stratified intent-to-treat analyses based on maternal vitamin D baseline levels and genotype-stratified analyses. These results demonstrate a statistically significant reduction in asthma among offspring aged 3 and 6 years when comparing vitamin D supplementation (4400 IU/d) to the standard prenatal multivitamin with vitamin D (400 IU/d). Furthermore, these post hoc analyses found that vitamin D supplementation led to a decrease in total serum IgE levels and improved lung function in children compared to those whose mothers received a placebo alongside the standard prenatal multivitamin with vitamin D. Last, the article concludes with recommendations regarding the optimal dosing of vitamin D for pregnant women to prevent childhood asthma as well as suggestions for future trials in this field.

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Key words : Vitamin D, supplementation, pregnancy, randomized trials, childhood asthma

Abbreviations used : COPSAC₂₀₁₀, ITT, SNP, 25(OH)D, VDAART