母亲补充维生素 A 与后代肺功能。

Maternal vitamin A supplementation and lung function in offspring.

机构信息

Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.

出版信息

N Engl J Med. 2010 May 13;362(19):1784-94. doi: 10.1056/NEJMoa0907441.

DOI:10.1056/NEJMoa0907441

PMID:20463338

Abstract

BACKGROUND

Vitamin A is important in regulating early lung development and alveolar formation. Maternal vitamin A status may be an important determinant of embryonic alveolar formation, and vitamin A deficiency in a mother during pregnancy could have lasting adverse effects on the lung health of her offspring. We tested this hypothesis by examining the long-term effects of supplementation with vitamin A or beta carotene in women before, during, and after pregnancy on the lung function of their offspring, in a population with chronic vitamin A deficiency.

METHODS

We examined a cohort of rural Nepali children 9 to 13 years of age whose mothers had participated in a placebo-controlled, double-blind, cluster-randomized trial of vitamin A or beta-carotene supplementation between 1994 and 1997.

RESULTS

Of 1894 children who were alive at the end of the original trial, 1658 (88%) were eligible to participate in the follow-up trial. We performed spirometry in 1371 of the children (83% of those eligible) between October 2006 and March 2008. Children whose mothers had received vitamin A had a forced expiratory volume in 1 second (FEV(1)) and a forced vital capacity (FVC) that were significantly higher than those of children whose mothers had received placebo (FEV(1), 46 ml higher with vitamin A; 95% confidence interval [CI], 6 to 86; FVC, 46 ml higher with vitamin A; 95% CI, 8 to 84), after adjustment for height, age, sex, body-mass index, calendar month, caste, and individual spirometer used. Children whose mothers had received beta carotene had adjusted FEV(1) and FVC values that were similar to those of children whose mothers had received placebo (FEV(1), 14 ml higher with beta carotene; 95% CI, -24 to 54; FVC, 17 ml higher with beta carotene, 95% CI, -21 to 55).

CONCLUSIONS

In a chronically undernourished population, maternal repletion with vitamin A at recommended dietary levels before, during, and after pregnancy improved lung function in offspring. This public health benefit was apparent in the preadolescent years.

摘要

背景

维生素 A 对调节早期肺发育和肺泡形成很重要。母体的维生素 A 状况可能是胚胎肺泡形成的重要决定因素，母亲在怀孕期间维生素 A 缺乏可能会对其后代的肺部健康产生持久的不良影响。我们通过检测在维生素 A 或β-胡萝卜素缺乏的人群中，孕妇在怀孕前、怀孕期间和怀孕后补充维生素 A 或β-胡萝卜素对其后代肺功能的长期影响来检验这一假说。

方法

我们对 1994 年至 1997 年参加维生素 A 或β-胡萝卜素补充剂安慰剂对照、双盲、整群随机试验的尼泊尔农村儿童的队列进行了研究，这些儿童当时 9 至 13 岁，其母亲参与了这项研究。

结果

在原试验结束时存活的 1894 名儿童中，有 1658 名（88%）符合参加随访试验的条件。我们在 2006 年 10 月至 2008 年 3 月间对其中 1371 名儿童（符合条件的 83%）进行了肺活量测定。与接受安慰剂的儿童相比，接受维生素 A 的儿童的一秒用力呼气容积（FEV1）和用力肺活量（FVC）明显更高（FEV1，接受维生素 A 者高 46ml；95%置信区间 [CI]，6 至 86；FVC，接受维生素 A 者高 46ml；95% CI，8 至 84），调整身高、年龄、性别、体重指数、日历月、种姓和个体肺活量计后。接受β-胡萝卜素的儿童的调整 FEV1 和 FVC 值与接受安慰剂的儿童相似（FEV1，接受β-胡萝卜素者高 14ml；95% CI，-24 至 54；FVC，接受β-胡萝卜素者高 17ml；95% CI，-21 至 55）。