Christensen Nikolas, Søndergaard Jens, Fisker Niels, Christesen Henrik Thybo
From the *Hans Christian Andersen Children's Hospital, Odense University Hospital, †Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, and ‡Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Pediatr Infect Dis J. 2017 Apr;36(4):384-391. doi: 10.1097/INF.0000000000001452.
Respiratory tract infections (RTIs) are a common cause of morbidity and mortality in young children and can be associated with wheeze. Vitamin D can have a protective role against RTI.
A systematic search of PubMed, Embase and the Cochrane library was performed. Titles and abstracts were evaluated, and selected articles were reviewed by 2 authors. We included randomized controlled trials (RCTs) investigating the effect of vitamin D supplementation during pregnancy on RTIs or wheeze in children of 5 years of age or younger. Observational studies on the association between serum 25-hydroxyvitamin D during pregnancy, or at birth, and RTIs and/or wheeze were included. The protocol was registered on PROSPERO (Registration number: CRD42015019183).
Of 4 RCTs, 1 showed a protective effect of a high daily dose (2000 IU) of vitamin D during pregnancy on offspring RTI doctor visits (P = 0.004; the RCT also included 800 IU/d supplement to the infants until 6 months). Meta-analysis of 3 RCTs showed a reduced relative risk for offspring wheeze when mothers were supplemented with vitamin D during pregnancy [relative risk: 0.81 (95% confidence interval: 0.68-0.97), P = 0.025]. In 3 of 4 strong-quality, and 5 of 10 moderate-quality observational studies, an inverse association between pregnancy and cord 25-hydroxyvitamin D and subsequent wheeze and/or RTI was seen.
Growing evidence supports a preventive role of vitamin D during pregnancy on offspring wheeze and/or RTI. Recommendations in future intervention studies may need to exceed current recommendations of vitamin D supplementation during pregnancy to show benefit against childhood wheeze or infections.
呼吸道感染（RTIs）是幼儿发病和死亡的常见原因，且可能与喘息相关。维生素D对呼吸道感染具有保护作用。
对PubMed、Embase和Cochrane图书馆进行了系统检索。评估了标题和摘要，并由两位作者对选定的文章进行了评审。我们纳入了调查孕期补充维生素D对5岁及以下儿童呼吸道感染或喘息影响的随机对照试验（RCTs）。纳入了关于孕期或出生时血清25-羟基维生素D与呼吸道感染和/或喘息之间关联的观察性研究。该方案已在PROSPERO上注册（注册号：CRD42015019183）。
在4项随机对照试验中，1项试验显示孕期每日高剂量（2000 IU）维生素D对后代呼吸道感染就诊有保护作用（P = 0.004；该随机对照试验还包括在婴儿6个月前每日补充800 IU）。对3项随机对照试验的荟萃分析显示，孕期母亲补充维生素D时，后代喘息的相对风险降低[相对风险：0.81（95%置信区间：0.68 - 0.97），P = 0.025]。在4项高质量和10项中等质量观察性研究中的3项中，观察到孕期和脐带血25-羟基维生素D与随后的喘息和/或呼吸道感染之间呈负相关。
越来越多的证据支持孕期维生素D对后代喘息和/或呼吸道感染具有预防作用。未来干预研究中的建议可能需要超过目前孕期补充维生素D的建议量，以显示对儿童喘息或感染的益处。
