Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK.
Br J Dermatol. 2022 Nov;187(5):659-666. doi: 10.1111/bjd.21721. Epub 2022 Aug 3.
Evidence linking prenatal maternal vitamin D supplementation with the offspring's risk of atopic eczema is inconsistent, with most data coming from observational studies.
To examine the influence of maternal cholecalciferol supplementation during pregnancy on the risk of atopic eczema in the offspring at ages 12, 24 and 48 months.
Within the UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) double-blind, randomized placebo-controlled trial, we examined the relationship of maternal vitamin D supplementation during pregnancy with offspring atopic eczema at ages 12, 24 and 48 months. In MAVIDOS, pregnant women were allocated to either cholecalciferol 1000 IU per day or matched placebo, taken from around 14 weeks' gestation until delivery, with the primary outcome of neonatal whole-body bone mineral content. The prevalence of atopic eczema in the offspring was ascertained at ages 12 (n = 635), 24 (n = 610) and 48 (n = 449) months, based on the UK Working Party criteria for the definition of atopic dermatitis. The trial was registered with ISRCTN (82927713) and EudraCT (2007-001716-23).
The characteristics of mothers and offspring were similar between the intervention and placebo groups, apart from longer breastfeeding duration in the intervention group. Adjusting for breastfeeding duration, offspring of mothers who received cholecalciferol 1000 IU daily had a lower odds ratio (OR) of atopic eczema at age 12 months [OR 0·55, 95% confidence interval (CI) 0·32-0·97, P = 0·04]; this effect weakened and was not statistically significant at ages 24 months (OR 0·76, 95% CI 0·47-1·23) or 48 months (OR 0·75, 95% CI 0·37-1·52). The statistical interaction of intervention and breastfeeding duration in relation to eczema at age 12 months was not significant (P = 0·41), but stratification showed reduced infantile eczema risk in the intervention group for infants breastfed for ≥ 1 month (OR 0·48, 95% CI 0·24-0·94, P = 0·03) but not in those breastfed for < 1 month (OR 0·80, 95% CI 0·29-2·17, P = 0·66).
Our data provide the first randomized controlled trial evidence of a protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema, with the effect potentially being via increased breast milk cholecalciferol levels. The findings support a developmental influence on atopic eczema, and point to a potentially modifiable perinatal influence on atopic eczema. What is already known about this topic? There are currently no antenatal interventions proven to reduce the incidence of infantile atopic eczema in the general population. However, observational studies have led to speculation that antenatal vitamin D supplementation may be beneficial.
将产前母体维生素 D 补充与后代特应性湿疹风险联系起来的证据不一致，大多数数据来自观察性研究。
检查妊娠期间母体胆钙化醇补充对 12、24 和 48 个月大的后代特应性湿疹风险的影响。
在英国母体维生素 D 骨质疏松症研究（MAVIDOS）的双盲、随机安慰剂对照试验中，我们检查了妊娠期间母体维生素 D 补充与 12、24 和 48 个月大的后代特应性湿疹之间的关系。在 MAVIDOS 中，孕妇被分配到每天胆钙化醇 1000 IU 或匹配的安慰剂组，从大约 14 周妊娠开始至分娩，主要结局是新生儿全身骨矿物质含量。根据英国工作组特应性皮炎的定义，在 12 个月（n=635）、24 个月（n=610）和 48 个月（n=449）时确定后代的特应性湿疹患病率。该试验在 ISRCTN（82927713）和 EudraCT（2007-001716-23）中注册。
干预组和安慰剂组的母亲和后代的特征除了干预组母乳喂养时间较长外，其他都相似。调整母乳喂养时间后，接受胆钙化醇 1000 IU 每日治疗的母亲的后代特应性湿疹的比值比（OR）在 12 个月时较低[OR 0.55，95%置信区间（CI）0.32-0.97，P=0.04]；这种效应在 24 个月（OR 0.76，95%CI 0.47-1.23）或 48 个月（OR 0.75，95%CI 0.37-1.52）时并不显著。干预与母乳喂养时间在 12 个月时与湿疹的统计学交互作用不显著（P=0.41），但分层显示干预组中母乳喂养≥1 个月的婴儿的婴儿湿疹风险降低（OR 0.48，95%CI 0.24-0.94，P=0.03），但母乳喂养<1 个月的婴儿的婴儿湿疹风险没有降低（OR 0.80，95%CI 0.29-2.17，P=0.66）。
我们的数据提供了第一个随机对照试验证据，表明产前胆钙化醇补充对婴儿特应性湿疹风险有保护作用，其作用可能是通过增加母乳中的胆钙化醇水平。研究结果支持特应性湿疹具有发育影响，并指出特应性湿疹可能具有潜在的可改变的围产期影响。关于这个话题，目前已经知道了什么？目前没有已被证明可以降低一般人群中婴儿特应性湿疹发病率的产前干预措施。然而，观察性研究导致人们推测产前维生素 D 补充可能有益。
