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产前维生素 D 补充以预防儿童哮喘:维生素 D 预防哮喘减少试验(VDAART)的 15 年结果。

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

机构信息

Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.

出版信息

J Allergy Clin Immunol. 2024 Feb;153(2):378-388. doi: 10.1016/j.jaci.2023.10.003. Epub 2023 Oct 16.

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.

摘要

本文概述了维生素 D 产前哮喘减少试验(VDAART)长达 15 年的研究结果。该综述涵盖了试验的原理、研究设计和初始意向治疗分析,以及解释为什么这些分析没有达到统计学意义。此外,本文还深入探讨了基于母体维生素 D 基线水平和基因型分层分析的事后分层意向治疗分析的结果。这些结果表明,与标准产前多种维生素加维生素 D(400IU/d)相比,维生素 D 补充(4400IU/d)可显著降低 3 岁和 6 岁儿童的哮喘发病率。此外,这些事后分析发现,与接受标准产前多种维生素加维生素 D 安慰剂的母亲的孩子相比,维生素 D 补充可降低儿童的总血清 IgE 水平并改善其肺功能。最后,本文就预防儿童哮喘的孕妇最佳维生素 D 剂量提出了建议,并为该领域的未来试验提供了建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53af/11740440/b503963ba777/nihms-2047339-f0001.jpg

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