Vitamins, Pregnancy and Asthma

Q: 24 years old female is admitted to ICU with severe exacerbation of Asthma. While recovering, her spouse, who also has history of severe asthma, inquires about a news report that some vitamin intake by mother during pregnancy may reduce the risk of developing Asthma in the offspring. Which vitamin has been shown to reduce such risk in the early childhood of offspring? - select one

A) Vitain A

B) Vitamin B

C) Vitamin C

D) Vitamin D

E) Multi-Vitamin

Answer: D

There is a weak evidence of high-dose vitamin D intake (2000 to 4000 IU/day) by women during pregnancy - that reduces the risk of developing early life wheezing and allergic rhinitis, at least up to the age of 3-5 years in their children. This effect has been said to be more pronounced in northern climates (away from the equator). The effect is at least a 20% reduction. This effect is independent of other related factors such as maternal smoking status, maternal intake of vitamin E, zinc, and calcium, and vitamin D intake by the children. 

The proposed mechanism involves immunomodulation of multiple cell types, notably dendritic and T regulatory cells, and effects on in-utero lung development.

The high dose intake is in addition to the recommended dietary allowance (RDA) of 600 IU/day of vitamin D (the standard dose of prenatal vitamins). 

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#vitamins

References:

1. Litonjua AA, Carey VJ, Laranjo N, et al. Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial. JAMA 2016; 315:362.

2. Erkkola M, Kaila M, Nwaru BI, et al. Maternal vitamin D intake during pregnancy is inversely associated with asthma and allergic rhinitis in 5-year-old children. Clin Exp Allergy 2009; 39:875.

3. Rothers J, Wright AL, Stern DA, et al. Cord blood 25-hydroxyvitamin D levels are associated with aeroallergen sensitization in children from Tucson, Arizona. J Allergy Clin Immunol 2011; 128:1093.

4. Litonjua AA. The role of vitamin D in the development, exacerbation, and severity of asthma and allergic diseases. In: Vitamin D and the lung: Mechanisms and disease associations, Litonjua AA (Ed), Humana Press, New York 2012.

5. Ramirez LG, Lee-Sarwar K, Kelly RS, et al. Association of Prenatal Maternal and Infant Vitamin D Supplementation with Offspring Asthma. Ann Am Thorac Soc 2024; 21:279.