Maternal vitamin A supplementation and lung function in offspring.
Author(s): Checkley W, West KP Jr, Wise RA, Baldwin MR, Wu L, LeClerq SC, Christian P, Katz
J, Tielsch JM, Khatry S, Sommer A.
Affiliation(s): Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins
University, Baltimore, MD 21205, USA. wcheckl1@jhmi.edu
Publication date & source: 2010, N Engl J Med. , 362(19):1784-94
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.
Erratum in
N Engl J Med. 2010 Dec 30;363(27):2674.
N Engl J Med. 2010 Aug 19;363(8):798.
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