RANDOMIZED TRIAL: MATERNAL VITAMIN D SUPPLEMENTATION TO PREVENT CHILDHOOD ASTHMA
A Augusto
Brigham And Women´s Hospitalcity: Boston country: United States (us)
Grant 5U01HL091528-04 from National Heart, Lung, And Blood Institute
Abstract: Asthma is one of the leading causes of morbidity in children with 60% of all cases diagnosed by age 3. Thus, finding factors that can lead to prevention of this disease would be of great public health importance. Vitamin D deficiency is highly prevalent among pregnant women, and thus, represents a potentially modifiable factor for the prevention of disease. Due to the effect of vitamin D in modulating immune responses, we believe that vitamin D deficiency in pregnant mothers leads to faulty immune system development in the neonate, predisposing them to asthma and allergy. We have observational data from two independent birth cohort studies that higher maternal intakes of vitamin D during pregnancy are each independently associated with a 50% reduction in risk for recurrent wheezing and asthma in 3- and 5-yr old children. However, in order to recommend this as a universal treatment to prevent asthma, a randomized, controlled, clinical trial is necessary. Therefore, we propose a two arm, double-blind, placebo controlled, randomized, clinical trial of Vitamin D, to determine whether higher vitamin D intake and levels in the pregnant mother will prevent asthma and allergy in the child at age 3. We will identify pregnant women who have asthma or allergies or whose partner has asthma or allergies, from obstetric clinics in the three clinical centers participating in this trial. We will recruit 870 pregnant women during the first trimester of pregnancy and randomize them to one of two treatment arms of a 4-year clinical trial 4000 IU of Vitamin D in addition to usual prenatal vitamins, n=435; and usual prenatal vitamins alone, n=435. Our primary specific aim is to determine whether adequate vitamin D supplementation in the pregnant mother is associated with reduced incidence of asthma in the child during the first 3 years of life. The sub-aims of the study will include (1) To determine whether adequate vitamin D supplementation in the pregnant mother is associated with reduced secondary outcomes in the child of (a) allergic sensitization, (b) doctor´s diagnosis of eczema and (c) lower respiratory tract infections during the first 3 years of life; and (2) To determine whether adequate vitamin D supplementation in the pregnant mother is associated with improved vitamin D status in the mothers and their offspring through measurement of 25(OH)D levels in maternal plasma, cord blood, and children´s blood at 1 and 3 yrs of age. We believe that it is likely that Vitamin D deficiency has had a significant impact on the asthma epidemic that began in the early 1980´s. Greater time spent indoors, and use of sun screen has resulted in reduced sun exposure and decreased production of vitamin D; and lack of adequate dietary supplementation to compensate for these behavioral changes, results in very low vitamin D levels. We believe that with adequate dosing of vitamin D in pregnant women, we can prevent half of all asthma cases in their offspring and ultimately reduce disease prevalence to pre-1980 levels. If successful, this trial will ultimately decrease asthma incidence by 50% and consequently decrease health care costs by 8 billion dollars. This intervention is cheap, safe, and will result in major public health benefit. It also represents the most innovative and novel approach to asthma treatment and prevention in the last 30 years
Keywords: 3 year old; Address; Affect; Age; Allergic; Area; arm; Asthma; asthma prevention; Autoimmune Diseases; Awareness; Behavioral; Birth; Blood; burden of illness; Cells; Child; Childhood; Childhood Asthma; Chronic Disease; Cities; Clinic; Clinical; Clinical Trials; Cohort Studies; Consensus; Control Groups; Data; Developing Countries; Diagnosis; Dietary intake; Dietary Supplementation; Discipline of obstetrics; Disease; disorder prevention; disorder risk; Dose; Double-Blind Method; Eczema; Environmental Risk Factor; Epidemic; Exposure to; Fatty acid glycerol esters; First Pregnancy Trimester; follow-up; Health Benefit; Health Care Costs; Healthcare; Hormones; Hypersensitivity; IgE; Immune response; Immune system; Immune System Diseases; improved; in utero; Incidence; Inflammation; Inflammatory Bowel Diseases; innovation; Insulin-Dependent Diabetes Mellitus; Intake; interest; Interleukin-10; Intervention; Lead; Life; Lower Respiratory Tract Infection; Lung; Maintenance; Measurement; Morbidity - disease rate; Mothers; Multi-Institutional Clinical Trial; Multiple Sclerosis; National Heart, Lung, and Blood Institute; neonate; novel strategies; Nutrient; offspring; Placebo Control; Placebos; Plasma; Population; Pregnancy; pregnant; Pregnant Women; prenatal; Prevalence; prevent; Prevention; primary outcome; Production; public health medicine (field); public health relevance; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; randomized trial; Recruitment Activity; Recurrence; Regulation; Respiratory Tract Infections; Rheumatoid Arthritis; Risk; Rural; Seasonal Variations; Second Pregnancy Trimester; secondary outcome; Skin Cancer; Spontaneous abortion; Stillbirth; Sun Exposure; Sunlight; Supplementation; Systems Development; TGFB1 gene; The Sun; Time; Umbilical Cord Blood; Variant; Vitamin D; Vitamin D Deficiency; Vitamins; Wheezing; Withdrawal
Relevance: Narrative - We believe that it is likely that Vitamin D deficiency has had a significant impact on the asthma epidemic that began in the 1970´s. Greater time spent indoors, and use of sun screen has resulted in reduced sun exposure and decreased production of vitamin D; and lack of adequate dietary supplementation to compensate for these behavioral changes, results in very low vitamin D levels. We believe that with adequate dosing of vitamin D in pregnant women, we can prevent half of all asthma cases in their offspring and ultimately reduce disease prevalence to pre-1980 levels. If successful, this trial will ultimately decrease asthma incidence by 25-50% and consequently decrease health care costs by 8 billion dollars. This intervention is cheap, safe, and will result in major public health benefit. It also represents the most innovative and novel approach to asthma treatment and prevention in the last 30 years
Project start date: 2009-03-01
Project end date: 2014-02-28
Budget start date: 1-MAR-2012
Budget end date: 28-FEB-2013
5U01HL091528-04 (2012): $2026165
Sponsored Links Excellgen http://Excellgen.com
RANDOMIZED TRIAL: MATERNAL VITAMIN D SUPPLEMENTATION TO PREVENT CHILDHOOD ASTHMA
A Augusto, Professor Of Medicine
Brigham And Women´s Hospitalcity: Boston country: United States (us)
Grant 5U01HL091528-03 from National Heart, Lung, And Blood Institute
Abstract: Asthma is one of the leading causes of morbidity in children with 60% of all cases diagnosed by age 3. Thus, finding factors that can lead to prevention of this disease would be of great public health importance. Vitamin D deficiency is highly prevalent among pregnant women, and thus, represents a potentially modifiable factor for the prevention of disease. Due to the effect of vitamin D in modulating immune responses, we believe that vitamin D deficiency in pregnant mothers leads to faulty immune system development in the neonate, predisposing them to asthma and allergy. We have observational data from two independent birth cohort studies that higher maternal intakes of vitamin D during pregnancy are each independently associated with a 50% reduction in risk for recurrent wheezing and asthma in 3- and 5-yr old children. However, in order to recommend this as a universal treatment to prevent asthma, a randomized, controlled, clinical trial is necessary. Therefore, we propose a two arm, double-blind, placebo controlled, randomized, clinical trial of Vitamin D, to determine whether higher vitamin D intake and levels in the pregnant mother will prevent asthma and allergy in the child at age 3. We will identify pregnant women who have asthma or allergies or whose partner has asthma or allergies, from obstetric clinics in the three clinical centers participating in this trial. We will recruit 870 pregnant women during the first trimester of pregnancy and randomize them to one of two treatment arms of a 4-year clinical trial 4000 IU of Vitamin D in addition to usual prenatal vitamins, n=435; and usual prenatal vitamins alone, n=435. Our primary specific aim is to determine whether adequate vitamin D supplementation in the pregnant mother is associated with reduced incidence of asthma in the child during the first 3 years of life. The sub-aims of the study will include (1) To determine whether adequate vitamin D supplementation in the pregnant mother is associated with reduced secondary outcomes in the child of (a) allergic sensitization, (b) doctor´s diagnosis of eczema and (c) lower respiratory tract infections during the first 3 years of life; and (2) To determine whether adequate vitamin D supplementation in the pregnant mother is associated with improved vitamin D status in the mothers and their offspring through measurement of 25(OH)D levels in maternal plasma, cord blood, and children´s blood at 1 and 3 yrs of age. We believe that it is likely that Vitamin D deficiency has had a significant impact on the asthma epidemic that began in the early 1980´s. Greater time spent indoors, and use of sun screen has resulted in reduced sun exposure and decreased production of vitamin D; and lack of adequate dietary supplementation to compensate for these behavioral changes, results in very low vitamin D levels. We believe that with adequate dosing of vitamin D in pregnant women, we can prevent half of all asthma cases in their offspring and ultimately reduce disease prevalence to pre-1980 levels. If successful, this trial will ultimately decrease asthma incidence by 50% and consequently decrease health care costs by 8 billion dollars. This intervention is cheap, safe, and will result in major public health benefit. It also represents the most innovative and novel approach to asthma treatment and prevention in the last 30 years
Keywords: 3 year old; Address; Affect; Age; Allergic; Area; arm; Asthma; asthma prevention; Autoimmune Diseases; Awareness; Behavioral; Birth; Blood; burden of illness; Cells; Child; Childhood; Childhood Asthma; Chronic Disease; Cities; Clinic; Clinical; Clinical Trials; Cohort Studies; Consensus; Control Groups; Data; Developing Countries; Diagnosis; Dietary intake; Dietary Supplementation; Discipline of obstetrics; Disease; disorder prevention; disorder risk; Dose; Double-Blind Method; Eczema; Environmental Risk Factor; Epidemic; Exposure to; Fatty acid glycerol esters; First Pregnancy Trimester; follow-up; Health Benefit; Health Care Costs; Healthcare; Hormones; Hypersensitivity; IgE; Immune response; Immune system; Immune System Diseases; improved; in utero; Incidence; Inflammation; Inflammatory Bowel Diseases; innovation; Insulin-Dependent Diabetes Mellitus; Intake; interest; Interleukin-10; Intervention; Lead; Life; Lower Respiratory Tract Infection; Lung; Maintenance; Measurement; Morbidity - disease rate; Mothers; Multi-Institutional Clinical Trial; Multiple Sclerosis; National Heart, Lung, and Blood Institute; neonate; novel strategies; Nutrient; offspring; Placebo Control; Placebos; Plasma; Population; Pregnancy; pregnant; Pregnant Women; prenatal; Prevalence; prevent; Prevention; primary outcome; Production; public health medicine (field); public health relevance; Randomized; Randomized Clinical Trials; Randomized Controlled Clinical Trials; randomized trial; Recruitment Activity; Recurrence; Regulation; Respiratory Tract Infections; Rheumatoid Arthritis; Risk; Rural; Seasonal Variations; Second Pregnancy Trimester; secondary outcome; Skin Cancer; Spontaneous abortion; Stillbirth; Sun Exposure; Sunlight; Supplementation; Systems Development; TGFB1 gene; The Sun; Time; Umbilical Cord Blood; Variant; Vitamin D; Vitamin D Deficiency; Vitamins; Wheezing; Withdrawal
Relevance: Narrative - We believe that it is likely that Vitamin D deficiency has had a significant impact on the asthma epidemic that began in the 1970´s. Greater time spent indoors, and use of sun screen has resulted in reduced sun exposure and decreased production of vitamin D; and lack of adequate dietary supplementation to compensate for these behavioral changes, results in very low vitamin D levels. We believe that with adequate dosing of vitamin D in pregnant women, we can prevent half of all asthma cases in their offspring and ultimately reduce disease prevalence to pre-1980 levels. If successful, this trial will ultimately decrease asthma incidence by 25-50% and consequently decrease health care costs by 8 billion dollars. This intervention is cheap, safe, and will result in major public health benefit. It also represents the most innovative and novel approach to asthma treatment and prevention in the last 30 years
Project start date: 2009-03-01
Project end date: 2014-02-28
Budget start date: 1-MAR-2011
Budget end date: 29-FEB-2012
PFA/PA: PA-07-070
5U01HL091528-03 (2011): $2026165