Prenatal vitamin D supplementation decreases incident atopic eczema in first year of birth

U.K.: According to a study published in the British Journal of Dermatology, administering mothers 1000 IU of cholecalciferol daily from 14 weeks of pregnancy till delivery resulted in a lower incidence of atopic eczema in the first year of life.

A surge in atopic eczema prevalence has been seen globally in recent decades, with estimates of prevalence ranging from 95% in children under the age of 4 to 16.5% in children ages 1 to 5.

With conflicting data, maternal vitamin D status has been extensively related to child risk of developing atopic eczema and other atopic illnesses. Maternal serum levels of 25-hydroxyvitamin D [25(OH)D] correspond with offspring levels at birth.

The researchers sought to determine whether maternal cholecalciferol supplementation during pregnancy affected the likelihood that the offspring would develop atopic eczema at ages 12, 24, and 48 months.

"Our findings offer the first randomized controlled trial substantiation of a protective benefit of antenatal cholecalciferol supplementation on the likelihood of infantile atopic dermatitis, an effect that may be mediated by elevated levels of cholecalciferol in breast milk," Keith M. Godfrey and colleagues wrote.

For this purpose, In the double-blind, randomized, placebo-controlled UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) trial, the researchers examined the link between maternal vitamin D supplementation during pregnancy and offspring atopic eczema at ages 12, 24, and 48 months. From roughly 14 weeks of pregnancy until delivery, pregnant women in the MAVIDOS study were randomly assigned to receive either 1000 IU of cholecalciferol per day or a matched placebo, with the primary outcome being the amount of bone mineral content in the newborn. At ages 12 (n = 635), 24 (n = 610), and 48 (n = 449) months, the prevalence of atopic eczema in the offspring was determined using the UK Working Party criteria for the definition of atopic dermatitis.

Major highlights of the trial:

• Except for the intervention group's extended duration of breastfeeding, mothers' and children's characteristics were comparable between the intervention and placebo groups.
• At age 12 months, children of mothers who received 1000 IU of cholecalciferol daily had a lower odds ratio (OR) of atopic eczema [OR 055, 95% confidence interval (CI) 032-097, P = 0.04] after accounting for the duration of breastfeeding; this effect waned and was not statistically significant at ages 24 months (OR 076, 95% CI 047-123) or 48 months (OR 0·75, 95% CI 0·37–1·52).
• stratification revealed a decreased risk of infantile eczema in the intervention group for infants breastfed for ≥ 1 month (OR 048, 95% CI 024-094, P = 0.03) but not for those breastfed for <1 month (OR 080, 95% CI 029-217, P = 0.66).
• This was true even though the statistical interaction of intervention and breastfeeding period in reference to eczema at age 12 months was not significant (P = 0·41).

The authors in their conclusion stated that with the best evidence for the prevention of neonatal hypocalcaemia and evolving research for effects on other health outcomes impacting the skeletal, respiratory, and immunological systems, numerous international and national guidelines advise taking cholecalciferol 400-600 IU daily (10-15 g) during pregnancy.

The results show that atopic eczema has a developmental component and indicate at a prenatal component that may be controllable.

REFERENCE

El-Heis, S., D'Angelo, S., Curtis, E.M., Healy, E., Moon, R.J., Crozier, S.R., Inskip, H., Cooper, C., Harvey, N.C., Godfrey, K.M. and (2022), Maternal antenatal vitamin D supplementation and offspring risk of atopic eczema in the first 4 years of life: evidence from a randomized controlled trial. Br J Dermatol, 187: 659-666. https://doi.org/10.1111/bjd.21721