Effect of Maternal Antenatal Vitamin D Supplementation on the Risk of Atopic Eczema in the First 4 Years of Life The British Journal of Dermatology

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• This double-blind, randomized, placebo-controlled trial investigated the associations between maternal vitamin D intake during pregnancy and infantile atopic dermatitis. A lower risk of eczema through 12 months (but not 24 or 48 months) was seen in children of mothers who received 1000 IU of cholecalciferol daily during pregnancy compared with the placebo group. Further stratification revealed that the decreased risk in the vitamin D supplementation group was seen only in children who were breastfed for 1 month or more.

• In pregnant patients with a personal or family history of atopy, vitamin D supplementation and breastfeeding are recommended, given their protective effect on infantile atopic dermatitis.

–  Ruth McTighe, MD

Written by

 

 

Sarah L. Chamlin MD

This randomized controlled trial examined the relationship of atopic dermatitis with prenatal maternal vitamin D supplementation and breastfeeding. The authors reported that infants of mothers who received 1000 IU of cholecalciferol had a lower odds ratio of atopic dermatitis at 12 months but not at 24 and 48 months of life. They speculated that breast milk vitamin D content might influence early eczema risk, but this effect was not long lasting.

While vitamin D supplementation in pregnancy and during breastfeeding is supported by this and other studies, lasting effects remain in question. Despite firm evidence for long-term atopy prevention, this study provides more evidence for maternal micronutrient supplementation with vitamin D.

Abstract 

BACKGROUND

Evidence linking prenatal maternal vitamin D supplementation with the offspring's risk of atopic eczema is inconsistent, with most data coming from observational studies.

OBJECTIVES

To examine the influence of maternal cholecalciferol supplementation during pregnancy on the risk of atopic eczema in the offspring at ages 12, 24 and 48 months.

METHODS

Within the UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) double-blind, randomized placebo-controlled trial, we examined the relationship of maternal vitamin D supplementation during pregnancy with offspring atopic eczema at ages 12, 24 and 48 months. In MAVIDOS, pregnant women were allocated to either cholecalciferol 1000 IU per day or matched placebo, taken from around 14 weeks' gestation until delivery, with the primary outcome of neonatal whole-body bone mineral content. The prevalence of atopic eczema in the offspring was ascertained at ages 12 (n = 635), 24 (n = 610) and 48 (n = 449) months, based on the UK Working Party criteria for the definition of atopic dermatitis. The trial was registered with ISRCTN (82927713) and EudraCT (2007-001716-23).

RESULTS

The characteristics of mothers and offspring were similar between the intervention and placebo groups, apart from longer breastfeeding duration in the intervention group. Adjusting for breastfeeding duration, offspring of mothers who received cholecalciferol 1000 IU daily had a lower odds ratio (OR) of atopic eczema at age 12 months [OR 0·55, 95% confidence interval (CI) 0·32-0·97, P = 0·04]; this effect weakened and was not statistically significant at ages 24 months (OR 0·76, 95% CI 0·47-1·23) or 48 months (OR 0·75, 95% CI 0·37-1·52). The statistical interaction of intervention and breastfeeding duration in relation to eczema at age 12 months was not significant (P = 0·41), but stratification showed reduced infantile eczema risk in the intervention group for infants breastfed for ≥ 1 month (OR 0·48, 95% CI 0·24-0·94, P = 0·03) but not in those breastfed for < 1 month (OR 0·80, 95% CI 0·29-2·17, P = 0·66).

CONCLUSIONS

Our data provide the first randomized controlled trial evidence of a protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema, with the effect potentially being via increased breast milk cholecalciferol levels. The findings support a developmental influence on atopic eczema, and point to a potentially modifiable perinatal influence on atopic eczema. What is already known about this topic? There are currently no antenatal interventions proven to reduce the incidence of infantile atopic eczema in the general population. However, observational studies have led to speculation that antenatal vitamin D supplementation may be beneficial.

The British Journal of Dermatology

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 2022 Jun 28;[EPub Ahead of Print], S El-Heis, S D'Angelo, EM Curtis, E Healy, RJ Moon, SR Crozier, H Inskip, C Cooper, NC Harvey, KM Godfrey 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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