The VDAART Randomized Clinical Trial
Augusto A. Litonjua, MD, MPH1,2; Vincent J. Carey, PhD1,2; Nancy Laranjo, BA1; Benjamin J. Harshfield, BA1; Thomas F. McElrath, MD, PhD2,3; George T. O’Connor, MD, MS4; Megan Sandel, MD, MPH5; Ronald E. Iverson Jr, MD, MPH6; Aviva Lee-Paritz, MD6; Robert C. Strunk, MD, PhD7,8; Leonard B. Bacharier, MD7,8; George A. Macones, MD, MSCE9; Robert S. Zeiger, MD, PhD10; Michael Schatz, MD, MS10; Bruce W. Hollis, PhD11; Eve Hornsby, PhD12; Catherine Hawrylowicz, PhD12; Ann Chen Wu, MD, MPH2,13; Scott T. Weiss, MD, MS
ABSTRACT
Importance Asthma and wheezing begin early in life, and prenatal vitamin D deficiency has been variably associated with these disorders in offspring.
Objective To determine whether prenatal vitamin D (cholecalciferol) supplementation can prevent asthma or recurrent wheeze in early childhood.
Design, Setting, and Participants The Vitamin D Antenatal Asthma Reduction Trial was a randomized, double-blind, placebo-controlled trial conducted in 3 centers across the United States. Enrollment began in October 2009 and completed follow-up in January 2015. Eight hundred eighty-one pregnant women between the ages of 18 and 39 years at high risk of having children with asthma were randomized at 10 to 18 weeks’ gestation. Five participants were deemed ineligible shortly after randomization and were discontinued.
Interventions Four hundred forty women were randomized to receive daily 4000 IU vitamin D plus a prenatal vitamin containing 400 IU vitamin D, and 436 women were randomized to receive a placebo plus a prenatal vitamin containing 400 IU vitamin D.
Main Outcomes and Measures Coprimary outcomes of (1) parental report of physician-diagnosed asthma or recurrent wheezing through 3 years of age and (2) third trimester maternal 25-hydroxyvitamin D levels.
Results Eight hundred ten infants were born in the study, and 806 were included in the analyses for the 3-year outcomes. Two hundred eighteen children developed asthma or recurrent wheeze: 98 of 405 (24.3%; 95% CI, 18.7%-28.5%) in the 4400-IU group vs 120 of 401 (30.4%, 95% CI, 25.7%-73.1%) in the 400-IU group (hazard ratio, 0.8; 95% CI, 0.6-1.0; P = .051). Of the women in the 4400-IU group whose blood levels were checked, 289 (74.9%) had 25-hydroxyvitamin D levels of 30 ng/mL or higher by the third trimester of pregnancy compared with 133 of 391 (34.0%) in the 400-IU group (difference, 40.9%; 95% CI, 34.2%-47.5%, P < .001).
Conclusions and Relevance In pregnant women at risk of having a child with asthma, supplementation with 4400 IU/d of vitamin D compared with 400 IU/d significantly increased vitamin D levels in the women. The incidence of asthma and recurrent wheezing in their children at age 3 years was lower by 6.1%, but this did not meet statistical significance; however, the study may have been underpowered. Longer follow-up of the children is ongoing to determine whether the difference is clinically important.
Trial Registration clinicaltrials.gov Identifier: NCT00920621
JAMA
