☆ 4.7 Article

Oral Vitamin C (500 mg/d) to Pregnant Smokers Improves Infant Airway Function at 3 Months (VCSIP) A Randomized Trial

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE (2019)

Journal

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE

Volume 199, Issue 9, Pages 1139-1147

Publisher

AMER THORACIC SOC

DOI: 10.1164/rccm.201805-1011OC

Keywords

infant pulmonary function; forced expiratory flows; smoking in pregnancy; vitamin C; wheezing

Funding

NHLBI [R01 HL105447, R01 HL105460]
Office of Dietary Supplements
Oregon Clinical Translational Research Institute - National Center for Advancing Translational Sciences [UL1TR000128]
[P51OD011092]
[UG3 OD023288]

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Abstract

Rationale: We reported a randomized trial demonstrating daily supplemental vitamin C to pregnant smokers significantly improved newborn pulmonary function tests. The current study tests these results in a new cohort using infant pulmonary function tests. Objectives: To determine if infants of pregnant smokers randomized to daily supplemental vitamin C would have improved forced expiratory flows (FEFs) at 3 months of age compared with those randomized to placebo, and to investigate the association of the alpha 5 nicotinic acetylcholine receptor. Methods: A randomized, double-blind, placebo-controlled trial was conducted at three centers. Two hundred fifty-one pregnant smokers were randomized at 13-23 weeks of gestation: 125 randomized to vitamin C (500 mg/d) and 126 to placebo. Measurements and Main Results: The primary outcome was FEF75 at 3 months of age performed with the raised volume rapid thoracic compression technique (Jaeger/Viasys). FEF50 and FEF25-75 obtained from the same expiratory curves were prespecified secondary outcomes. The infants of pregnant smokers randomized to vitamin C (n = 113) had the following FEFs at 3 months of age compared with those randomized to placebo (n = 109) as measured by FEF75 (200.7 vs. 188.7 ml/s; adjusted 95% confidence interval [CI] for difference, -3.33 to 35.64; P = 0.10), FEF50 (436.7 vs. 408.5 ml/s; adjusted 95% CI for difference, 6.10-61.30; P = 0.02), and FEF25-75 (387.4 vs. 365.8 ml/s; adjusted 95% CI for difference, 0.92-5534; P = 0.04). Infant FEFs seemed to be negatively associated with the maternal risk alleles for the alpha 5 nicotinic acetylcholine receptor (rs16969968). Conclusions: Although the primary outcome of FEF75 was not improved after vitamin C supplementation to pregnant smokers, the predetermined secondary outcomes FEF50 and FEF25-75 were significantly improved. These results extend our previous findings and demonstrate improved airway function (FEF50 and FEF25-75) at 3 months of age in infants after vitamin C supplementation to pregnant smokers.

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Forced expiratory flows and diffusion capacity in infants born from mothers with pre-eclampsia

Clement L. Ren, James E. Slaven, David M. Haas, Laura S. Haneline, Christina Tiller, Graham Hogg, Jeffrey Bjerregaard, Robert S. Tepper

Summary: This study aimed to assess the impact of pre-eclampsia (Pre-E) on airway function, diffusion capacity, and respiratory morbidity in infants born from mothers with Pre-E. The results showed that Pre-E did not affect lung function and the risk of respiratory morbidity. These findings contradict animal models and highlight the complex relationships between Pre-E and lung function and respiratory morbidity in human infants.

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