Antenatal cholecalciferol (Vitamin D) supplementation may protect infants from developing infantile atopic eczema, according to a UK study just published in British Journal of Dermatology.
How many children suffer?
Atopic dermatitis (also known as eczema) is a common skin condition in babies with the American Academy of Dermatology (AAD) citing that it affects up to 25% of children. Further, AAD data finds that 60% of people with eczema develop it during their first year of life.
Authors from a 2104 study in the journal Dermatitis sought to determine the distribution and associations of childhood eczema severity in the United States. After analyzing data from the 2007 National Survey of Children’s Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children (0-17yr), Silverberg and colleagues found that the prevalence of childhood eczema in the US was nearly 13%. Of those children, 67% had mild, 26% moderate, and 7% severe disease.
There was significant statewide variation of the distribution of eczema severity with highest rates of severe disease in Northeastern and Midwestern states. Eczema severity was increased with older age, African-American and Hispanic race/ethnicity, lower household income, oldest child in the family, home with a single mother, lower paternal/maternal education level, maternal general health, maternal/paternal emotional health, and dilapidated housing (Silverberg et al, 2014).
Could vitamin D help?
This latest double-blind, randomized placebo-controlled trial called the Maternal Vitamin D Osteoporosis Study (MAVIDOS) was performed at the University of Southampton Medical Research Council Lifecourse Epidemiology Centre and the NIHR Southampton Biomedical Research Centre to determine if Vitamin D supplementation in pregnant women could reduce atopic eczema in their children.
Pregnant women participating in the study took either 1000 IU of cholecalciferol per day or a placebo beginning at approximately 14 weeks’ gestation and continuing until delivery.
Of the 965 births involved in the study, follow-up included 703 children: 352 whose mothers had received Vitamin D supplementation and 351 whose mothers had been part of the placebo group in the study.
Trained research nurses who were blinded to intervention and control allocation utilized a standardized questionnaire and examination in assessing 703 children for eczema at ages 12 months, 24 months, and 48 months using the UK Working Party diagnostic criteria for the definition of atopic eczema.
Early affect, but not fully sustained
The children of mothers who received Vitamin D had a lower odds ratio of atopic eczema at age 12 months, the study found. However, this effect weakened and was not statistically significant at ages 24 months and 48 months.
Additionally, in the group that had received Vitamin D, the rate of eczema was lower for infants breastfed for longer than one month, but not for those breastfed for less than one month.
Many international and national guidelines recommend cholecalciferol 400–600 IU daily throughout pregnancy, with the strongest evidence for the prevention of neonatal hypocalcemia and emerging evidence for effects on other health outcomes affecting the skeletal, respiratory and immune systems (Harvey et all, 2014). The authors believe that the current findings from their study inform understanding of the early-life influences on infantile eczema and support recommendations for routine vitamin D supplementation during pregnancy.
Better when breastfed
“We know that Vitamin D can affect the immune system and the proteins that make up our skin,” lead author Professor Keith Godfrey stated in a University of Southampton press release accompanying publication of the study. “We were interested to know if Vitamin D supplements taken by pregnant women would have an impact on their child’s risk of atopic eczema.”
The authors contend that their 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 conveyed via increased breast milk cholecalciferol levels.
“Our findings showed a positive effect, which was more evident in infants that breastfed. This may reflect supplementation during pregnancy increasing the amount of Vitamin D in breast milk,” Godfrey concluded.
Access Professor Godfrey and colleagues’ paper “Maternal antenatal vitamin D supplementation and offspring risk of atopic eczema in the first 4 years of life: evidence from a randomized controlled trial” via PubMed at https://pubmed.ncbi.nlm.nih.gov/35763390/
Clinicians’ Bonus: More To Know
Resources for you and your patients
For You
ACOG provides its latest Committee Opinion “Vitamin D: Screening and Supplementation During Pregnancy” which reviews clinical guidance and evidence-based recommendations for your patients concerning routine screening and vitamin D supplementation during pregnancy. It is also available to you on the page as a downloadable PDF.
For Your Patients
The America Academy of Dermatology sets out practical advice for navigating eczema for your patients in its Eczema Resource Center with additional links to types and treatments for the skin condition, sections on both childhood and adult eczema, and a featured video “to help manage your baby’s symptoms and decrease flare-ups.”
The contents of this feature are not provided or reviewed by NPWH.