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      Vitamin D supplementation in pregnant women or infants for preventing allergic diseases: a systematic review and meta-analysis of randomized controlled trials

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          Abstract

          Background:

          It is still unclear if and to what extent antenatal or infant or childhood vitamin D supplementation would affect the development of allergy diseases later in life. This study aimed to review the efficacy of vitamin D supplementation in pregnant women, infants, or children for the prevention of allergies.

          Methods:

          MEDLINE (PubMed), EMBASE (OVID), and the Cochrane Central Register of Controlled Trials were searched up to March 1, 2020. We included only randomized controlled trials (RCTs). We performed a systematic review and meta-analysis for vitamin D supplementation in primary allergy prevention. These trials were assessed for risk of bias using the Cochrane Collaboration domains and the consensus was reached via discussion with the full study group. We descriptively summarized and quantitatively synthesized original data to evaluate vitamin D supplementation in primary allergy prevention by using Review Manager software for meta-analysis.

          Results:

          The search yielded 1251 studies. Seven RCTs were included in this analysis. A meta-analysis revealed that vitamin D supplementation for pregnant women or infants may not decrease the risk of developing allergic diseases, such as asthma or wheezing (supplementation for pregnant women, risk ratio [RR]: 1.01, 95% confidence interval [CI]: 0.81–1.26, P = 0.90, I 2  = 47%; supplementation for infants, RR: 1.00, 95% CI: 0.70–1.43, P = 0.99, I 2  = 0%; supplementation for pregnant women and infants, RR: 0.35, 95% CI: 0.10–1.25, P = 0.11), eczema (supplementation for pregnant women, RR: 0.95, 95% CI: 0.80–1.13, P = 0.77, I 2  = 0%; supplementation for infants, RR: 0.84, 95% CI: 0.64–1.11, P = 0.19, I 2  = 42%), allergic rhinitis (supplementation for pregnant women, RR: 0.93, 95% CI: 0.78–1.11, P = 0.15, I 2  = 47%), lower respiratory tract infection (LRTI) (supplementation for pregnant women, RR: 0.97, 95% CI: 0.85–1.11, P = 0.59, I 2  = 0%), or food allergy.

          Conclusions:

          Supplementation of vitamin D in pregnant women or infants does not have an effect on the primary prevention of allergic diseases.

          Systematic Review Registration:

          PROSPERO (CRD42020167747)

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          Most cited references40

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          Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.

          The objective was to provide guidelines to clinicians for the evaluation, treatment, and prevention of vitamin D deficiency with an emphasis on the care of patients who are at risk for deficiency. The Task Force was composed of a Chair, six additional experts, and a methodologist. The Task Force received no corporate funding or remuneration. Consensus was guided by systematic reviews of evidence and discussions during several conference calls and e-mail communications. The draft prepared by the Task Force was reviewed successively by The Endocrine Society's Clinical Guidelines Subcommittee, Clinical Affairs Core Committee, and cosponsoring associations, and it was posted on The Endocrine Society web site for member review. At each stage of review, the Task Force received written comments and incorporated needed changes. Considering that vitamin D deficiency is very common in all age groups and that few foods contain vitamin D, the Task Force recommended supplementation at suggested daily intake and tolerable upper limit levels, depending on age and clinical circumstances. The Task Force also suggested the measurement of serum 25-hydroxyvitamin D level by a reliable assay as the initial diagnostic test in patients at risk for deficiency. Treatment with either vitamin D(2) or vitamin D(3) was recommended for deficient patients. At the present time, there is not sufficient evidence to recommend screening individuals who are not at risk for deficiency or to prescribe vitamin D to attain the noncalcemic benefit for cardiovascular protection.
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            Prevention of rickets and vitamin D deficiency in infants, children, and adolescents.

            Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.
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              Effect of Prenatal Supplementation With Vitamin D on Asthma or Recurrent Wheezing in Offspring by Age 3 Years: The VDAART Randomized Clinical Trial.

              Asthma and wheezing begin early in life, and prenatal vitamin D deficiency has been variably associated with these disorders in offspring.
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                Author and article information

                Journal
                Chin Med J (Engl)
                Chin Med J (Engl)
                CM9
                Chinese Medical Journal
                Lippincott Williams & Wilkins (Hagerstown, MD )
                0366-6999
                2542-5641
                5 February 2022
                12 January 2022
                : 135
                : 3
                : 276-284
                Affiliations
                Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 610075, China.
                Author notes
                Correspondence to: Dr. Shunlin Peng, Department of Otolaryngology, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Twelve Bridge Road, Jinniu District, Chengdu, Sichuan 610000, China E-Mail: shunlin_peng@ 123456163.com
                Article
                CMJ-2021-838 00004
                10.1097/CM9.0000000000001951
                8812613
                35108226
                66785c8a-9cbc-4595-8253-b664db022732
                Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 22 March 2021
                Categories
                Meta Analysis
                Custom metadata
                TRUE

                vitamin d,prevention,pregnancy,infants,allergy,meta-analysis
                vitamin d, prevention, pregnancy, infants, allergy, meta-analysis

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