Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: a randomized clinical trial.
Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: a randomized clinical trial.
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DOI：
10.1001/jama.2014.5217
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发表时间：
2014-05
影响因子：
120.7
通讯作者：
Spindel, Eliot R.
中科院分区：
文献类型：
--
作者：
McEvoy, Cindy T.;Schilling, Diane;Clay, Nakia;Jackson, Keith;Go, Mitzi D.;Spitale, Patricia;Bunten, Carol;Leiva, Maria;Gonzales, David;Hollister-Smith, Julie;Durand, Manuel;Frei, Balz;Buist, A. Sonia;Peters, Dawn;Morris, Cynthia D.;Spindel, Eliot R.
母亲在怀孕期间吸烟会对后代的肺发育产生不利影响，导致肺功能终身下降，哮喘风险增加。在灵长类动物模型中，维生素C阻断了尼古丁对肺发育和后代肺功能的一些子宫内效应。确定随机接受每日维生素C治疗的孕妇吸烟者的新生儿与随机接受安慰剂治疗的新生儿相比，肺功能检查（PFT）是否改善，喘息是否减少。在太平洋西北部的三个地点进行的随机双盲试验。在2007年3月至2011年1月期间，招募了206名怀孕吸烟者，其中179人随机接受维生素C（500 mg/天）与安慰剂（89人接受维生素C，90人接受安慰剂）。159名随机妊娠吸烟者（76名维生素C治疗，83名安慰剂治疗）和76名妊娠非吸烟者的新生儿进行了新生儿PFT研究。随访评估包括一岁时的喘鸣，并在一岁时进行PFT。主要结局是72小时内新生儿肺功能的测量（特别是潮气呼气流量峰值时间与呼气时间的比值[TPTEF：TE]和每千克被动呼吸顺应性[Crs/kg]）。次要结果包括一岁内喘息的发生率和一岁时的PFT。一个亚组的怀孕吸烟者和非吸烟者进行基因分型。随机分配至维生素C组的女性新生儿（n = 76）通过TPTEF测量肺功能改善：TE（0.383 vs 0.345;差异0.011，0.062的校正95%置信区间[CI]; p = 0.006）和Crs/kg（1.32 vs 1.20 mL/cm H2O/kg; 95% CI 0.02，0.20; p = 0.012）。随机接受维生素C治疗的妇女的后代在1岁内喘息明显减少（15/70 [21%] vs 31/77 [40%];相对风险0.56，95%CI 0.33，0.95; p = 0.03）。维生素C组和安慰剂组之间的一年PFT没有显著差异。母亲吸烟对新生儿肺功能的影响与母亲α 5烟碱受体基因型（rs16969968）相关（相互作用p值= 0.0006）。对怀孕吸烟者补充维生素C改善了新生儿PFT，并减少了后代1年内的喘息。维生素C在怀孕吸烟者可能是一种廉价和简单的方法，以减少吸烟对新生儿肺功能和呼吸道疾病的影响。Clinicaltrials.gov
Maternal smoking during pregnancy adversely affects offspring lung development with lifelong decreases in pulmonary function and increased asthma risk. In a primate model, vitamin C blocked some of the in-utero effects of nicotine on lung development and offspring pulmonary function. To determine if newborns of pregnant smokers randomized to daily vitamin C would have improved pulmonary function tests (PFTs) and decreased wheezing compared to those randomized to placebo. Randomized, double-blind trial in three sites in the Pacific Northwest. Between March 2007 and January 2011, 206 pregnant smokers were recruited and 179 randomized to vitamin C (500 mg/day) versus placebo (89 to vitamin C and 90 to placebo). 159 newborns of randomized pregnant smokers (76 vitamin C treated and 83 placebo treated) and 76 of pregnant nonsmokers were studied with newborn PFTs. Follow-up assessment including wheezing was assessed through one year of age and PFTs were done at one year of age. The primary outcome was measurements of newborn pulmonary function (specifically the ratio of the time to peak tidal expiratory flow to expiratory time [TPTEF:TE] and passive respiratory compliance per kilogram [Crs/kg]) within 72 hours of age. Secondary outcomes included incidence of wheezing through one year of age and PFTs at one year of age. A subgroup of pregnant smokers and nonsmokers had genotyping performed. Newborns of women randomized to vitamin C (n= 76) had improved pulmonary function as measured by TPTEF:TE (0.383 vs 0.345; adjusted 95% confidence interval [CI] for difference 0.011, 0.062; p =0.006) and Crs/kg (1.32 vs 1.20 mL/cm H2O/kg; 95% CI 0.02, 0.20; p =0.012) than those randomized to placebo (n=83). Offspring of women randomized to vitamin C had significantly decreased wheezing through 1 year of age (15/70 [21%] vs 31/77 [40%]; relative risk 0.56, 95% CI 0.33, 0.95; p =0.03). There were no significant differences in the one year PFTs between the vitamin C and placebo groups. The effect of maternal smoking on newborn lung function was associated with maternal genotype for the alpha 5 nicotinic receptor (rs16969968) (p value for interaction = 0.0006). Supplemental vitamin C to pregnant smokers improved newborn PFTs and decreased wheezing through 1 year in the offspring. Vitamin C in pregnant smokers may be an inexpensive and simple approach to decrease the effects of smoking in pregnancy on newborn pulmonary function and respiratory morbidities. Clinicaltrials.gov, Identifier: NCT00632476
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DOI：
10.1073/pnas.171318198
发表时间：
2001-08-14
影响因子：
11.1
作者：
Levine, M;Wang, YH;Morrow, J
通讯作者：
Morrow, J
影响因子：
5.1
作者：
McEvoy, Cindy;Venigalla, Sridevi;Thuan Nguyen
通讯作者：
Thuan Nguyen
影响因子：
10
作者：
Hayatbakhsh, M. R.;Sadasivam, S.;O'Callaghan, M. J.
通讯作者：
O'Callaghan, M. J.
影响因子：
120.7
作者：
Saiman, Lisa;Anstead, Michael;Ratjen, Felix
通讯作者：
Ratjen, Felix
影响因子：
24.3
作者：
Gappa, M;Colin, AA;Stocks, J
通讯作者：
Stocks, J