Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec 3;56(6):1902208.
doi: 10.1183/13993003.02208-2019. Print 2020 Dec.

Vitamin C to pregnant smokers persistently improves infant airway function to 12 months of age: a randomised trial

Cindy T McEvoy  1 , Lyndsey E Shorey-Kendrick  2 , Kristin Milner  3 , Diane Schilling  3 , Christina Tiller  4 , Brittany Vuylsteke  3 , Ashley Scherman  3 , Keith Jackson  5 , David M Haas  6 , Julia Harris  3 , Byung S Park  7 , Annette Vu  8 , Dale F Kraemer  8 , David Gonzales  9 , Carol Bunten  10 , Eliot R Spindel  2 , Cynthia D Morris  8   11 , Robert S Tepper  4
Affiliations

Vitamin C to pregnant smokers persistently improves infant airway function to 12 months of age: a randomised trial

Cindy T McEvoy et al. Eur Respir J. .

Abstract

Background: Vitamin C (500 mg·day-1) supplementation for pregnant smokers has been reported to increase newborn pulmonary function and infant forced expiratory flows (FEFs) at 3 months of age. Its effect on airway function through 12 months of age has not been reported.

Objective: To assess whether vitamin C supplementation to pregnant smokers is associated with a sustained increased airway function in their infants through 12 months of age.

Methods: This is a pre-specified secondary outcome of a randomised, double-blind, placebo-controlled trial that randomised 251 pregnant smokers between 13 and 23 weeks of gestation: 125 to 500 mg·day-1 vitamin C and 126 to placebo. Smoking cessation counselling was provided. FEFs performed at 3 and 12 months of age were analysed by repeated-measures analysis of covariance.

Results: FEFs were performed in 222 infants at 3 months and 202 infants at 12 months of age. The infants allocated to vitamin C had significantly increased FEFs over the first year of life compared to those allocated to placebo. The overall increased flows were 40.2 mL·s-1 for at FEF75 (75% of forced vital capacity (FVC)) (adjusted 95% CI for difference 6.6-73.8; p=0.025); 58.3 mL·s-1 for FEF50 (10.9-105.8; p=0.0081); and 55.1 mL·s-1 for FEF25-75 (9.7-100.5; p=0.013).

Conclusions: In offspring of pregnant smokers randomised to vitamin C versus placebo, vitamin C during pregnancy was associated with a small but significantly increased airway function at 3 and 12 months of age, suggesting a potential shift to a higher airway function trajectory curve. Continued follow-up is underway.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: C.T. McEvoy reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: L.E. Shorey-Kendrick reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: K. Milner reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: D. Schilling reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: C. Tiller reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: B. Vuylsteke reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: A. Scherman reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: K. Jackson reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: D.M. Haas reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: J. Harris reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: B.S. Park reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: A. Vu reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: D.F. Kraemer reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: D. Gonzales reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: C. Bunten has nothing to disclose. Conflict of interest: E.R. Spindel reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: C.D. Morris reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study. Conflict of interest: R.S. Tepper reports grants from NHLBI (R01HL105447 and R01 HL105460), Office of Dietary Supplements, P51 OD011092565, NIH (UH3 OD023288) and UL1TR000128, during the conduct of the study.

Figures

Figure 1.
Figure 1.. CONSORT Diagram for Randomized Smokers.
Enrollment, randomization, and follow-up of randomized smokers and their infants through the 3 and 12 month measurements of airway function / forced expiratory flows (FEFs). In addition, 237 of the infants had respiratory questionnaires completed as per protocol.
Figure 2.
Figure 2.. Effect of Vitamin C Supplementation During Pregnancy on Infant Airway Function Tests at 3 and 12 Months of Age.
Plots of unadjusted means (expressed as Means ± SEM) for FEF75 (the measurement of FEF at 75% of the expired volume), FEF50 (FEF at 50% of expired volume), FEF25–75, (FEF between 25 and 75% of expired volume), FVC (forced vital capacity). Vitamin C treated is solid line, closed square and placebo is dotted line, closed circle. FEF75, FEF50, and FEF25–75, were significantly improved in the vitamin C versus placebo group through 12 months of age by repeated measures analysis of covariance. There were no significant interactions for treatment group by study visit (3 and 12-month), suggesting effectively parallel differences between the treatment groups. See Table 2 legend and text.
See this image and copyright information in PMC

References

    1. Agusti A, Faner R. Lung function trajectories in health and disease. Lancet Respir Med 2019; 7:358–64. - PubMed
    1. Svanes C, Sunyer J, Plana E, Dharmage S, Heinrich J, Jarvis J, deMarco R, Norback D, Raherison C, Villani S, Wjst M, Svanes K, Anto JM. Early life origins of chronic obstructive pulmonary disease. Thorax 2010;65(1):14–20. - PubMed
    1. Stern DA, Morgan WJ, Wright AL, Guerra S, Martinez FD. Poor airway function in early infancy and lung function by age 22 years: a non-selective longitudinal cohort study. Lancet 2007;370(9589):758–764. - PMC - PubMed
    1. Martinez FJ, Han MK, Allinson JP, Barr RG, BOucher RC, Calverley PMA, Celli BR, Christenson SA, Crystal RG, Fageras M, Freeman CM, Groenke L, Hoffman EA, Kesimer M, Kstikas K, Paine R, Rafi S, Rennard SI, Segal LN, Shaykhiev R, Stevenson C, Tal-Singer R, Vestbo J, Woodruff PG, Curtis JL, Wedzchia JA. At the root: defining and halting progression of early chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2018;197(12):1540–1551. - PMC - PubMed
    1. Best D. From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure. Pediatrics 2009;124(5):e1017–e1044. - PubMed

LinkOut - more resources