Vitamin C to Pregnant Smokers Persistently Improves Infant Airway Function to 12 Months of Age: A Randomised Trial

Cindy T McEvoy, Lyndsey E Shorey-Kendrick, Kristin Milner, Diane Schilling, Christina Tiller, Brittany Vuylsteke, Ashley Scherman, Keith Jackson, David M Haas, Julia Harris, Byung S Park, Annette Vu, Dale F Kraemer, David Gonzales, Carol Bunten, Eliot R Spindel, Cynthia D Morris, Robert S Tepper, Cindy T McEvoy, Lyndsey E Shorey-Kendrick, Kristin Milner, Diane Schilling, Christina Tiller, Brittany Vuylsteke, Ashley Scherman, Keith Jackson, David M Haas, Julia Harris, Byung S Park, Annette Vu, Dale F Kraemer, David Gonzales, Carol Bunten, Eliot R Spindel, Cynthia D Morris, Robert S Tepper

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 prespecified 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·sec-1 for FEF75 (adjusted 95% CI for difference 6.6 to 73.8; p=0.025); 58.3 mL·sec-1 for FEF50 (95% CI 10.9 to 105.8; p=0.0081); and 55.1 mL·sec-1 for FEF25-75 (95% CI, 9.7 to 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.

Copyright ©ERS 2020.

Figures

Figure 1.. CONSORT Diagram for Randomized Smokers.
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.. Effect of Vitamin C Supplementation…
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.

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