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Vitamin A, C and/or E Intake During Pregnancy and Offspring Respiratory Health: A Systematic Review and Meta-Analysis.

  • 2025-07-02
  • Journal of human nutrition and dietetics : the official journal of the British Dietetic Association 38(4)
    • Vanessa E Murphy
    • Megan E Jensen
    • Soriah Harvey
    • Tesfalidet Beyene
    • Jake Gregson
    • Farihah Islam
    • William Huang
    • Katie Aistrope
    • Adam Collison

Study Design

Type
Meta-Analysis
Sample size
n = 213
Population
12 observational studies and six RCTs (total sample size n = 58,769) assessing maternal vitamin intake during pregnancy and respiratory outcomes in offspring
Methods
Systematic review and meta-analyses of studies identified through electronic databases; eligible studies assessed maternal levels and/or intake of vitamins A, C and/or E via dietary intake or supplements in pregnancy and respiratory outcomes in the first 5 years of life

Introduction

Poor respiratory health in childhood is common, and asthma is the most common chronic disease among children, for which there is no known cure. Maternal intake of vitamins (A, C, E) may be a modifiable nutritional exposure to reduce adverse respiratory health in offspring.

Objective

We aimed to systematically review the evidence for the association between maternal vitamin (A, C, E) intake during pregnancy (via questionnaire or blood assay) and respiratory outcomes in the offspring.

Methods

Studies identified through electronic databases were eligible if they assessed maternal levels and/or intake of vitamins A, C and/or E via dietary intake or supplements in pregnancy and respiratory outcomes in the first 5 years of life. Meta-analyses were conducted where possible. Outcomes included wheeze, cough, asthma, infant respiratory distress syndrome (RDS), respiratory tract infection (RTI) and lung function measurement.

Results

Of 1170 articles screened, 12 observational studies and six RCTs met the inclusion criteria (total sample size n = 58,769). Meta-analysis could not be performed for vitamin A; however, there was no evidence to suggest that maternal vitamin A intake improves early life respiratory outcomes in offspring. Two RCTs found that vitamin C supplementation (500 mg/day vs. placebo) reduced the incidence of wheeze at 12 months (n = 206 children) and 5 years (n = 213 children) in pregnancies exposed to smoking. In meta-analyses, maternal intake in the highest vitamin E quartile versus lowest reduced the odds of wheeze at 2 years by 36% (aOR: 0.64, 95% CI: 0.47-0.87, n = 2 observational studies, very low certainty); this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n = 2 observational studies, very low certainty). Vitamin supplementation (C + E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n = 2 studies, moderate certainty) relative to placebo.

Conclusion

There may be some benefit to vitamin C supplementation during pregnancy in the context of maternal smoking or higher maternal vitamin E intake during pregnancy, for reducing the risk of childhood wheeze in early life. This emerging evidence warrants further studies to enable translation into dietary guidelines.

Research Insights

  • Vitamin C→Reduced Respiratory Distress Syndrome

    Vitamin supplementation (C+E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n=2 studies, moderate certainty) relative to placebo.

    Effect
    Neutral
    Effect size
    Small
    Dose
    500 mg/day
  • Vitamin C→Reduced Wheeze

    this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n=2 observational studies, very low certainty).

    Effect
    Neutral
    Effect size
    Small
    Dose
    500 mg/day
  • Vitamin E→Reduced Respiratory Distress Syndrome

    Vitamin supplementation (C+E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n=2 studies, moderate certainty) relative to placebo.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin E→Reduced Wheeze

    this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n=2 observational studies, very low certainty).

    Effect
    Neutral
    Effect size
    Small
    Dose
    500 mg/day

Adverse Events Reported

  • Vitamin E→infant respiratory distress syndrome

    Vitamin supplementation (C + E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n = 2 studies, moderate certainty) relative to placebo

    Finding
    No significant difference
    Magnitude
    OR: 1.15, 95% CI: 0.80-1.64
    Significant
    No
  • Vitamin C→wheeze

    maternal intake in the highest vitamin E quartile versus lowest reduced the odds of wheeze at 2 years by 36% (aOR: 0.64, 95% CI: 0.47-0.87, n = 2 observational studies, very low certainty); this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n = 2 observational studies, very low certainty)

    Finding
    No significant difference
    Magnitude
    aOR: 0.85, 95% CI: 0.63-1.16
    Significant
    No
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