Abstract
BACKGROUND: Fetal oxidative balance (achieved when protective prenatal factors counteract sources of oxidative stress), may be critical for preventing asthma and allergic disease. OBJECTIVE: We examined prenatal intakes of hypothesized protective nutrients (including antioxidants) in conjunction with potential sources of oxidative stress, in models for adolescent asthma and allergic disease. METHODS: We used data from 996 mother-child pairs in Project Viva. Exposures of interest were maternal pre-pregnancy body mass index and prenatal nutrients (energy-adjusted intakes of vitamins D, C, and E, β-carotene, folate, choline, and n-3 and n-6 polyunsaturated fatty acids (PUFAs)), air pollutant exposures (residence-specific 3rd trimester black carbon or PM2.5), acetaminophen, and smoking. Outcomes were offspring current asthma, allergic rhinitis, and allergen sensitization at a median age of 12.9 years. We performed logistic regression. Continuous exposures were log-transformed and modeled as z-scores. RESULTS: We observed protective associations for Vitamin D (OR = 0.69; 95% CI 0.53 to 0.89 for allergic rhinitis), the sum of n-3 PUFAs EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) (OR=0.81, 95% CI 0.66 to 0.99 for current asthma)), and n-3 PUFA alpha linolenic acid (OR=0.78; 95% CI 0.64 to 0.95 for allergen sensitization). Black carbon and PM2.5 were associated with ∼30% elevated risk for allergen sensitization. No multiplicative interactions were observed for protective nutrient intakes with sources of oxidative stress. CONCLUSIONS: We identified potential protective prenatal nutrients (Vitamin D, n-3 PUFAs), as well as adverse prenatal pro-oxidant exposures that may alter risk of asthma and allergic disease into adolescence.
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Key Points
In Project Viva, a pre-birth cohort study, showed the potential protective prenatal nutrients, Vitamin D, n-3 PUFAs, as well as adverse prenatal pro-oxidant exposures that may alter risk of asthma and allergic disease into adolescence. The roles of protective prenatal factors (nutrient intakes of Vitamin D, n-3 fatty acids, Vitamin C and others) and those of potential adverse exposures (prenatal exposure to air pollution, increased maternal adiposity, smoking and acetaminophen intake), are often considered individually in epidemiological studies, but are rarely modeled simultaneously. In this work, data from mother-child pairs in Project Viva, a Massachusetts based prenatal birth cohort study with follow-up data through early adolescence (median age 12.9 years) was used to examine associations of prenatal intakes of maternal antioxidant nutrients. It was hypothesized oxidative stress exposures encountered in utero would be associated with current allergic disease outcomes (current asthma, current rhinitis, and allergen sensitization) in adolescence. It was also hypothesized that associations for individual nutrients previously identified (Vitamin D and n-3 PUFAs) as protective against allergic disease risk at the mid-childhood time point in this cohort would carry forward into adolescence, and that the combined exposure to multiple hypothesized protective nutrients from diet (Vitamin C, Vitamin E, Vitamin D, beta-carotene, folate) would have the largest impact on reducing risk.
The study did not observe any beneficial effects of nutrients that function primarily as antioxidants (Vitamin C, Beta-carotene). The findings suggest that a few key prenatal nutrients with immunomodulatory potential (Vitamin D and n-3 PUFAs) may have long-term implications for reducing asthma and allergic disease risk. The study had several strengths. It was able to relate multiple sources of prenatal dietary antioxidants and pro-oxidant exposures simultaneously to development of allergic disease, and the extended follow-up period allowed the authors to demonstrate that many of these associations persist into adolescence. In conclusion, potential protective prenatal nutrient exposures (Vitamin D, n-3 PUFAs), as well as prenatal pro-oxidant exposures (maternal smoking, maternal acetaminophen intake, maternal BMI, and prenatal air pollutants) that may increase risk of allergic disease outcomes in adolescence were found. Protective nutrients may counterbalance the adverse effects of pro-oxidant exposures.