Rigorously designed randomized controlled trials (RCTs) and meta-analysis of RCTs have failed to show a consistent efficacy for vitamin C supplementation in the intervention of common human diseases, including cardiovascular disorders, sepsis, diabetes, and cancer. It, however, has been becoming increasingly evident that vitamin C supplementation for pregnant smokers may be an effective modality for improving offspring airway function and pulmonary health. This Cutting-Edge Research Highlights article summarizes the latest clinical research development regarding vitamin C-mediated offspring pulmonary protection from maternal smoking. (First online: June 4, 2023) REFERENCES Sauberlich HE. Pharmacology of vitamin C. Annu Rev Nutr 1994; 14:371–91. doi: https://dx.doi.org/10.1146/annurev.nu.14.070194.002103 Young JI, Zuchner S, Wang G. Regulation of the epigenome by vitamin C. Annu Rev Nutr 2015; 35:545–64. doi: https://dx.doi.org/10.1146/annurev-nutr-071714-034228 An P, Wan S, Luo Y, Luo J, Zhang X, Zhou S, et al. Micronutrient supplementation to reduce cardiovascular risk. J Am Coll Cardiol 2022; 80(24):2269–85. doi: https://dx.doi.org/10.1016/j.jacc.2022.09.048 Sesso HD, Buring JE, Christen WG, Kurth T, Belanger C, MacFadyen J, et al. Vitamins E and C in the prevention of cardiovascular disease in men: the Physicians' Health Study II randomized controlled trial. JAMA 2008; 300(18):2123–33. doi: https://dx.doi.org/10.1001/jama.2008.600 Lamontagne F, Masse MH, Menard J, Sprague S, Pinto R, Heyland DK, et al. Intravenous vitamin C in adults with sepsis in the intensive care unit. N Engl J Med 2022; 386(25):2387–98. doi: https://dx.doi.org/10.1056/NEJMoa2200644 Mason SA, Keske MA, Wadley GD. Effects of vitamin C supplementation on glycemic control and cardiovascular risk factors in people with type 2 diabetes: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials. Diabetes Care 2021; 44(2):618–30. doi: https://dx.doi.org/10.2337/dc20-1893 Zheng JS, Luan J, Sofianopoulou E, Imamura F, Stewart ID, Day FR, et al. Plasma vitamin C and type 2 diabetes: genome-wide association study and mendelian randomization analysis in european populations. Diabetes Care 2021; 44(1):98–106. doi: https://dx.doi.org/10.2337/dc20-1328 Creagan ET, Moertel CG, O'Fallon JR, Schutt AJ, O'Connell MJ, Rubin J, et al. Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer: a controlled trial. N Engl J Med 1979; 301(13):687–90. doi: https://dx.doi.org/10.1056/NEJM197909273011303 Moertel CG, Fleming TR, Creagan ET, Rubin J, O'Connell MJ, Ames MM. High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy: a randomized double-blind comparison. N Engl J Med 1985; 312(3):137–41. doi: https://dx.doi.org/10.1056/NEJM198501173120301 Lin J, Cook NR, Albert C, Zaharris E, Gaziano JM, Van Denburgh M, et al. Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial. J Natl Cancer Inst 2009; 101(1):14–23. doi: https://dx.doi.org/10.1093/jnci/djn438 Tsuchiya M, Asada A, Kasahara E, Sato EF, Shindo M, Inoue M. Smoking a single cigarette rapidly reduces combined concentrations of nitrate and nitrite and concentrations of antioxidants in plasma. Circulation 2002; 105(10):1155–7. doi: https://dx.doi.org/10.1161/hc1002.105935 McEvoy CT, Schilling D, Clay N, Jackson K, Go MD, Spitale P, et al. Vitamin C supplementation for pregnant smoking women and pulmonary function in their newborn infants: a randomized clinical trial. JAMA 2014; 311(20):2074–82. doi: https://dx.doi.org/10.1001/jama.2014.5217 McEvoy CT, Shorey-Kendrick LE, Milner K, Schilling D, Tiller C, Vuylsteke B, et al. Oral vitamin C (500 mg/d) to pregnant smokers improves infant airway function at 3 months (VCSIP): a randomized trial. Am J Respir Crit Care Med 2019; 199(9):1139–47. doi: https://dx.doi.org/10.1164/rccm.201805-1011OC McEvoy CT, Shorey-Kendrick LE, Milner K, Schilling D, Tiller C, Vuylsteke B, et al. Vitamin C to pregnant smokers persistently improves infant airway function to 12 months of age: a randomised trial. Eur Respir J 2020. doi: https://dx.doi.org/10.1183/13993003.02208-2019 McEvoy CT, Shorey-Kendrick LE, Milner K, Harris J, Vuylsteke B, Cunningham M, et al. Effect of vitamin C supplementation for pregnant smokers on offspring airway function and wheeze at age 5 years: follow-up of a randomized clinical trial. JAMA Pediatr 2023; 177(1):16–24. doi: https://dx.doi.org/10.1001/jamapediatrics.2022.4401 Moshammer H, Hoek G, Luttmann-Gibson H, Neuberger MA, Antova T, Gehring U, et al. Parental smoking and lung function in children: an international study. Am J Respir Crit Care Med 2006; 173(11):1255–63. doi: https://dx.doi.org/10.1164/rccm.200510-1552OC Toppila-Salmi S, Luukkainen AT, Xu B, Lampi J, Auvinen J, Dhaygude K, et al. Maternal smoking during pregnancy affects adult onset of asthma in offspring: a follow up from birth to age 46 years. Eur Respir J 2020; 55(6). doi: https://dx.doi.org/10.1183/13993003.01857-2019