Breastfeeding duration modifies the effect of smoking during pregnancy on eczema from early childhood to adolescence

Maternal tobacco exposure during pregnancy and atopic dermatitis in offspring: A systematic review and meta-analysis

The main purpose of this review was to examine the evidence of the relationship between active smoking or passive smoking during pregnancy and atopic dermatitis in offspring. The protocol was written following the PRISMA Checklist and was registered in the PROSPERO database (registration number CRD42022381136). We implemented a comprehensive search in PubMed, Embase and Web of Science databases to identify all potentially related articles from inception through 1 December 2022. We assessed cohort studies and case-control studies using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) critical appraisal tool to assess the quality of cross-sectional studies. Heterogeneity was investigated by using Cochrane Q tests and I2 statistics. In addition, according to the research design, population source and population size, the reasons for the heterogeneity were analysed. A total of 15 observational studies were included in this analysis. Our meta-analysis suggests that atopic dermatitis in offspring is not associated with active smoking during pregnancy (pooled OR, 0.96 [95% CI 0.86-1.07]); however, it is related to passive smoking (OR, 1.52 [95% CI 1.36-1.70]). Passive smoking during pregnancy is associated with an increased risk of eczema development in offspring. More research is needed to explore the risk of active smoking and eczema development in offspring, especially the association between measurements of pregnancy cotinine levels in maternal body fluids and AD in offspring.

Infant factors that impact the ecology of human milk secretion and composition-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 3

Infants drive many lactation processes and contribute to the changing composition of human milk through multiple mechanisms. This review addresses the major topics of milk removal; chemosensory ecology for the parent-infant dyad; the infant's inputs into the composition of the human milk microbiome; and the impact of disruptions in gestation on the ecology of fetal and infant phenotypes, milk composition, and lactation. Milk removal, which is essential for adequate infant intake and continued milk synthesis through multiple hormonal and autocrine/paracrine mechanisms, should be effective, efficient, and comfortable for both the lactating parent and the infant. All 3 components should be included in the evaluation of milk removal. Breastmilk "bridges" flavor experiences in utero with postweaning foods, and the flavors become familiar and preferred. Infants can detect flavor changes in human milk resulting from parental lifestyle choices, including recreational drug use, and early experiences with the sensory properties of these recreational drugs impact subsequent behavioral responses. Interactions between the infant's own developing microbiome, that of the milk, and the multiple environmental factors that are drivers-both modifiable and nonmodifiable-in the microbial ecology of human milk are explored. Disruptions in gestation, especially preterm birth and fetal growth restriction or excess, impact the milk composition and lactation processes such as the timing of secretory activation, adequacy of milk volume and milk removal, and duration of lactation. Research gaps are identified in each of these areas. To assure a sustained and robust breastfeeding ecology, these myriad infant inputs must be systematically considered.

Prenatal Maternal Risk Factors Contributing to Atopic Dermatitis: A Systematic Review and Meta-Analysis of Cohort Studies

BACKGROUND

The gestational risk factors predispose to the manifestation of early childhood atopic dermatitis (AD).

OBJECTIVE

We evaluated the association between modifiable and non-modifiable gestational and prenatal risk factors that affect the AD prevalence in children.

METHODS

We performed the systematic review and meta-analysis of cohort studies (n=27) in PubMed and EMBASE (2000~2021). A meta-analysis was performed using random-effects models to estimate pooled odds ratios (OR) or hazard ratio (HR). We performed a systematic review according to Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarized cohort studies investigating gestational and prenatal risk factor those predispose to AD in off spring. Leading modifiable and non-modifiable were identified through ORs. Meta-analysis using the random effect model was also conducted to provide an overall estimate for several significant factors.

RESULTS

Among the non-modifiable risk factors gestational diabetes (7.2, 95% confidence interval [CI]: 1.4~34.5), maternal history of allergy (2.14, 95% CI: 1.54~2.97) and prenatal history of eczema (2.46, 95% CI: 1.0~5.8) were found as major determining risk factors in early manifestation of AD in children. Further, maternal exposure to industrial products (1.89, 95% CI: 1.10~3.16), exposure to antibiotics during pregnancy (3.59, 95% CI: 1.19~10.85) and passive smoking during pregnancy (2.60, 95% CI: 1.11~6.1) are leading causes of early AD manifestation.

CONCLUSION

Conclusively, both genetic and environmental factors play a pivotal role in early manifestation of AD. The better managing the environmental factors during gestational phase to the least can help curtail the prevalence of AD in children.

Maternal smoking around birth may lower the protective effects of breastfeeding on anxiety, depression and neuroticism in adult offspring: a UK biobank study

We aim to explore the combined effects of the smoking and breastfeeding on offspring mental health outcomes. We used data from UK biobank (N = 342,846) to evaluate joint effect of breastfeeding and maternal smoke during pregnancy (MSDP) on seven adult offspring mental health outcomes (self-reported depression, depression score, self-reported anxiety, anxiety score, neuroticism score, self-harm, suicide). We stratified individuals to MSDP group and non-MSDP group as well as breastfeeding group and non-breastfeeding group. Multiple linear regression and logistic regressions analysis were performed between independent variables (MSDP or breastfeeding) and dependent variables separately (seven mental health outcomes) in each stratum. Effect estimates were expressed as β values and OR values. Sex, age, 10 principle components of population structure, smoking, alcohol use, and Townsend deprivation index were examined as covariates. At MSDP grouping level, coefficients (odds ratio [OR]) for association of breastfed as a baby with self-reported anxiety (category variable) were 0.87 (95%CI, (0.82-0.93), P = 1.74 × 10^-5) in the MSDP group and 0.83 (95%CI, (0.79-0.87), P = 2.76 × 10^-17) in the non-MSDP group. At breastfeeding grouping level, OR for association of MSDP and self-reported anxiety were 1.15 (95%CI, (1.10-1.20), P = 5.36 × 10^-11) in breastfeeding group and 1.12(95%CI, (1.06-1.20), P = 2.02 × 10^-4) in non-breastfeeding group. At MSDP grouping level, negatively associations were found for breastfeeding and anxiety score (continuable variable) in MSDP group (-0.04 SD change per SD change in MSDP, 95% CI, (- 0.06, - 0.02), P = 2.42 × 10^-3) and non-MSDP group (-0.06 SD change per SD change in MSDP, 95%CI, (- 0.07, - 0.04), P = 1.70 × 10^-11). At breastfeeding grouping level, positive association was found for MSDP and anxiety score in the breastfeeding group (0.07 SD change per SD change in MSDP, 95%CI, (0.06-0.09), P = 1.49 × 10^-20) and non-breastfeeding group (0.07 SD change per SD change in MSDP, 95%CI, (0.05-0.09), P = 7.19 × 10^-8). Compared with non-MSDP group, the protective effect (reflected by coefficients) of breastfeeding on anxiety in the MSDP decreased. Our preliminary study found MSDP may lower the protective effect of breastfeeding on the adult offspring anxiety, depression and neuroticism, providing useful recommendations for health care service via quitting smoking during pregnancy and encouraging prolonged breastfeeding.

Atopic Dermatitis: Conventional and Integrative Medicine

Although Western medicine and ideas about atopic dermatitis (AD) have become popular in many Asian countries, local beliefs about the disease and its treatment often prevail. The multi- racial background of these countries as well as the influence of the diverse religions (such as Taoism and Ramadan) in these regions often lead to diverse belief systems about the causes of AD (such as the Chi concept, also known as the balance of yin and yang) and the types of treatment (e.g. herbal remedies, topical versus concoctions, and decoctions). In addition, many of the cultural practices are preserved among the Southeast Asian minorities residing in the United Kingdom and North America. Eastern treatments typically take a holistic approach to AD and emphasize the psychosomatic component of the disorder. This overview provides a summary of the difference between conventional, complementary, alternative, and integrative medicine in terms of epidemiology, aetiology, therapy, and prognosis in children with AD. There are a number of similarities in genetic and environmental factors in epidemiology and aetiology; however, differences exist in terms of the concept of management. Complementary and alternative medicine, traditional Chinese medicine, and integrative medicine usage are not only prevalent among the Asian population but are also becoming more popular and accepted in Western societies.

Atopic dermatitis incidence and risk factors in young adults in Castellon (Spain): A prospective cohort study

INTRODUCTION

There are few atopic dermatitis (AD) incidence cohort studies in young adults, the etiology of this disease remains obscure, and AD risk factors in adults are not well understood. The objective of this study was to estimate AD ten-year incidence and prevalence in a cohort of adolescent aged 14-16 at inception in Castellon province in Valencia Region, Spain and describe related risk factors.

MATERIAL AND METHODS

From 2002 to 2012, a population-based prospective cohort study was carried out. Questionnaires from the International Study of Asthma and Allergies in Childhood (ISAAC) were used with an additional questionnaire for related factors completed by participants and their parents, respectively, in 2002. In 2012 the same questionnaires were completed by the participants' through a telephone interview, and incidence and prevalence of AD were estimated. Directed acyclic graphs, Poisson regression and inverse probability weighted regression adjustment were used.

RESULTS

The participation rate was 79.5% (1435/1805) with AD lifetime prevalence of 34.9% and AD incidence of 13.5 per 1000 person years. Females presented higher prevalence and incidence than males. After adjustment significant risk factors were being female, history of asthma or allergic rhinitis, family history of AD, history of respiratory infections, history of bronchitis, history of pneumonia, history of sinusitis, and birthplace outside Castellon province. The highest AD population attributable risks were female, 30.3%, and history of respiratory infections 15.3%. Differences with AD childhood risk factors were found.

CONCLUSIONS

AD incidence in our cohort was high and several risks factors were related to AD.

Developments in the field of clinical allergy in 2018 through the eyes of Clinical and Experimental Allergy, Part II

In this article, we describe developments in the field of clinical allergy as described by Clinical and Experimental Allergy in 2018; epidemiology, asthma and rhinitis, clinical allergy and allergens are all covered.

Associations of gestational and the first year of life exposure to ambient air pollution with childhood eczema in Hubei, China

Whether exposure to air pollution is associated with the increased incidence of childhood eczema is controversial. Only a few previous researches about the relationship between gestational and early-life exposures to ambient air pollutants and childhood eczema were conducted in China, and there is a lack of studies in Hubei province. This study aimed to explore the associations between air pollution exposure in gestation and the first year of life and childhood eczema. From November to December 2017, a total of 3383 children aged 3-6 years were recruited from 12 kindergartens in Hubei, China; 3167 were included in the final analysis. Parent-reported data involved with childhood eczema was inquired by questionnaire, and the concentrations of NO₂, PM_2.5, and PM₁₀ were acquired from air quality monitoring stations which were the nearest to the twelve kindergartens. A binary logistic regression model was used to evaluate the associations of period-mean concentrations of individual pollutant exposure with childhood eczema. Of the 3167 children, 848 (26.8%) had a history of doctor-diagnosed eczema. After adjusting for the covariates, high levels of NO₂, PM_2.5, and PM₁₀ exposures were significantly associated with a positive increase in risk of childhood eczema during the gestational period and the first year of life. In the gestational period, the estimate OR in the 3rd and 4th quartiles of NO₂ was 1.256 and 1.496, respectively. During the first year of life, the estimate OR in the 3rd and 4th quartiles of NO₂ was 1.371 and 1.335, respectively. Our study indicated that the gestational period and the first year of life exposures to high levels of ambient NO₂, PM_2.5, and PM₁₀ were significantly associated with increased eczema among preschool children. Some effective measures of prevention and intervention could be developed for preschool children.