Prepregnancy BMI, gestational weight gain and risk of childhood atopic dermatitis: A systematic review and meta‐analysis

Abstract

Background Maternal weight before and during pregnancy influences the health of offspring. Several observational studies have investigated a link between the risk of childhood atopic dermatitis (AD) and prepregnancy maternal body mass index (BMI) and gestational weight gain (GWG), but the conclusions of these studies were inconsistent. The aim of this review was to evaluate the association between the risk of childhood AD and prepregnancy maternal BMI and GWG. Methods The PubMed, Embase, Cochrane, Web of Science, and Scopus databases were searched from inception to February 2, 2021. Observational studies investigating the association between the risk of childhood AD and prepregnancy maternal BMI and GWG were included. Fixed‐ or random‐effects models with inverse variance weights were used to calculate pooled risk estimates. Subgroup analysis and sensitivity analysis were used to explore the sources of heterogeneity. Results Thirteen studies with a total of 114 485 participants were included. Ten studies reported prepregnancy maternal BMI, and five reported GWG. Maternal underweight was associated with a higher risk of childhood AD (odds ratio [OR] = 1.06; 95% confidence interval [CI], 1.02‐1.10). Continuous BMI was not related to childhood AD (OR = 1.00; 95% CI, 0.98‐1.02). In comparison with normal GWG, moderate/very high GWG increased the risk of childhood AD (OR = 1.05; 95% CI, 1.02‐1.08; OR = 1.13; 95% CI, 1.07‐1.19, respectively), while low GWG decreased the risk (OR = 0.92; 95% CI, 0.89‐0.96). Excessive GWG relative to recommendations was associated with a higher risk of childhood AD (OR = 1.05; 95% CI, 1.01‐1.10), while a lower risk of childhood AD was associated with inadequate GWG relative to recommendations (OR = 0.87, 95% CI: 0.83‐0.91). Conclusions Maternal underweight, high GWG, and excessive GWG relative to recommendations are associated with an elevated risk of childhood AD, while low GWG and inadequate GWG relative to recommendations decreased the risk. Weight management before and during pregnancy is encouraged for primary prevention of childhood AD.

Examining the role of pre‐pregnancy weight and gestational weight gain in allergic disease development among offspring: A population‐based cohort study in Ontario, Canada

“…22,26 Likewise, in a recent metaanalysis of ten observational studies, Chen and colleagues found an inverse association between maternal pre-pregnancy BMI category and atopic dermatitis development among offspring. 28 Three cohort studies investigated rhinitis as an outcome, 21,22,24 all finding no relationship with pre-pregnancy BMI, consistent with our study.…”

“…Of the five prospective studies that explored the association with dermatitis, three observed inverse associations similar to ours, where lower BMI category was generally associated to higher risk of dermatitis, 21,23,24 whereas two found no association, though neither studied underweight mothers 22,26 . Likewise, in a recent meta‐analysis of ten observational studies, Chen and colleagues found an inverse association between maternal pre‐pregnancy BMI category and atopic dermatitis development among offspring 28 21,22,24 all finding no relationship with pre‐pregnancy BMI, consistent with our study.…”

“…Growing evidence supports this hypothesis, linking pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with the risk of common allergic diseases, such as asthma, rhinitis and dermatitis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Nevertheless, previous longitudinal studies have been limited by self-reported measures of exposures or outcomes, sometimes recalled years later, homogenous and non-representative samples, and low response and high attrition rates over follow-up, with a consequent high risk of information and selection bias. Furthermore, while most focused on asthma alone, less is known about the impact of these exposures on other common childhood allergic diseases.…”

“…In turn, these changes directly affect the intrauterine environment and can alter the immunological development of the foetus, 11,12 potentially conferring increased risk of later‐life allergy. Growing evidence supports this hypothesis, linking pre‐pregnancy body mass index (BMI) and gestational weight gain (GWG) with the risk of common allergic diseases, such as asthma, rhinitis and dermatitis 13–28 …”

Associations of maternal weight status with the risk of offspring atopic dermatitis and wheezing by 1 year of age

“…A recent meta-analysis showed that both maternal pre-pregnancy overweight and obesity were associated with a lower risk of childhood AD. 25 However, about half of the original studies included in this meta-analysis did not adjust for any confounders.…”