TY - JOUR
T1 - Dietary factors during pregnancy and atopic outcomes in childhood
T2 - A systematic review from the European Academy of Allergy and Clinical Immunology
AU - Venter, Carina
AU - Agostoni, Carlo
AU - Arshad, S. Hasan
AU - Ben-Abdallah, Miriam
AU - Du Toit, George
AU - Fleischer, David M.
AU - Greenhawt, Matthew
AU - Glueck, Deborah H.
AU - Groetch, Marion
AU - Lunjani, Nonhlanhla
AU - Maslin, Kate
AU - Maiorella, Alexander
AU - Meyer, Rosan
AU - Antonella, Muraro
AU - Netting, Merryn J.
AU - Ibeabughichi Nwaru, Bright
AU - Palmer, Debra J.
AU - Palumbo, Micheala P.
AU - Roberts, Graham
AU - Roduit, Caroline
AU - Smith, Pete
AU - Untersmayr, Eva
AU - Vanderlinden, Lauren A.
AU - O’Mahony, Liam
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Rationale: Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring. Methods: We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs. Results: We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy. Conclusions: Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.
AB - Rationale: Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring. Methods: We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs. Results: We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy. Conclusions: Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.
KW - AD
KW - allergic diseases
KW - allergic rhinitis
KW - allergic rhinoconjunctivitis
KW - asthma
KW - children
KW - eczema
KW - food allergy
KW - hay fever
KW - infants
KW - maternal diet
KW - pregnancy
KW - prevention
KW - seasonal allergies
KW - wheeze
UR - http://www.scopus.com/inward/record.url?scp=85089090899&partnerID=8YFLogxK
U2 - 10.1111/pai.13303
DO - 10.1111/pai.13303
M3 - Article
C2 - 32524677
AN - SCOPUS:85089090899
SN - 0905-6157
VL - 31
SP - 889
EP - 912
JO - Pediatric Allergy and Immunology
JF - Pediatric Allergy and Immunology
IS - 8
ER -