Atopic dermatitis and skin disease
Gestational diabetes, atopic dermatitis, and allergen sensitization in early childhood

https://doi.org/10.1016/j.jaci.2009.06.052Get rights and content

Background

The relationship between the prenatal environment, maternal-fetal interaction, and allergic disease in the offspring remains understudied.

Objective

We sought to determine whether gestational diabetes (GDM) modifies the risk of early childhood atopic manifestations, including atopic dermatitis and allergen sensitization.

Methods

This study includes 680 children from the Boston Birth Cohort. Mother-child dyads were recruited at birth and followed prospectively to a mean age of 3.2 ± 2.3 years, with study visits aligned with the pediatric primary care schedule. The primary outcomes were physician-diagnosed atopic dermatitis on standardized medical record abstraction and allergen sensitization based on ImmunoCAP to 7 common foods and 5 common aeroallergens (specific IgE, ≥0.10 kUA/L; Phadia, Uppsala, Sweden). GDM was determined by means of standardized medical record review. Logistic regression analysis, stratified by term/preterm status, evaluated the association of GDM with atopic dermatitis and allergen sensitization, respectively, controlling for maternal prepregnancy body mass index, fetal growth, and pertinent covariates.

Results

Of the 680 children, 488 were term, and 192 were preterm (<37 weeks' gestation). Overall, 4.9% of the mothers had GDM. Among the 680 children, 34.4% had atopic dermatitis, and 51% had allergen sensitization. In term births GDM was significantly associated with atopic dermatitis (odds ratio [OR], 7.2; 95% CI, 1.5-34.5) and allergen sensitization (OR, 5.7; 95% CI, 1.2-28.0). Adjusting for fetal growth had little effect. The association with sensitization was driven primarily by food sensitization (OR, 8.3; 95% CI, 1.6-43.3). The above associations were not observed in preterm births.

Conclusions

In term births GDM increased the risk of atopic dermatitis and early childhood allergen sensitization independently of maternal prepregnancy body mass index and fetal growth.

Section snippets

Patient population

The Boston Birth Cohort was initiated in 1998, and recruitment is ongoing at the Boston University Medical Center (BMC). It is a multiethnic cohort (56% black, 11% white, and 20% Hispanic) that includes subjects from a range of socioeconomic strata, including inner-city poor up to middle-class subjects.

The Boston Birth Cohort was originally designed to study adverse birth outcomes, particularly preterm birth. The inclusion criteria of the parent study are as follows: any woman admitted to the

Baseline characteristics of the cohort

When we examine the mother-infant dyads in the entire cohort (n = 1,262), this is a predominantly low-income minority population. Most (60.1%, n = 759) mothers were African American, and 21.1% (n = 266) were Latino. The majority (81.4%, n = 639) of mothers had an annual household income of less than $30,000. The mean age of children at follow-up was 3.1 years (SD, 2.3 years), with equal numbers of male and female subjects. Prematurity was present in 28% of deliveries. The mean age of follow-up

Discussion

In this prospective birth cohort study, we found that GDM was significantly associated with increased risk of early childhood atopic dermatitis and sensitization to both food allergens and aeroallergens in term infants, even after accounting for maternal prepregnancy BMI and fetal growth status. Specifically, term infants of pregnancies with GDM have a 7.57-fold increased risk of atopic dermatitis and a 5.91-fold increased risk of allergen sensitization. Furthermore, only a minority of this

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    Supported in part by the March of Dimes PERI grants (PI: Wang, 20-FY02-56), the National Institute of Environmental Health Sciences (PI: Wang, R21 ES011666), and the National Institute of Child Health and Human Development (PI: Wang, R01 HD041702). The follow-up study is in part supported by Food Allergy Project and National Institute for Allergy and Infectious Disease (PI Wang, R21AI079872). R. K. is also supported by the National Heart, Lung, and Blood Institute (PI: Kumar, K23HL093023).

    Disclosure of potential conflict of interest: R. Kumar has received research support from the National Heart, Lung, and Blood Institute. J. A. Pongracic has received research support from the National Institutes of Health. The rest of the authors have declared that they have no conflict of interest.

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    Copyright © 2009 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.