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Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child.
Evid Based Child Health 2014; 9(2):447-83EB

Abstract

BACKGROUND

Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.

OBJECTIVES

To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).

SELECTION CRITERIA

All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.

DATA COLLECTION AND ANALYSIS

We extracted data from published reports, supplemented by additional information received from the trialists we contacted.

MAIN RESULTS

The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.

AUTHORS' CONCLUSIONS

Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.

Authors+Show Affiliations

Departments of Pediatrics and Epidemiology, Biostatistics andOccupationalHealth,McGillUniversity Faculty ofMedicine,Montreal, Canada. michael.kramer@mcgill.ca.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25404609

Citation

Kramer, Michael S., and Ritsuko Kakuma. "Maternal Dietary Antigen Avoidance During Pregnancy or Lactation, or Both, for Preventing or Treating Atopic Disease in the Child." Evidence-based Child Health : a Cochrane Review Journal, vol. 9, no. 2, 2014, pp. 447-83.
Kramer MS, Kakuma R. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Evid Based Child Health. 2014;9(2):447-83.
Kramer, M. S., & Kakuma, R. (2014). Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Evidence-based Child Health : a Cochrane Review Journal, 9(2), pp. 447-83. doi:10.1002/ebch.1972.
Kramer MS, Kakuma R. Maternal Dietary Antigen Avoidance During Pregnancy or Lactation, or Both, for Preventing or Treating Atopic Disease in the Child. Evid Based Child Health. 2014;9(2):447-83. PubMed PMID: 25404609.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. AU - Kramer,Michael S, AU - Kakuma,Ritsuko, PY - 2014/11/19/entrez PY - 2014/11/19/pubmed PY - 2014/11/19/medline KW - *Diet, Protein-Restricted KW - *Lactation KW - Allergens [*adverse effects] KW - Dermatitis, Atopic [prevention&control] KW - Dietary Proteins [*adverse effects] KW - Female KW - Food Hypersensitivity KW - Humans KW - Hypersensitivity, Immediate [*prevention&control] KW - Infant KW - Infant, Newborn KW - Pregnancy KW - Randomized Controlled Trials as Topic KW - Risk Factors SP - 447 EP - 83 JF - Evidence-based child health : a Cochrane review journal JO - Evid Based Child Health VL - 9 IS - 2 N2 - BACKGROUND: Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta. OBJECTIVES: To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012). SELECTION CRITERIA: All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment. DATA COLLECTION AND ANALYSIS: We extracted data from published reports, supplemented by additional information received from the trialists we contacted. MAIN RESULTS: The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity. AUTHORS' CONCLUSIONS: Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed. SN - 1557-6272 UR - https://www.unboundmedicine.com/medline/citation/25404609/Maternal_dietary_antigen_avoidance_during_pregnancy_or_lactation_or_both_for_preventing_or_treating_atopic_disease_in_the_child_ L2 - https://doi.org/10.1002/ebch.1972 DB - PRIME DP - Unbound Medicine ER -