547: Meconium stained amniotic fluid as a protective factor against childhood dermatitis and skin rash in the offspring - A population based cohort analysis

Abstract

The human microbiome plays a role in the pathogenesis of cutaneous diseases including atopic dermatitis. The microbiome's assembly is known to be influenced by mode of delivery, type of feeding and use of antibiotics. We investigated the possible impact of intrauterine extra-alimentary exposure to the infantile gut microbiome (meconium stained amniotic fluid - MSAF) recently found not to be sterile as previously thought, on the occurrence of dermatitis and skin rash in the offspring throughout childhood and adolescence. In this population-based cohort analysis all singleton deliveries occurring between 1991-2014 at a single tertiary medical center were included. The study population was divided into two study groups based on lack or presence of MSAF during delivery. Fetuses with congenital malformations were excluded. A Kaplan-Meier survival analysis was constructed for evaluation of cumulative hospitalization rate due to dermatitis and skin rash over the 18 years of follow-up, and a Cox proportional hazards model was used to study the independent association between MSAF and the cutaneous morbidity while controlling for potential confounders. During the study period 238,622 deliveries met the inclusion criteria. A total of 2304 hospitalizations due to dermatitis and skin rash were documented with a rate of 0.9% (n=312) in children exposed to MSAF compared with 1.0% (n=1992) in the unexposed group. During the follow-up period, the cumulative incidence of dermatitis and skin rash related morbidity among the exposed group was 0.78 per 1,000-person years and 0.98 per 1,000-person years among the unexposed group (HR 0.86; 95%CI 0.76-0.96, p=0.011). The survival curve (Figure) showed lower cumulative hospitalization rate in the MSAF exposed group as compared to the unexposed group (log rank p=0.01). The Cox analysis, controlled for maternal diabetes and hypertension as well as for preterm delivery, demonstrated MSAF exposure to be an independent protective factor for dermatitis and skin rash hospitalizations during childhood in the offspring (adjusted HR=0.87, 95%CI 0.77-0.98, p=0.018). Fetal exposure to MSAF appears to be an independent protective factor for dermatitis and skin rash in the offspring throughout childhood and adolescence.