Maternal Allergy Research Articles

The influence of maternal respiratory allergy on obstetrics and perinatal outcomes: A nested case-control study.

To evaluate the influence of respiratory allergy on obstetrics and perinatal outcomes. A nested case-control retrospective study on 41 035 pregnant women. Obstetrics and perinatal outcomes of women with or without respiratory allergy were compared. Rates of preterm delivery (<37 weeks of gestation), low birth weight (<2500 g), neonatal acidosis (pH < 7.20), low 5-min APGAR score (<7), cesarean section rate and indications, and perinatal morbidity and mortality were analyzed. Results are expressed as number and percentages. χ2 and Fisher exact tests were used for comparisons. Logistic regression was used. Statistical significance was set at 95% level (P< 0.05). A total of 724 (1.8%) patients had respiratory allergy, and their rates of preterm delivery and low birth weight were significantly higher than those of control women (both P< 0.001). Nevertheless, analyzing the causes, multiple gestation rate was significantly higher in this group, and adjusting by this, no statistical difference was found in any of the perinatal outcomes studied. In addition, in vitro fertilization and sterility were also significantly higher in the respiratory allergy group (both P< 0.001). Women with respiratory allergy are at higher risks of prematurity and low birth weight but these results are mediated by sterility, in vitro fertilization, and multiple gestation rate. Nonetheless, participation of inflammatory mechanisms should be further studied.

The human milk proteome and allergy of mother and child: Exploring associations with protein abundances and protein network connectivity.

BackgroundThe human milk proteome comprises a vast number of proteins with immunomodulatory functions, but it is not clear how this relates to allergy of the mother or allergy development in the breastfed infant. This study aimed to explore the relation between the human milk proteome and allergy of both mother and child.MethodsProteins were analyzed in milk samples from a subset of 300 mother-child dyads from the Canadian CHILD Cohort Study, selected based on maternal and child allergy phenotypes. For this selection, the definition of “allergy” included food allergy, eczema, allergic rhinitis, and asthma. Proteins were analyzed with non-targeted shotgun proteomics using filter-aided sample preparation (FASP) and nanoLC-Orbitrap-MS/MS. Protein abundances, based on label-free quantification, were compared using multiple statistical approaches, including univariate, multivariate, and network analyses.ResultsUsing univariate analysis, we observed a trend that milk for infants who develop an allergy by 3 years of age contains higher abundances of immunoglobulin chains, irrespective of the allergy status of the mother. This observation suggests a difference in the milk’s immunological potential, which might be related to the development of the infant’s immune system. Furthermore, network analysis showed overall increased connectivity of proteins in the milk of allergic mothers and milk for infants who ultimately develop an allergy. This difference in connectivity was especially noted for proteins involved in the protein translation machinery and may be due to the physiological status of the mother, which is reflected in the interconnectedness of proteins in her milk. In addition, it was shown that network analysis complements the other methods for data analysis by revealing complex associations between the milk proteome and mother-child allergy status.ConclusionTogether, these findings give new insights into how the human milk proteome, through differences in the abundance of individual proteins and protein-protein associations, relates to the allergy status of mother and child. In addition, these results inspire new research directions into the complex interplay of the mother-milk-infant triad and allergy.

Perinatal outcome and long-term infectious hospitalizations of offspring born to women with known drug allergy.

Maternal drug allergy has been associated with altered immune status and an inflammatory environment, which may affect the risk of future infectious diseases in the offspring. We aimed to evaluate perinatal outcomes and long-term infectious hospitalization in the offspring of women with documented drug allergy. The study was conducted at the Soroka University Medical Center (SUMC), a tertiary medical center. For perinatal outcomes, generalized estimation equation (GEE) models were used controlling for maternal age, maternal diabetes mellitus, smoking, and hypertensive disorders. The study groups were followed until 18 years of age for infectious-related hospitalizations. A Kaplan-Meier survival curve was used to compare the cumulative incidence of long-term infectious hospitalizations. A Cox proportional hazards model was conducted to control for confounders. During the study period, 243 682 deliveries met the inclusion criteria, of which 9756 (4.0%) occurred in women with documented drug allergy. Using GEE, maternal drug allergy was found to be a significant independent risk factor for hypertensive disorders, diabetes mellitus, intra-uterine growth restriction (IUGR), and preterm delivery. Offspring also had significantly higher rates of long-term infectious hospitalizations. Kaplan-Meier survival curves demonstrated significantly higher cumulative incidence rates of infectious hospitalization (log-rank p<.001). In a Cox proportional hazards model, being born to a mother with documented drug allergy was independently associated with infectious hospitalization of the offspring in the long term. Maternal documented drug allergy is independently associated with an adverse perinatal outcome such as IUGR and preterm delivery and increased risk of long-term infectious hospitalization of the offspring.

Association of Maternal Erythrocyte PUFA during Pregnancy with Offspring Allergy in the Chinese Population.

Findings on prenatal polyunsaturated fatty acids (PUFA) and offspring allergies have been inconsistent, and the majority of studies have focused on Western populations. This study aimed to investigate the associations between maternal erythrocyte PUFA and offspring allergies in the first 2 years in the Chinese population. We included 573 mother–infant pairs from a birth cohort. Based on the outpatient medical records, we identified the diagnosis and time of offspring allergic disease onset. We measured erythrocyte fatty acids by gas chromatography. Associations were examined using Cox regression. We found that higher maternal total PUFA levels (HR = 0.80; 95% CI: 0.68, 0.94), especially of arachidonic acid (AA) (HR = 0.79; 95% CI: 0.65, 0.97) and n-3 PUFA (HR = 0.77; 95% CI: 0.62, 0.97), were associated with reduced risk of offspring allergies. Similar results were found for eczema. Compared with children without a maternal allergy history, the associations of total PUFA (p = 0.028) and n-6 PUFA (p = 0.013) with offspring allergies were stronger in those with a maternal allergy history. Maternal erythrocyte total PUFA, especially AA, and n-3 PUFA were inversely associated with offspring allergies within 2 years of age. There was a significant interaction between maternal allergy history and maternal PUFA in offspring allergies.

Mode of Birth Is Not Associated With Food Allergy Risk in Infants

The association between mode of delivery and the risk of food allergy remains unclear due to the absence of studies with both challenge-proven food allergy outcomes and detailed information on the type of caesarean delivery. We assessed whether emergency or elective caesarean, or caesarean delivery in the presence or absence of labor initiation, is associated with the risk of food allergy. The HealthNuts study recruited 5276 12-month-old infants who underwent skin prick testing and oral food challenge to ascertain food allergy status, and linked the child's study data to additional birth data from the Victorian Perinatal Data Collection. Parents of 3006 children consented to data linkage, and birth data were obtained on 2045. In this subgroup, 30% were born by caesarean and 13% had food allergy. Caesarean delivery, compared with vaginal birth, was not associated with the risk of food allergy (adjusted odds ratio [aOR]: 0.95, 95% confidence interval [CI]: 0.70, 1.30). Neither caesarean delivery before the onset of labor, nor after the onset of labor, was associated with the risk of food allergy (aOR: 0.83, 95% CI: 0.55-1.23 and aOR: 1.13, 95% CI: 0.75-1.72, respectively). Delivery by elective or emergency caesarean, compared with vaginal delivery, was not associated with risk of food allergy (aOR: 1.05, 95% CI: 0.71-1.55 and aOR: 0.86, 95% CI: 0.56-1.31). There was no evidence of effect modification by breastfeeding, older siblings, pet dog ownership, or maternal allergy. Caesarean delivery, either with or without labor, or elective or emergency, was not associated with the risk of food allergy in a population-based cohort of 12-month-old infants.

Maternal BMI and allergy in children until 3 years of age (JECS).

Maternal prepregnancy body mass index (BMI) may influence allergic diseases in the children who are the product of those pregnancies. The purpose of our study was to investigate the association between mothers' prepregnancy BMI and the risk of physician-diagnosed asthma, food allergy (FA), and atopic dermatitis (AD) in their children during the first 3 years of life. Data on mothers' prepregnancy BMI and physician-diagnosed asthma, FA, and AD in their children until the age of 3 years were obtained from the Japan Environment and Children's Study, a nationwide birth cohort study that has recruited 103,099 pregnant women between 2011 and 2014. Logistic regression analysis was used to analyze the results. We analyzed 67,204 mother-child pairs with available information on physician-diagnosed allergic diseases. The risk of asthma was significantly higher in children born to overweight mothers (adjusted OR [aOR]=1.17 [95% CI= 1.07-1.28]) and obese mothers (aOR= 1.28 [95% CI= 1.08-1.50]), whereas the risk of FA, cow's milk allergy, and egg allergy decreased significantly in children born to overweight mothers (aOR= 0.84 [95% CI= 0.76-0.92]; aOR= 0.78 [95% CI= 0.64-0.93]; and aOR= 0.83 [95% CI= 0.74-0.94]) and obese mothers (aOR= 0.81 [95% CI= 0.67-0.97]; aOR= 0.58 [95% CI= 0.36-0.87]; and aOR= 0.73 [95% CI= 0.56-0.93]) compared with in children born to normal weight mothers, respectively. Associations between AD and maternal BMI were not detected. Our study showed that an increase in mothers' prepregnancy BMI was associated with an increase in asthma prevalence and a decrease in FA prevalence in their children. Further studies are needed to reveal the mechanisms associated with maternal BMI and pediatric allergic diseases.

Cord blood sphingolipids are associated with atopic dermatitis and wheeze in the first year of life.

Background:Allergen-sensitized pregnant mice have increased plasma levels of the lipids β-glucosylceramides (βGlcCers) that are transplacentally transferred to the fetus, increased subsets of proinflammatory dendritic cells in the fetal liver and pup lung, and increased allergen-induced offspring lung inflammation.Objective:Our aim was to determine whether these preclinical observations extend to a human association of βGlcCers with wheeze and allergic disease in the prospective Wisconsin Infant Study Cohort.Methods:We measured 74 lipids in cord blood plasma by using mass spectrometry detection of sphingolipids, eicosanoids, and docosinoids, as well as an ELISA for 13-hydroxyoctadecadienoic acid. Lipid profiles were determined by unbiased Uniform Manifold Approximation and Projection dimensional reduction machine learning. Lipid profiles and a proinflammatory lipid index were analyzed for association with maternal allergy and childhood outcomes of wheeze, atopic dermatitis, cord blood leukocytes, and total IgE level at age 1 year.Results:Uniform Manifold Approximation and Projection analysis of lipids defined 8 cluster-specific plasma lipid profiles. Cluster 6 had significantly lower levels of plasma βGlcCers and a higher frequency of cord blood plasmacytoid dendritic cells that mediate anti-inflammatory responses, which is consistent with an anti-inflammatory profile. For clusters and for each infant, a proinflammatory lipid index was calculated to reflect the sum of the proinflammatory lipids minus the anti-inflammatory lipids that were significantly different than in cluster 6. The cluster proinflammatory lipid index was associated with cord blood basophil frequency and with wheeze and atopic dermatitis in the first year of life. The infant inflammatory lipid index was associated with increased risk of wheeze in the first year of life.Conclusion:The cord blood proinflammatory lipid index is associated with early-life atopic dermatitis and wheezing.

Associations between Body Mass Index Trajectories in the first two years of life and Allergic Rhinitis, Eczema and Food Allergy outcomes up to early adulthood.

Early life body mass index (BMI) trajectories influence the risk of asthma at 18 years of age. However, it is unclear if these are also associated with other allergic diseases. We investigated the associations between BMI trajectories and subsequent allergic rhinitis, eczema and food sensitisation/allergies. Parent-reported anthropometric data were collected 18 times in the first two years of life from a cohort of 620 participants in a high-risk cohort. Group-based trajectory modelling was applied to develop BMI trajectories. Associations between trajectories and allergic rhinitis, eczema and food sensitisation at 6, 12 and 18 years of age were assessed using logistic regression models. Potential effect modifications by parental allergic disease, sex and allocated infant formula were assessed. We identified five BMI trajectories: average, below average, persistently low, early low and catch up, and persistently high. None showed an association with allergic rhinitis. In participants with maternal allergic rhinitis, 'early-low and catch-up' (OR=2.83;95%CI 1.34-5.96, Pint =0.05) and 'below average' trajectories (OR=2.39; 1.18-7.23, Pint =0.02) were associated with allergic rhinitis at 18 years of age compared with the average trajectory. No associations were observed with eczema or food sensitisation. Infants with early-low and catch-up, or below average BMI growth, were at increased risk of allergic rhinitis at 18 years if they had a mother with allergic rhinitis. These results require replication, but suggest that interactions between poor intrauterine growth, failure to thrive and maternal allergies may influence the risk of allergic rhinitis.

155. Antihistamine use in pregnancy and risk of early-onset preeclampsia

Introduction:/aims: Pregestational maternal allergy is an isolated risk factor for early-onset preeclampsia. The aim of this study was to assess the association between maternal use of antihistamines and early-onset preeclampsia, Methods: A population-based cohort study with data from the Medical Birth Registry of Norway and the Norwegian Prescription Database 2004-2016. We divided the prescription of antihistamines into pregestational (last six months before conception), first half of pregnancy (from conception to week 20) and second half of pregnancy (from week 20 to 36).

Maternal Influences and Intervention Strategies on the Development of Food Allergy in Offspring.

Food allergies and other immune-mediated diseases have become serious health concerns amongst infants and children in developed and developing countries. The absence of available cures limits disease management to allergen avoidance and symptomatic treatments. Research has suggested that the presence of maternal food allergies may expose the offspring to genetic predisposition, making them more susceptible to allergen sensitization. The following review has focused on epidemiologic studies regarding maternal influences of proneness to develop food allergy in offspring. The search strategy was “food allergy OR maternal effects OR offspring OR prevention”. A systematically search from PubMed/MEDLINE, Science Direct and Google Scholar was conducted. Specifically, it discussed the effects of maternal immunity, microbiota, breastfeeding, genotype and allergy exposure on the development of food allergy in offspring. In addition, several commonly utilized prenatal and postpartum strategies to reduce food allergy proneness were presented, including early diagnosis of high-risk infants and various dietary interventions.

Maternal allergy modifies the association between reported domestic mold and asthma-related emergency department visits among New York City children

Report of domestic mold has been associated with asthma related emergency department (ED) visits. Maternal allergy is a risk for developing asthma and could increase susceptibility to wheeze with mold exposure. We hypothesized that self-report of mold or water damage is associated with asthma-related ED visits among children living in lower-income New York City neighborhoods and that this association would be more pronounced among children whose mothers reported having allergy.

Autism Spectrum Disorder Initiation by Inflammation-Facilitated Neurotoxin Transport.

Autism spectrum disorders have been linked to genetics, gut microbiota dysbiosis (gut dysbiosis), neurotoxin exposures, maternal allergies or autoimmune diseases. Two barriers to ingested neurotoxin transport into the central nervous system of a fetus or child are the gastrointestinal wall of the mother or child and the blood-brain barrier of the fetus or child. Inflammation from gut dysbiosis or inflammation from a disease or other agent can increase the gastrointestinal wall and the blood-brain barrier permeabilities to enable neurotoxins to reach the brain of a fetus or child. Postnatal gut dysbiosis is a particular inflammation risk for autism spectrum disorders caused by neurotoxin transport into a child's brain. An extensive gut dysbiosis or another source of inflammation such as a disease or other agent in combination with neurotoxins, including aluminum, mercury, lead, arsenic, cadmium, arsenic, organophosphates, and neurotoxic bacterial toxins and fungal toxins resulting from the gut dysbiosis, can elevate neurotoxin levels in a fetal or child brain to cause neurodevelopmental damage and initiate an autism spectrum disorder. The neurotoxins aluminum and mercury are especially synergistic in causing neurodevelopmental damage. There are three plausible causational pathways for autism spectrum disorders. They include inflammation and neurotoxin loading into the fetal brain during the prenatal neurodevelopment period, inflammation and neurotoxin loading into the brain during the postnatal neurodevelopment period or a two-stage loading of neurotoxins into the brain during both the prenatal and postnatal neurodevelopment periods.

FEATURES OF CLINICAL SYMPTOMS AND THE INFLUENCE OF RISK FACTORS ON THE OCCURRENCE OF BRONCHIAL ASTHMA IN CHILDREN OF LVIV REGION OF DIFFERENT AGES

Bronchial asthma (BA) is a common chronic pathology of the lower respiratory tract in children. The first manifestations of the disease can begin at any age, but the clinical features, of the course, are different in different periods of childhood. Manifestations and course of asthma may disappear or progress with age. Therefore, it is likely that there are differences in the pathophysiology, inflammatory response of the body and the features of the clinic of asthma in children of different ages, which affects the diagnosis and treatment. The aim of the study was to determine the features of clinical symptoms and the influence of risk factors for asthma on its occurrence in children of different ages.&#x0D; Materials and methods. We analyzed the anamnesis and clinical symptoms of 57 children aged 3 to 18 years, who were treated from September 2020 to June 2021 in the Lviv Regional Children's Clinical Hospital “OHMATDYT” and in the Lviv Municipal City Children's Clinical Hospital. The age groups did not differ statistically in the severity of asthma (P&gt; 0.05). Thus, in group 1 was 1 patient (9.09%) with mild form, 1 patient (9.09%) - moderate persistent form, 8 patients (72.73%) - with severe persistent form. Among patients of age group 2 was 1 patient (3.85%) with mild persistent form, 3 children (11.54%) - moderate and 21 children (80.77%) - with severe persistent form. In group 3 was 1 patient (5%) with a mild persistent form, 6 patients (30%) - moderate and 12 children (80%) - with a severe persistent form. The vast majority of patients were boys (84.21 ± 4.83%). All patients underwent general clinical examinations, spirometry, and allergy tests. We used the clinical-anamnestic method to perform the tasks of the work, which consisted in collecting a detailed somatic and genealogical anamnesis during the parents` questionnaire. Physical development of children was assessed using centile tables. Statistics were evaluated by calculating Student's t-test and Pearson's consistency test. Preschool children with asthma were more likely to experience shortness of breath during exercise and a wet low-yielding cough, and children of primary and secondary school age were more characterized by concomitant allergic rhinitis. Autumn was more unfavorable period for the exacerbation of clinical manifestations of asthma in children of Lviv region was period. We did not find correlation of birth weight on the timing of asthma. However, a burdensome obstetric history contributed to the early development of clinical manifestations of asthma. Preschool children were more likely to be exposed to nicotine during the antenatal period and had a shorter duration of breastfeeding, which may be a probable risk factor for asthma in preschool children. In 77% of children from different age groups were burdened with a history of allergies, with 66% of cases more pronounced in the maternal line. An analysis of physical development revealed that most preschool children were overweight.&#x0D; Conclusions. Asthma has features of clinical symptoms in children of different ages - shortness of breath during exercise and whooping cough are characteristic of preschool children, and concomitant chronic persistent rhinitis - for older age groups. Seasonal exacerbations are characteristic of asthma in children; in particular, the autumn period is more unfavorable, common for asthmatics in children of all ages among patients in Lviv region. Maternal smoking during pregnancy has a significant effect on the risk of developing asthma in children. Also, a burdened maternal allergy history and overweight child contributes to the development of asthma in children.

Association of infant antibiotic exposure and risk of childhood asthma: A meta-analysis

BackgroundInfant antibiotic exposure may be associated with childhood asthma development. ObjectiveTo examine and detail this association considering potential confounders. Study designPubMed, EMBASE, Web of Science, and the Cochrane Library were searched for publications from January 2011 to March 2021. Eligible studies were independently reviewed to extract data and assess quality. Random effect model was used to pool odds ratio (OR) and corresponding 95% confidence intervals (CIs). ResultsA total of 52 studies were included. The association of infant antibiotic exposure and childhood asthma was statistically significant for overall analysis (OR, 1.37; 95% CI, 1.29–1.45) and for studies that addressed reverse causation (RC) and confounding by indication (CbI) (1.19; 95% CI, 1.11–1.28). Significance remained after stratification by adjustment for maternal antibiotic exposure, medical consultation, sex, smoke exposure, parental allergy, birth weight, and delivery mode. In detailed analyses, macrolides (OR, 1.56; 95% CI, 1.31–1.86), antibiotic course≥5 (OR, 1.79; 95% CI, 1.36–2.36), exposure within 1 week of birth (OR, 1.82; 95% CI, 1.34–2.47), asthma developed among 1–3 years (OR, 1.84; 95% CI, 1.63–2.08), short time lag between exposure and asthma onset (OR, 2.05; 95% CI, 1.91–2.20), persistent asthma (OR, 2.61; 95% CI, 1.49–4.59), and atopic asthma (OR, 2.14; 95% CI, 1.58–2.90) showed higher pooled estimates. ConclusionInfant antibiotic exposure is associated with increased risk of childhood asthma considering confounding, and the association varied with different settings of exposure and outcomes. This highlights the need for prevention of asthma after early antibiotic exposure. Heterogeneity among studies called for caution when interpretation.

Maternal dietary allergen restriction while breast-feeding: Pediatric resident knowledge and practices.

An adequate understanding of the relationship between breast-feeding practices and infant food allergy is essential for clinicians. Although there is evidence of an education gap in general breast-feeding concepts, little is known about the pediatric trainee knowledge and practice with regard to breast-feeding, maternal diet, and potential allergy outcomes. To assess pediatric residents' knowledge, describe practices, and evaluate a module designed to provide evidence-based education about breast-feeding, food allergy, and food avoidance to inform future resources on the topic of breast-feeding and allergic outcomes. Pediatric residents completed a survey to assess the knowledge and comfort with regard to maternal dietary restriction, breast-feeding, and infant food allergy. Residents then viewed an online educational module about evidence-based breast-feeding and infant food allergy guidelines, and, after 1 month, completed the online questionnaire again. Among respondents (N = 68), only 8% and 5%, felt knowledgeable and comfortable with current maternal diet during breast-feeding and infant food allergy recommendations, respectively. Eighty-seven percent had not received formal training on the topic, and a large percentage relied on mentor teaching (49%) or anecdotal evidence (19%) as opposed to available guidelines (32%) for guidance. Most respondents (61-93%) correctly answered questions with regard to guidelines on primary and secondary food allergy prevention in relation to maternal diet. The upper-level residents answered more questions correctly about allergic proctocolitis compared with the interns (p < 0.05); no differences were noted for other topics. The majority (63%) did not believe that a mother's nutritional status could be adversely affected by dietary allergen restriction. A review of the pre- and posttest scores showed the educational module had little impact on knowledge. Pediatric residents reported low comfort and perceived that they had little knowledge about maternal diet and infant food allergy, yet their actual performance suggested the opposite. Those who completed the educational module did not demonstrate knowledge improvement, which highlighted the need for the development of robust educational resources.

Prenatal Air Pollution, Maternal Immune Activation, and Autism Spectrum Disorders

BACKGROUND AND AIM: Early-life causes of autism spectrum disorders (ASD) are multifactorial, including prenatal air pollution and gestational conditions with maternal immune activation (MIA) which may share common biological mechanisms. This study examined the potential synergistic effects of prenatal air pollution and MIA on ASD risk. METHODS: This retrospective cohort study included 311,617 mother-child pairs with singleton deliveries in Kaiser Permanente Southern California (KPSC) hospitals in 2001-2014. Children were followed through electronic medical records (EMR) until ASD diagnosis, non-KPSC membership, death, or December 31, 2019, whichever came first. The presence of five broad categories of MIA during pregnancy (asthma, infections, any hypertension, allergies, and autoimmune diseases) were identified by International Classification of Diseases, Ninth Revision (ICD-9). Pregnancy average PM2.5, NO2, and O3 exposures were estimated using high spatio-temporal resolution models based on maternal residential address history during pregnancy. Hazard ratios of ASD associated with air pollution and MIA were estimated using Cox regression models adjusted for birth year, KPSC medical center, child sex, and maternal sociodemographic characteristics. Multiplicative interactions were assessed in Cox models using interaction terms; additive interactions were assessed using relative excess risk due to interaction (RERI). RESULTS:The prevalence of maternal asthma, infection, hypertension, allergy, and autoimmune diseases was 7.17%, 48.6%, 9.6%, 13.7%, and 11.2%, respectively. During follow-up 6,291 children were diagnosed with ASD. Higher levels of average pregnancy PM2.5, and each of the five categories of MIA exposures was associated with ASD risk (p-value0.05). However, no statistically significant interactions were found between the five categories of MIA and any of the three air pollutants on either multiplicative or the additive scales. CONCLUSIONS:This study found little evidence that MIA and prenatal air pollution have synergistic effects on ASD. MIA and prenatal air pollution may contribute independently to ASD risk. KEYWORDS: Air pollution, Neurodevelopmental outcomes, Pregnancy outcomes

Potential sex differences in human milk leptin and their association with asthma and wheeze phenotypes: Results of the Ulm Birth Cohorts.

The hormone leptin has been suggested to play a role in the respiratory and immune systems. Evidence on sex-specific concentrations of leptin in human milk and sex-specific associations with the development of asthma and wheeze has been put forward but is still scarce. To investigate whether male and female infants receive different levels of leptin through human milk and whether leptin is implicated in the development of asthma and wheeze in a sex-dependent manner using data from the two Ulm Birth Cohort studies. Leptin data were available from human milk samples collected at 6weeks (Ulm Birth Cohort Study [UBCS, n=678; Ulm SPATZ Health Study, n=587]), and, in SPATZ only, at 6months (n=377) and 12months (n=66) of lactation. Sex-specific associations with doctor-diagnosed asthma and wheeze phenotypes were assessed in crude and adjusted models using logistic regression. Adjustments were made for maternal allergy, exclusive breastfeeding, infant age at the time of milk sampling, and child BMI z-score. At 6weeks, leptin levels (median [min, max], in ng/L) were higher in the milk for girls (197 [0.100, 4120]) than in milk for boys (159 [1.02, 3280], p=.045) in UBCS. No significant sex differences were observed in SPATZ (p=.152). There were no significant associations of leptin with asthma or wheeze in both studies, even in a sex-dependent manner (p>.05). It remains unclear whether male and female infants receive different levels of leptin through human milk. However, leptin in human milk may not be associated with history and development of asthma and wheeze in a sex-specific manner.

Association between preterm birth and maternal allergy considering IgE level.

The aim of this study was to explore the association between maternal allergies and preterm birth by different total immunoglobulin E (IgE) levels. Data of 81791 pregnant women from the Japan Environment and Children's Study, a prospective birth cohort, were used. Maternal allergic diseases, including a history of bronchial asthma (BA), atopic dermatitis (AD), and allergic rhinitis (AR), were obtained by self-administered questionnaires. Total serum IgE levels were measured at the first trimester and obstetrical outcomes from medical records transcripts were analyzed. The association between maternal allergic disease and obstetric outcome, including threatened abortion, preterm labor, early preterm birth (22-33weeks), and late preterm birth (34-36weeks), were examined by logistic regression. Subgroup analyses were performed by IgE level. Maternal BA and AR were associated with an increased risk of threatened abortion and preterm labor, but high total IgE level was associated with a decreased risk of preterm labor. There was little difference in associations between allergic disease and threatened abortion and preterm labor by total IgE levels. Although there was no significant association between allergic disease and preterm birth, if total IgE was high, AR was significantly associated with a decreased risk of early preterm birth (adjusted odds ratio, 0.60; 95% confidence interval 0.43-0.86). There was significant evidence for differences associated with total IgE levels (P-values for the interaction of the effects of AD and AR on early preterm birth were 0.039 and 0.015, respectively). The effect of allergy on preterm birth might differ depending on the total IgE level.

Free and Total Amino Acids in Human Milk in Relation to Maternal and Infant Characteristics and Infant Health Outcomes: The Ulm SPATZ Health Study.

Free amino acids (FAAs) are important regulators of key pathways necessary for growth, development, and immunity. Data on FAAs in human milk (HM) and their roles in infant development are limited. We investigated the levels of FAAs and total amino acids (TAA, i.e., the sum of conjugated amino acids and FAAs) in HM in relation to infant and maternal characteristics and immunological conditions. FAA and TAA levels in HM sampled at 6 weeks (n = 671) and 6 months (n = 441) of lactation were determined using high-performance liquid chromatography. Child growth was ascertained at 4–5 weeks and at 6–7 months of age. Child allergy and lower respiratory tract infections were assessed in the first years of life. Associations of amino acid (AA) levels in HM with child growth and health outcomes were determined by Spearman correlation and modified Poisson regression, respectively. Free glutamine, glutamate, and serine in 6-week HM positively correlated with infant weight gain in the first 4–5 weeks of age. Maternal pre-pregnancy weight and body mass index (BMI) were negatively correlated with free glutamine and asparagine in 6-week and 6-month HM and positively correlated with the sum of TAAs in 6-month HM, but significance was lost following confounder adjustment. Free glutamine was lower in 6-month HM of mothers with an allergy (either active or non-active). No consistent associations were found between FAAs in HM and child health outcomes. However, potential negative associations were observed between specific FAAs and the risk of food allergy. These results suggest that specific FAAs play a role in infant growth. Moreover, these findings warrant further investigations into the relation of FAAs in HM with infant health outcomes and maternal allergy.

Maternal asthma during pregnancy and risks of allergy and asthma in progeny: a systematic review protocol.

The primary objective of this systematic review is to synthesize the best available evidence on the relationship between in utero exposure to maternal asthma and postnatal allergy. Secondary objectives are to investigate the impact of asthma loss of control, asthma exacerbation, and asthma severity during pregnancy on risks of allergy and asthma in progeny. Maternal asthma is a well-known risk factor for childhood asthma, with recent evidence suggesting that children of asthmatic mothers are also at increased risk of allergic diseases. Importantly, these do not appear to be purely genetic associations, since maternal asthma is more strongly associated with childhood asthma than paternal asthma. In addition, experimentally induced allergic asthma during pregnancy increases allergic responses to sensitization in mice. The strength of the relationships between exposure to maternal asthma or severity of maternal asthma, and progeny asthma and allergy are unknown. This review will include primary studies that report incidence of physician-diagnosed asthma or allergic disease in human progeny who were exposed in utero to maternal asthma, in comparison to progeny not exposed to maternal asthma. Initial search terms include (pregnan∗ OR gestat∗) AND asthma∗ AND allerg∗. We will search the following electronic databases for published and unpublished evidence: PubMed, Embase, MEDLINE (Ovid), Web of Science, Cochrane Library, CINAHL, Scopus, Informit Health, MedNar, ProQuest, and Trove. There will be no restrictions on publication date. Only studies available as a full-text English publication will be considered for inclusion. PROSPERO CRD42020201538.