A protective influence of maternal inflammatory status on infantile atopic eczema risk has been proposed, but few studies have investigated these potential links. We examined the associations between energy-adjusted dietary inflammatory index (E-DII) scores indicative of an inflammatory dietary pattern, maternal serum neopterin levels, a biomarker elevated in Th1 immune activation, and infantile risk of atopic eczema. Within the UK Southampton Women’s Survey, mothers’ diets were recorded using questionnaires at preconception, early and late pregnancy and E-DII scores derived. Atopic eczema was ascertained using the UK Working Party Diagnostic Criteria at ages 6 and 12 months (n=2955 and 2871, respectively). A sub-sample of 497 mothers had serum neopterin measured in late pregnancy. Unadjusted analyses showed that higher E-DII in preconception and late pregnancy was associated with a lower risk of eczema at ages 6 and 12 months. After adjusting for maternal BMI, age, parity, education, smoking during pregnancy, breastfeeding duration and sex, higher E-DII in late pregnancy was associated with reduced risks of eczema at age 6 and 12 months (OR 0.89 [95%CI 0.81,0.99], p=0.03 and OR 0.91 [0.82,1.00], p=0.05, respectively). Consistent with this, higher maternal serum neopterin was associated with a lower risk of eczema at ages 6 months (OR 0.72 (0.51,1.01), p=0.05) and 12 months (OR 0.71 (0.53,0.96), p=0.03). The findings suggest that a pro-inflammatory maternal diet and an inflammatory maternal environment during pregnancy may protect the developing infant from Th2 driven inflammation and lower the risk of infantile atopic eczema.

Background Evidence linking prenatal maternal vitamin D supplementation and offspring risk of atopic eczema is inconsistent, with most data coming from observational studies. Methods Within the UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) double-blind, randomised, placebo-controlled trial, we examined the relation of maternal vitamin D supplementation during pregnancy with offspring atopic eczema at ages 12, 24 and 48 months. In MAVIDOS, pregnant women were allocated to either cholecalciferol 1000 IU/day or matched placebo, taken from around 14 weeks’ gestation until delivery, with the primary outcome of neonatal whole-body bone mineral content. The prevalence of atopic eczema in the offspring was ascertained at ages 12 (n=636), 24 (n=611) and 48 (n=450) months, based on the UK Working Party Criteria for the Definition of Atopic Dermatitis. Results Mothers and offspring characteristics were similar between the intervention and placebo groups, apart from longer breastfeeding duration in the intervention group. Adjusting for breastfeeding duration, offspring of mothers who received 1000 IU cholecalciferol daily had a lower odds ratio (OR) of atopic eczema at age 12 months: OR (95%CI) 0.55 (0.32-0.97), p=0.04. The ORs of atopic eczema in the intervention group at ages 24 and 48 months were 0.77 (0.47-1.24) and 0.71 (0.35-1.43), respectively. Conclusion Our data demonstrated a clinically important reduction in offspring risk of atopic eczema in infancy following maternal cholecalciferol supplementation during pregnancy. The findings support a developmental influence on infantile atopic eczema and point to gestational cholecalciferol supplementation as a preventive strategy to reduce the burden of atopic eczema during infancy.

Early life exposure to antibiotics and laxatives in relation to infantile atopic eczemaSarah El-Heis 1 DMSarah R Crozier1,2 PhDNicholas C Harvey1,3 PhDEugene Healy4 PhDKeith M Godfrey1,3,5 FMedSci1 Medical Research Council Lifecourse Epidemiology Centre, University of Southampton,Southampton, UK2 NIHR Applied Research Collaboration Wessex, Southampton Science Park, Innovation Centre, Southampton, UK3 NIHR Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK4 Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK5 Developmental Sciences, University of Southampton, Southampton, UK

Background: Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. Objectives: To review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants. Search Strategy: We searched online bibliographic databases for studies investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. Selection Criteria: Observational, interventional studies, and systematic reviews assessing the relationships between folic acid and ankyloglossia. Data Collection and Analysis: The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia Main Results: One case-control study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question. Conclusions: Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.

Objective To examine the change in maternal body mass index (BMI) between the first two deliveries and outcomes in the second delivery. Design Cohort study using electronic medical records. Setting and population Medical records of women with their first two consecutive deliveries between 2015 and 2020 at KK Women’s and Children’s Hospital, Singapore were retrieved. Methods Analysis was limited to women with BMI available for both pregnancies, which was standardised/adjusted to 12 weeks gestation. The difference between gestational-age-adjusted BMI in both pregnancies was calculated as the change in interpregnancy BMI. The risk ratios (RR) of pregnancy outcomes were estimated using modified Poisson regression models with confounder adjustment. Main outcome measures Low birthweight (<2.5 kg), high birthweight (≥4 kg), small-for-gestational-age, large-for-gestational-age, preterm delivery, gestational diabetes, elective and emergency caesarean deliveries. Results Of 6264 included women with a median interpregnancy interval of 1.44 years, 40.7% had a stable BMI change within +1 kg/m2, 10.3% lost >1 kg/m2, 34.3% gained 1-3 kg/m2 and 14.8% gained ≥3 kg/m2. Compared to women with stable BMI change, those with >1 kg/m2 loss had a higher risk of low birthweight delivery (RR 1.36; 95% confidence interval 1.02, 1.80), while those with 1-3 kg/m2 gain had higher risks of large-for-gestational-age birth (1.16; 1.03, 1.31), gestational diabetes (1.25; 1.06, 1.49) and emergency caesarean delivery (1.16; 1.03, 1.31); these risks were higher in those with ≥3 kg/m2 gain. Conclusion Our study demonstrated the importance of returning to pre-pregnancy weight and maintaining a stable interpregnancy BMI, to achieve better pregnancy outcomes.

Background The interconception period is considered a time when parents are likely to engage with health messages and are in frequent contact with healthcare professionals. Objectives Through this literature review and policy analysis, we synthesised articles and guidelines on interconception care to provide recommendations to improve health outcomes for parents, infants and future generations. Search Strategy Four databases were searched systematically, using MeSH and free-text terms based on ‘interconception’ and ‘postpartum’. Selection Criteria Selected articles included reviews, pilot studies and guidelines on interconception and postpartum interventions published in English by UK public health organisations and government agencies between 1st January 2010-12th January 2021. Data Collection and Analysis 30% of titles, abstracts and full-text papers were double-screened. The description table of identified guidelines were qualitatively analysed to generate categories, later developed into a framework of six domains. Findings are described using a narrative synthesis approach. Main Results We found 47 documents with guidelines, 29 reviews and six pilot studies on interconception and postpartum care. Interconception care opportunities include the postpartum period, family planning, routine practice, and risk assessments. Health and non-healthcare professionals have a role to play in the interconception period including GPs, health visitors, dieticians, nutritionists, health psychologists, community groups, local authorities and charities such as Tommy’s and First Step Nutrition. Conclusions The interconception and postpartum periods offer crucial opportunities to intervene to reduce possible long-term effects of suboptimal nutrition. Though the policy analysis for this review focused on the UK, the recommendations can have wider implications for other countries.

Background: Infants with atopic dermatitis (AD) are reported to be at higher risk of early childhood caries (ECC) at 3-years, but the clinical validity of the reported link remains unknown. We investigated if clinical severity of AD in young children is associated with increased ECC risk at 3-years. Methods: In Growing Up in Singapore Towards healthy Outcomes (GUSTO) mother-offspring cohort, AD was diagnosed by trained physicians using Hanifin and Rajka criteria at 18-month and 3-year clinic visits (n=837). Of the children diagnosed with AD, disease severity was assessed using SCORAD (SCORing Atopic Dermatitis) index and categorized into moderate-to-severe AD (SCORAD≥25), and mild AD (SCORAD<25), with children without AD (non-AD) as a reference group. Oral examinations for ECC detection was performed by calibrated dentists in 656 children at age 3-years. Negative binomial regression was used to calculate the adjusted incidence risk ratio (aIRR; adjusted for socio-demographic factors and prenatal tobacco smoke exposure). Results: Atopic dermatitis was diagnosed in 7.3% (61/837) children; amongst which 23% had moderate-to-severe AD and 77% had mild AD. ECC was observed in 85.7%, 36.8% and 42.8% of the children in moderate-to-severe, mild and non-AD groups, respectively. Children with moderate-to-severe AD were at higher risk of ECC (aIRR 2.30 [95% confidence interval (CI) 1.04-5.06]; p=0.03) at 3 years compared to non-AD, while no association was seen between mild AD and ECC. Conclusions: Children with moderate-to-severe atopic dermatitis were at higher risk of ECC compared to those without AD and may benefit from early dental referral.