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Meta-Analysis
. 2020 Nov;31(8):889-912.
doi: 10.1111/pai.13303. Epub 2020 Aug 6.

Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology

Carina Venter  1   2 , Carlo Agostoni  3 , S Hasan Arshad  4   5 , Miriam Ben-Abdallah  2 , George Du Toit  6   7 , David M Fleischer  1   2 , Matthew Greenhawt  1   2 , Deborah H Glueck  8 , Marion Groetch  9 , Nonhlanhla Lunjani  10   11 , Kate Maslin  12 , Alexander Maiorella  13 , Rosan Meyer  14 , Muraro Antonella  15 , Merryn J Netting  16   17 , Bright Ibeabughichi Nwaru  18 , Debra J Palmer  19 , Micheala P Palumbo  20 , Graham Roberts  5   6   21   22 , Caroline Roduit  23   24 , Pete Smith  25 , Eva Untersmayr  26 , Lauren A Vanderlinden  27 , Liam O'Mahony  28
Affiliations
Meta-Analysis

Dietary factors during pregnancy and atopic outcomes in childhood: A systematic review from the European Academy of Allergy and Clinical Immunology

Carina Venter et al. Pediatr Allergy Immunol. 2020 Nov.

Abstract

Rationale: Allergic diseases are an increasing public health concern, and early life environment is critical to immune development. Maternal diet during pregnancy has been linked to offspring allergy risk. In turn, maternal diet is a potentially modifiable factor, which could be targeted as an allergy prevention strategy. In this systematic review, we focused on non-allergen-specific modifying factors of the maternal diet in pregnancy on allergy outcomes in their offspring.

Methods: We undertook a systematic review of studies investigating the association between maternal diet during pregnancy and allergic outcomes (asthma/wheeze, hay fever/allergic rhinitis/seasonal allergies, eczema/atopic dermatitis (AD), food allergies, and allergic sensitization) in offspring. Studies evaluating the effect of food allergen intake were excluded. We searched three bibliographic databases (MEDLINE, EMBASE, and Web of Science) through February 26, 2019. Evidence was critically appraised using modified versions of the Cochrane Collaboration Risk of Bias tool for intervention trials and the National Institute for Clinical Excellence methodological checklist for cohort and case-control studies and meta-analysis performed from RCTs.

Results: We identified 95 papers: 17 RCTs and 78 observational (case-control, cross-sectional, and cohort) studies. Observational studies varied in design and dietary intakes and often had contradictory findings. Based on our meta-analysis, RCTs showed that vitamin D supplementation (OR: 0.72; 95% CI: 0.56-0.92) is associated with a reduced risk of wheeze/asthma. A positive trend for omega-3 fatty acids was observed for asthma/wheeze, but this did not reach statistical significance (OR: 0.70; 95% CI: 0.45-1.08). Omega-3 supplementation was also associated with a non-significant decreased risk of allergic rhinitis (OR: 0.76; 95% CI: 0.56-1.04). Neither vitamin D nor omega-3 fatty acids were associated with an altered risk of AD or food allergy.

Conclusions: Prenatal supplementation with vitamin D may have beneficial effects for prevention of asthma. Additional nutritional factors seem to be required for modulating the risk of skin and gastrointestinal outcomes. We found no consistent evidence regarding other dietary factors, perhaps due to differences in study design and host features that were not considered. While confirmatory studies are required, there is also a need for performing RCTs beyond single nutrients/foods.

Keywords: AD; allergic diseases; allergic rhinitis; allergic rhinoconjunctivitis; asthma; children; eczema; food allergy; hay fever; infants; maternal diet; pregnancy; prevention; seasonal allergies; wheeze.

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Figures

FIGURE 1
FIGURE 1
Flow chart for study inclusion
FIGURE 2
FIGURE 2
A-C, Randomized controlled trials with asthma/wheeze as an outcome
FIGURE 3
FIGURE 3
A and B, Observational studies with asthma/wheeze (age 0-<3 y) as an outcome
FIGURE 4
FIGURE 4
A and B, Observational studies with asthma/wheeze (age 3 y and above) as an outcome
FIGURE 5
FIGURE 5
Randomized controlled trials with allergic rhinitis/hay fever as an outcome
FIGURE 6
FIGURE 6
A and B, Observational studies with allergic rhinitis/hay fever as an outcome
FIGURE 7
FIGURE 7
A and B, Randomized controlled trials with atopic dermatitis as an outcome
FIGURE 8
FIGURE 8
A and B, Observational studies with atopic dermatitis as an outcome
FIGURE 9
FIGURE 9
Randomized controlled trials with food allergy as an outcome
FIGURE 10
FIGURE 10
Observational studies with food allergy as an outcome
FIGURE 11
FIGURE 11
A and B, Randomized controlled trials with “any” sensitization as an outcome
FIGURE 12
FIGURE 12
A and B, Observational studies with “any” sensitization as an outcome
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