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Maternal periconceptional folate status and infant atopic dermatitis: A prospective cohort study

Ying Ye^1,2, Li-Min Dou², Yi Zhang¹

¹Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai, China.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology

|July 15, 2020

Insights

Higher maternal red blood cell folate in early pregnancy is linked to an increased risk of infant atopic dermatitis (AD). This suggests maintaining appropriate folate levels may help reduce AD risk in newborns.

Area of Science:

Obstetrics and Gynecology
Pediatrics
Dermatology
Nutritional Science

Background:

Maternal folate status is a potential factor influencing childhood allergic disorders like atopic dermatitis (AD).
Existing research on the link between maternal folate and infant AD risk is inconclusive.
This study investigates the association between folate levels during early pregnancy and the development of early-onset infant AD.

Purpose of the Study:

To assess the relationship between maternal folate status in early gestation and the incidence of early-onset infant atopic dermatitis (AD).
To determine if red blood cell (RBC) folate or serum folate levels in pregnant women are associated with AD risk in their children.
To evaluate the impact of periconceptional folic acid supplementation on infant AD risk.

Main Methods:

Prospective mother-child cohort study involving pregnant women recruited at 12-14 weeks gestation.
Measurement of maternal red blood cell (RBC) folate and serum folate concentrations at enrollment.
Diagnosis of AD in infants before 6 months of age using Williams' criteria; analysis via multivariate logistic regression.

Main Results:

Of 458 infants, 107 (23.4%) developed AD before 6 months; males were more affected.
Higher maternal RBC folate levels were significantly associated with an increased risk of infant AD (aOR 1.16 per 100 ng/mL).
Elevated RBC folate (≥620 ng/mL) correlated with a 91% increased risk of infant AD; no association found for serum folate or supplementation.

Conclusions:

This study presents the first evidence linking higher maternal RBC folate concentrations in early gestation to an increased risk of early-onset infant AD.
Findings underscore the importance of monitoring and maintaining optimal maternal folate levels during the periconceptional period.
Further research may be needed to clarify the mechanisms and optimal folate thresholds for preventing infant AD.

Read full analysis

Abstract

Background:

Maternal folate status is linked with the risk of allergic disorders including atopic dermatitis (AD) in children, but findings remain inconclusive. We aim to assess the relationship between maternal folate status in early gestation and early-onset infant AD, based on a prospective mother-child cohort study.

Methods:

Pregnant women were recruited at 12-14 weeks of gestation. Red blood cell folate (RBC folate) and serum folate concentrations were examined at enrollment. Periconceptional folic acid supplementation was investigated through a self-administered questionnaire. The primary outcome was AD incidence before 6 months of age, diagnosed according to Williams' criteria. Multivariate logistic regression was used to evaluate associations of maternal folate status with infant AD by adjusting parental and child covariates.

Results:

In total, 107 (23.4%) of 458 infants developed AD before 6 months, with more male infants affected (P = .002). Higher maternal RBC folate levels (per 100 ng/mL) were associated with an increased risk of AD (adjusted odds ratio [aOR] 1.16, 95% confidence interval [CI] 1.04-1.31). An RBC folate level ≥620 ng/mL was associated with increased infant AD by 91% (aOR 1.91, 95% CI 1.09-3.36). However, associations were not observed for maternal serum folate at early gestation or periconceptional folic acid supplement intakes.

Conclusions:

We provide the first evidence that higher maternal RBC folate concentrations during early gestation are associated with increased early-onset infant AD. Our findings support the importance of maintaining appropriate folate levels during the periconceptional period to reduce the risk of AD in infants.

Keywords:

allergy atopic dermatitis birth cohort folic acid supplement infant maternal folate status pregnancy

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