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PEDIATRICS Vol. 113 No. 3 March 2004, pp. 468-474

Perinatal Predictors of Atopic Dermatitis Occurring in the First Six Months of Life

Megan M. Moore, MD*, Sheryl L. Rifas-Shiman, MPH*, Janet W. Rich-Edwards, ScD*, Ken P. Kleinman, ScD*, Carlos A. Camargo, Jr, MD, DrPH{ddagger},§, Diane R. Gold, MD, MPH{ddagger},||, Scott T. Weiss, MD, MS{ddagger} and Matthew W. Gillman, MD, SM*,¶

* Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
{ddagger} Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital
§ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
|| Departments of Environmental Epidemiology
Nutrition, Harvard School of Public Health, Boston, Massachusetts

Objective. Previous studies of predictors of atopic dermatitis have had limited sample size, small numbers of variables, or retrospective data collection. The purpose of this prospective study was to investigate several perinatal predictors of atopic dermatitis occurring in the first 6 months of life.

Design. We report findings from 1005 mothers and their infants participating in Project Viva, a US cohort study of pregnant women and their offspring. The main outcome measure was maternal report of a provider’s diagnosis of eczema or atopic dermatitis in the first 6 months of life. We used multiple logistic regression models to assess the associations between several simultaneous predictors and incidence of atopic dermatitis.

Results. Cumulative incidence of atopic dermatitis in the first 6 months of life was 17.1%. Compared with infants born to white mothers, the adjusted odds ratio (OR) for risk of atopic dermatitis among infants born to black mothers was 2.41 (95% confidence interval [CI]: 1.47, 3.94) and was 2.58 among infants born to Asian mothers (95% CI: 1.27, 5.24). Male infants had an OR of 1.76 (95% CI: 1.24, 2.51). Increased gestational age at birth was a predictor (OR: 1.14; 95% CI: 1.02, 1.27, for each 1-week increment), but birth weight for gestational age was not. Infants born to mothers with a history of eczema had an OR of 2.67 (95% CI: 1.74, 4.10); paternal history of eczema also was predictive, although maternal atopic history was more predictive than paternal history. Several other perinatal, social, feeding, and environmental variables were not related to risk of atopic dermatitis.

Conclusions. Black and Asian race/ethnicity, male gender, higher gestational age at birth, and family history of atopy, particularly maternal history of eczema, were associated with increased risk of atopic dermatitis in the first 6 months of life. These findings suggest that genetic and pre- and perinatal influences are important in the early presentation of this condition.

Key Words: atopic dermatitis • eczema • perinatal • infancy • gestational age • race/ethnicity • gender

Abbreviations: BMI, body mass index • OR, odds ratio • CI, confidence interval • IgE, immunoglobulin E

Received for publication Feb 21, 2003; Accepted Jun 23, 2003.




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