Moore MM, Rifas-Shiman SL, Rich-Edwards JW, et al. Pediatrics. 2004;113:468–474
Purpose of the Study.
To prospectively investigate perinatal predictors of atopic dermatitis during the first 6 months of life.
Study subjects were 1005 urban and suburban mothers and their infants enrolled in Project Viva, based in the greater Boston, Massachusetts, area. The main outcome measure was maternal report of a provider’s diagnosis of eczema or atopic dermatitis in the first 6 months of life.
The authors used a prospective birth cohort study design and multiple logistic-regression models to assess the associations between potential predictors and incidence of atopic dermatitis.
The incidence of atopic dermatitis in the first 6 months of life was 17.1%. The risk of atopic dermatitis was increased among infants born to black or Asian mothers (adjusted odds ratio [OR]: 2.41 and 2.58, respectively) and among infants whose mothers had eczema (OR: 2.67). Other predictors included increased gestational age at birth (OR: 1.14; 95% confidence interval: 1.02, 1.27, for each 1-week increment) and male gender (OR: 1.76).
These findings suggest that genetic and prenatal and perinatal influences are important in the early presentation of atopic dermatitis.
There are relatively little data about risk factors for atopic dermatitis in the United States, and the strengths of this study are the prospective evaluation of risk factors in a large population with data collection beginning in the prenatal period. The results of the study point to a number of risk factors related to heredity and potentially genetics as being important in early onset of eczema. The preponderance of affected males is interesting given that infant boys are also more likely to wheeze. Although this may be due in part to changes in airway mechanics, the results of this study, together with data demonstrating higher total serum IgE levels in boys, suggest that immune development is also related to gender. Environmental factors were not prominent as risk factors for eczema, although there was a trend toward an association with greater cockroach exposure. It is likely that environmental exposures play a greater role in determining the persistence of atopic dermatitis or perhaps the incidence after the first 6 months of age.