Birth mode is associated with development of atopic dermatitis in infancy and early childhood

Sveinung T Hoel; Johanna Wiik; Karin C L Carlsen; Kim M A Endre; Hrefna Katrín Gudmundsdóttir; Guttorm Haugen; Angela Hoyer; Christine Monceyron Jonassen; Marissa LeBlanc; Björn Nordlund; Knut Rudi; Håvard O Skjerven; Anne Cathrine Staff; Gunilla Hedlin; Cilla Söderhäll; Riyas Vettukattil; Hilde Aaneland; Eva M Rehbinder

doi:10.1016/j.jacig.2023.100104

Birth mode is associated with development of atopic dermatitis in infancy and early childhood

J Allergy Clin Immunol Glob. 2023 Mar 29;2(3):100104. doi: 10.1016/j.jacig.2023.100104. eCollection 2023 Aug.

Authors

Sveinung T Hoel¹, Johanna Wiik^{2

3

4}, Karin C L Carlsen^{1

5}, Kim M A Endre^{1

6}, Hrefna Katrín Gudmundsdóttir^{1

5}, Guttorm Haugen^{1

7}, Angela Hoyer^{8

9}, Christine Monceyron Jonassen^{10

11}, Marissa LeBlanc¹², Björn Nordlund^{8

9}, Knut Rudi¹³, Håvard O Skjerven^{1

5}, Anne Cathrine Staff^{1

7}, Gunilla Hedlin^{8

9}, Cilla Söderhäll^{8

9}, Riyas Vettukattil^{1

5}, Hilde Aaneland^{1

5}, Eva M Rehbinder^{1

6}

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Department of Gynecology and Obstetrics, Østfold Hospital Trust, Kalnes, Norway.
³ Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁴ Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁵ Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
⁶ Department of Dermatology and Vaenerology, Oslo University Hospital, Oslo, Norway.
⁷ Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway.
⁸ Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
⁹ Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
¹⁰ Centre for Laboratory Medicine, Østfold Hospital Trust, Grålum, Norway.
¹¹ Department of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
¹² Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
¹³ Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.

Abstract

Background: Birth by caesarean section (CS) is associated with development of allergic diseases, but its role in the development of atopic dermatitis (AD) is less convincing.

Objective: Our primary aim was to determine if birth mode was associated with AD in 3-year-olds and secondarily to determine if birth mode was associated with early onset and/or persistent AD in the first 3 years of life.

Methods: We included 2129 mother-child pairs from the Scandinavian population-based prospective PreventADALL cohort with information on birth mode including vaginal birth, either traditional (81.3%) or in water (4.0%), and CS before (6.3%) and after (8.5%) onset of labor. We defined early onset AD as eczema at 3 months and AD diagnosis by 3 years of age. Persistent AD was defined as eczema both in the first year and at 3 years of age, together with an AD diagnosis by 3 years of age.

Results: AD was diagnosed at 3, 6, 12, 24, and/or 36 months in 531 children (25%). Compared to vaginal delivery, CS was overall associated with increased odds of AD by 3 years of age, with adjusted odds ratio (95% confidence interval) of 1.33 (1.02-1.74), and higher odds of early onset AD (1.63, 1.06-2.48). The highest odds for early onset AD were observed in infants born by CS after onset of labor (1.83, 1.09-3.07). Birth mode was not associated with persistent AD.

Conclusion: CS was associated with increased odds of AD by 3 years of age, particularly in infants presenting with eczema at 3 months of age.

Keywords: Atopic dermatitis; C-section; birth mode; caesarean section; early onset atopic dermatitis; obstetrics; persistent atopic dermatitis; vaginal birth; water birth.