Faltering of prenatal growth precedes the development of atopic eczema in infancy: cohort study
Authors El-Heis S, Crozier SR, Healy E, Robinson SM, Harvey NC, Cooper C, Inskip HM, Baird J, Godfrey KM
Received 31 May 2018
Accepted for publication 25 September 2018
Published 12 December 2018 Volume 2018:10 Pages 1851—1864
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Ms Justinn Cochran
Peer reviewer comments 2
Editor who approved publication: Professor Henrik Toft Sørensen
Sarah El-Heis,1 Sarah R Crozier,1 Eugene Healy,2 Sian M Robinson,1,3 Nicholas C Harvey,1,3 Cyrus Cooper,1,3,4 Hazel M Inskip,1,3 Janis Baird,1,3 Keith M Godfrey1,3,5
On behalf of Southampton Women’s Survey Study Group
1Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; 2Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK; 3NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; 4NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; 5Institute of Developmental Sciences, University of Southampton, Southampton, UK
Background: Infants with atopic eczema have an increased risk of impaired growth, but the origin of this impairment is unclear. The aim of this study was to examine fetal and infant growth in relation to infantile atopic eczema.
Methods: Within the UK Southampton Women’s Survey, 1,759 infants with known maternal menstrual data had anthropometric measurements at 11, 19, and 34 weeks’ gestation, birth, and ages 6 and 12 months, enabling derivation of growth velocity SD scores. Infantile atopic eczema at ages 6 and/or 12 months was ascertained using modified UK Working Party diagnostic criteria.
Results: Expressed per SD increase, higher femur length and abdominal circumference at 34 weeks’ gestation were associated with decreased risks of atopic eczema (eczema OR/SD increase 0.81 [95% CI 0.69–0.96], P=0.017 and 0.78 [95% CI 0.65–0.93], P=0.006, respectively), while every SD increase in head to abdominal circumference ratio (indicating disproportionate growth) was associated with an increase in risk of atopic eczema (1.37 [1.15–1.63], P=0.001). Lower velocities of linear growth from 11 weeks’ gestation to birth and birth to age 6 months were associated with atopic eczema (atopic eczema OR/SD increase 0.80 [0.65–0.98], P=0.034 and 0.8 [1 0.66–1.00], P=0.051, respectively). Infants with atopic eczema at age 12 months had a larger head circumference in early gestation and faltering of abdominal growth velocity from 19 to 34 weeks’ gestation (atopic eczema OR/SD increase 0.67 [0.51–0.88], P=0.003).
Conclusion: Infants with atopic eczema demonstrate altered patterns of fetal growth, including faltering of linear growth in utero, prior to the clinical onset of atopic eczema. These findings suggest growth falters prior to the start of clinical atopic eczema and its treatment.
Keywords: atopic eczema, fetal growth, infant growth
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