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. 2023 Mar 29;2(3):100104.
doi: 10.1016/j.jacig.2023.100104. eCollection 2023 Aug.

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

Sveinung T Hoel  1 , 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 LeBlanc  12 , Björn Nordlund  8   9 , Knut Rudi  13 , 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

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

Sveinung T Hoel et al. J Allergy Clin Immunol Glob. .

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.

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Figures

Fig 1
Fig 1
Flowchart showing selection process of study population in current substudy from PreventADALL cohort.
Fig 2
Fig 2
Forest plot for CS overall, water birth, CS before onset of labor, and CS after onset of labor compared to traditional vaginal birth, adjusted for sex, GA, and parity. CS before onset of labor was defined as CS before start of contractions and membrane rupture; CS after onset of labor was defined as CS after start of contractions and/or membrane rupture.
Fig 3
Fig 3
Grouped column graph showing persistence of AD according to age at onset. AD was defined as follows: AD with no early onset indicates no eczema at 3 months but AD by 36 months; early onset AD, eczema at 3 months and AD by 36 months; nonpersistent AD, no observed eczema by 12 months of age or at 36 months’ investigation, and AD diagnosed by 36 months; and persistent AD, eczema by both 12 months and at 36 months, and AD diagnosis by 36 months.
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