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Breastfeeding and perinatal exposure, and the risk of asthma and allergies

Lodge, Caroline J.; Dharmage, Shyamali C.

Current Opinion in Allergy and Clinical Immunology: June 2016 - Volume 16 - Issue 3 - p 231–236
doi: 10.1097/ACI.0000000000000266
OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez
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Purpose of review Exposures during the perinatal period, a phase of rapid development, may have a profound and sustained effect on disease risk. In particular, perinatal exposures may influence the development and maturation of the infant immune system and the risk of allergic disease. We aimed to summarize the current literature on perinatal exposures and the risk of asthma and allergic disease

Recent findings Increased risk of offspring wheeze or asthma was found for: maternal obesity and hypertension during pregnancy; febrile illness, gynaecological, and viral respiratory infections in pregnancy; exposure to bisphenol A and phthalates in pregnancy and childhood; exposure to smoking in utero; low birth weight; caesarean section and neonatal hyperbilirubinaemia. Reduced risk of offspring atopic eczema was found for hookworm infection in pregnancy and reduced risk of offspring wheeze was associated with increased pregnancy dietary intake of vitamin E and zinc. Higher levels of selenium in pregnancy were associated with less risk of asthma in genetically susceptible offspring. Early life pet ownership was associated with a decrease in atopic asthma but an increase in nonatopic asthma risk.

Summary A diverse range of exposures were associated with allergic disease risk, highlighting the susceptibility of children during the perinatal period. Clinicians should reinforce public health messages concerning maternal obesity, smoking, and breastfeeding. The infant gut microbiome is emerging as an important hypothesis, which may mediate the relationship between many perinatal exposures and allergic disease.

aAllergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne

bMurdoch Children's Research Centre, Royal Childrens Hospital, Melbourne, Victoria, Australia

Correspondence to Caroline J. Lodge, National Health and Medical Research Council (NHMRC) Early Career Fellow, Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207, Bouverie Street, University of Melbourne, Victoria 3010, Australia. Tel: +61 3 83440848; e-mail: clodge@unimelb.edu.au

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