Is Atopic Dermatitis Really Mom's Fault?

Prenatal Maternal Distress Affects Atopic Dermatitis in Offspring Mediated by Oxidative Stress

Chang HY, Suh DI, Yang SI, et al
J Allergy Clin Immunol. 2016;138:468-475

The Study

The Cohort for Childhood Origin of Asthma and Allergic Diseases (COCOA) study^[1] investigated an inner-city population to assess which factors might influence pediatric allergic disease, including genetics, perinatal environment, maternal lifestyle, and psychosocial stress of both mother and child. The study, conducted in Korea, was longitudinal, prospective, and observational.

Perinatal indoor and outdoor factors (allergens, smoking, pollutants) were measured along with maternal prenatal psychosocial stress and the child's neurodevelopment, perinatal nutrition, and microbiome.

The allergic diseases of interest included asthma, food allergy, rhinoconjunctivitis, and atopic dermatitis (AD). Researchers assessed maternal, paternal, cord, and child blood draws. Through maternal questionnaire responses, they documented stress levels and AD diagnoses. Objective markers of stress were also measured, including placental levels of 11β-hydroxysteroid dehydrogenase type 2 (11β-HSD2) and the antioxidant glutathione.

The researchers concluded that prenatal maternal distress puts offspring at greater risk for AD and that the condition was mediated by oxidative stress.^[2] Both depression and anxiety in the mother increased the risk for AD in children. High scores in these areas were also associated with markers of prenatal distress (11β-HSD2) and total glutathione levels.

The authors admit to multiple limitations of the study, including that prenatal distress was measured by survey rather than interview, that one third of study participants were excluded due to missing data, that distress was measured retrospectively, and that the diagnosis of AD relied upon parental report.

Viewpoint

As someone who has lived with AD almost his entire life, I have more than a passing interest in this study. In the early 1970s, the treatment was topical steroids with occlusive "Saran™ wrap" dressings. This study would not have been comforting to my mother, who worried plenty about my eczema and always wondered if there was something she could have done to prevent it.

Medicine, and allergy in particular, has a long history of blaming the mother. In the early half of the 20th century, asthma was largely considered a psychosomatic disorder, with the maternal-child interaction at its center. Because mother was considered the source of asthma, treatment entailed removing afflicted offspring from the home. This was actually effective for those asthmatic children who received treatment at National Jewish Hospital in Denver because at the facility's high altitude, dust mite populations were very low, and allergic asthma naturally improved. One can only imagine how hard this was for mothers.

One hundred years later, this study comes out suggesting that prenatal maternal distress contributes to the pathogenesis of AD. It is possible that this is the case, but of what practical use is this information, and how should it be transmitted to the parent? I know what my mother would say: "Don't blame mothers!" Maybe we should be asking why mothers are under so much stress. Perhaps it is because they bear the brunt of the workload at home even as they earn a living outside of it (and in many societies for less pay). Maybe if the fathers had been equal partners in domestic duties, the outcome would have been different.

This may seem like a glib response to an important topic, but there could be unintended consequences (guilt) of sharing this information with mothers. These are my personal views, and I dedicate this article review to the memory of my late mother who passed away this past April.

Abstract

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