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COMMENTARY
IsAtopicDermatitisReallyMom'sFault?
PhysiciansShouldCarefullyConsiderProsandConsofSharing
GaryStadtmauer,MD |January27,2017

PrenatalMaternalDistressAffectsAtopicDermatitisinOffspringMediatedbyOxidativeStress
ChangHY,SuhDI,YangSI,etal
JAllergyClinImmunol.2016138:468475

TheStudy

TheCohortforChildhoodOriginofAsthmaandAllergicDiseases(COCOA)study[1]investigatedaninnercitypopulationto
assesswhichfactorsmightinfluencepediatricallergicdisease,includinggenetics,perinatalenvironment,maternallifestyle,
andpsychosocialstressofbothmotherandchild.Thestudy,conductedinKorea,waslongitudinal,prospective,and
observational.

Perinatalindoorandoutdoorfactors(allergens,smoking,pollutants)weremeasuredalongwithmaternalprenatal
psychosocialstressandthechild'sneurodevelopment,perinatalnutrition,andmicrobiome.

Theallergicdiseasesofinterestincludedasthma,foodallergy,rhinoconjunctivitis,andatopicdermatitis(AD).Researchers
assessedmaternal,paternal,cord,andchildblooddraws.Throughmaternalquestionnaireresponses,theydocumented
stresslevelsandADdiagnoses.Objectivemarkersofstresswerealsomeasured,includingplacentallevelsof11
hydroxysteroiddehydrogenasetype2(11HSD2)andtheantioxidantglutathione.

TheresearchersconcludedthatprenatalmaternaldistressputsoffspringatgreaterriskforADandthattheconditionwas
mediatedbyoxidativestress. [2]BothdepressionandanxietyinthemotherincreasedtheriskforADinchildren.High
scoresintheseareaswerealsoassociatedwithmarkersofprenataldistress(11HSD2)andtotalglutathionelevels.

Theauthorsadmittomultiplelimitationsofthestudy,includingthatprenataldistresswasmeasuredbysurveyratherthan
interview,thatonethirdofstudyparticipantswereexcludedduetomissingdata,thatdistresswasmeasured
retrospectively,andthatthediagnosisofADrelieduponparentalreport.

Viewpoint

AssomeonewhohaslivedwithADalmosthisentirelife,Ihavemorethanapassinginterestinthisstudy.Intheearly
1970s,thetreatmentwastopicalsteroidswithocclusive"Saranwrap"dressings.Thisstudywouldnothavebeen
comfortingtomymother,whoworriedplentyaboutmyeczemaandalwayswonderediftherewassomethingshecould
havedonetopreventit.

Medicine,andallergyinparticular,hasalonghistoryofblamingthemother.Intheearlyhalfofthe20thcentury,asthma
waslargelyconsideredapsychosomaticdisorder,withthematernalchildinteractionatitscenter.Becausemotherwas
consideredthesourceofasthma,treatmententailedremovingafflictedoffspringfromthehome.Thiswasactuallyeffective
forthoseasthmaticchildrenwhoreceivedtreatmentatNationalJewishHospitalinDenverbecauseatthefacility'shigh
altitude,dustmitepopulationswereverylow,andallergicasthmanaturallyimproved.Onecanonlyimaginehowhardthis
wasformothers.

Onehundredyearslater,thisstudycomesoutsuggestingthatprenatalmaternaldistresscontributestothepathogenesisof
AD.Itispossiblethatthisisthecase,butofwhatpracticaluseisthisinformation,andhowshoulditbetransmittedtothe
parent?Iknowwhatmymotherwouldsay:"Don'tblamemothers!"Maybeweshouldbeaskingwhymothersareunderso
muchstress.Perhapsitisbecausetheybearthebruntoftheworkloadathomeevenastheyearnalivingoutsideofit(and
inmanysocietiesforlesspay).Maybeifthefathershadbeenequalpartnersindomesticduties,theoutcomewouldhave
beendifferent.

Thismayseemlikeaglibresponsetoanimportanttopic,buttherecouldbeunintendedconsequences(guilt)ofsharing
thisinformationwithmothers.Thesearemypersonalviews,andIdedicatethisarticlereviewtothememoryofmylate

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motherwhopassedawaythispastApril.

Abstract

References

1.YangHJ,LeeSY,SuhDI,etal.TheCohortforChildhoodOriginofAsthmaandallergicdiseases(COCOA)study:
design,rationaleandmethods.BMCPulmMed.201414:109.

2.ChangHY,SuhDI,YangSI,etal.Prenatalmaternaldistressaffectsatopicdermatitisinoffspringmediatedby
oxidativestress.JAllergyClinImmunol.2016138:468475.Abstract

MedscapeAllergy&ampImmunology2017WebMD,LLC

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