Kramer Michael S, Kakuma Ritsuko
Departments of Pediatrics and Epidemiology, Biostatistics andOccupationalHealth,McGillUniversity Faculty ofMedicine,Montreal, Canada.
Evid Based Child Health. 2014 Jun;9(2):447-83. doi: 10.1002/ebch.1972.
Some breastfed infants with atopic eczema benefit from elimination of cow milk, egg, or other antigens from their mother's diet. Maternal dietary antigens are also known to cross the placenta.
To assess the effects of prescribing an antigen avoidance diet during pregnancy or lactation, or both, on maternal and infant nutrition and on the prevention or treatment of atopic disease in the child.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 July 2012).
All randomized or quasi-randomized comparisons of maternal dietary antigen avoidance prescribed to pregnant or lactating women. We excluded trials of multimodal interventions that included manipulation of the infant's diet other than breast milk or of non-dietary aspects of the infant's environment.
We extracted data from published reports, supplemented by additional information received from the trialists we contacted.
The evidence from five trials, involving 952 participants, does not suggest a protective effect of maternal dietary antigen avoidance during pregnancy on the incidence of atopic eczema during the first 18 months of life. Data on allergic rhinitis or conjunctivitis, or both, and urticaria are limited to a single trial each and are insufficient to draw meaningful inferences. Longer-term atopic outcomes have not been reported. The restricted diet during pregnancy was associated with a slightly but statistically significantly lower mean gestational weight gain, a non-significantly higher risk of preterm birth, and a non-significant reduction in mean birthweight. The evidence from two trials, involving 523 participants, did not observe a significant protective effect of maternal antigen avoidance during lactation on the incidence of atopic eczema during the first 18 months or on positive skin-prick tests to cow milk, egg, or peanut antigen at one, two, or seven years. One crossover trial involving 17 lactating mothers of infants with established atopic eczema found that maternal dietary antigen avoidance was associated with a non-significant reduction in eczema severity.
AUTHORS' CONCLUSIONS: Prescription of an antigen avoidance diet to a high-risk woman during pregnancy is unlikely to reduce substantially her child's risk of atopic diseases, and such a diet may adversely affect maternal or fetal nutrition, or both. Prescription of an antigen avoidance diet to a high-risk woman during lactation may reduce her child's risk of developing atopic eczema, but better trials are needed. Dietary antigen avoidance by lactating mothers of infants with atopic eczema may reduce the severity of the eczema, but larger trials are needed.
一些患有特应性皮炎的母乳喂养婴儿，通过从其母亲饮食中去除牛奶、鸡蛋或其他抗原而受益。已知母体饮食中的抗原也会穿过胎盘。
评估在孕期或哺乳期或两者同时规定避免抗原饮食，对母体和婴儿营养以及对预防或治疗儿童特应性疾病的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2012年7月6日）。
所有针对孕妇或哺乳期妇女规定避免母体饮食抗原的随机或半随机对照试验。我们排除了多模式干预试验，这些试验包括除母乳外对婴儿饮食的调整或对婴儿环境非饮食方面的调整。
我们从已发表的报告中提取数据，并补充了与我们联系的试验者提供的其他信息。
五项试验（涉及952名参与者）的证据表明，孕期避免母体饮食抗原对婴儿出生后18个月内特应性皮炎发病率无保护作用。关于过敏性鼻炎或结膜炎或两者兼有的数据以及荨麻疹的数据，每项仅来自一项试验，不足以得出有意义的推论。尚未报告长期的特应性结局。孕期限制饮食与平均孕期体重增加略有但在统计学上显著降低、早产风险非显著升高以及平均出生体重非显著降低有关。两项试验（涉及523名参与者）的证据未观察到哺乳期避免母体抗原对婴儿出生后18个月内特应性皮炎发病率或1岁、两岁或七岁时对牛奶、鸡蛋或花生抗原皮肤点刺试验阳性率有显著保护作用。一项涉及17名患有特应性皮炎婴儿的哺乳期母亲的交叉试验发现，母体避免饮食抗原与湿疹严重程度非显著降低有关。
在孕期对高危女性规定避免抗原饮食不太可能大幅降低其孩子患特应性疾病的风险，且这种饮食可能对母体或胎儿营养或两者均产生不利影响。在哺乳期对高危女性规定避免抗原饮食可能降低其孩子患特应性皮炎的风险，但需要更好的试验。患有特应性皮炎婴儿的哺乳期母亲避免饮食抗原可能降低湿疹严重程度，但需要更大规模的试验。
