Association between maternal anemia during pregnancy and risk of eczema in early childhood: A cohort study in Japan
Main Article Content
Keywords
anemia, child, eczema, Japan, pre-birth cohort
Abstract
Background: There is limited evidence on the association between maternal anemia during pregnancy and the risk of childhood allergic disorders, with regards to atopic eczema. The current pre-birth cohort study aimed to examine the association between maternal anemia during pregnancy and the risk of atopic eczema in Japanese 2-year-olds.
Methods: The study included 1354 Japanese mother–child pairs. Maternal anemia during pregnancy was determined based on self-reported iron treatment for anemia during pregnancy. Eczema was defined according to the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC). Physician-diagnosed atopic eczema was evaluated through a questionnaire completed by the mothers.
Results: The prevalence of maternal anemia during pregnancy was 52.8%. The study found that maternal anemia during pregnancy was associated with an increased risk of physician-diagnosed atopic eczema in children; with an adjusted odds ratio of 1.79 and a 95% confidence interval of 1.04–3.17. However, there was no observed association between maternal anemia during pregnancy and the risk of eczema as defined by the ISAAC criteria.
Conclusions: Although the study relied on self-reported information, it suggested a potential positive association between maternal anemia during pregnancy and the risk of atopic eczema in children.
References
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15 Shaheen SO, Newson RB, Henderson AJ, Emmett PM, Sherriff A, Cooke M; ALSPAC Study Team. Umbilical cord trace elements and minerals and risk of early childhood wheezing and eczema. Eur Respir J. 2004;24(2):292–7. 10.1183/09031936.04.00117803
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18 Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121(4):947–54.e15. 10.1016/j.jaci.2007.11.004
19 Miyake Y, Tanaka K, Okubo H, Sasaki S, Arakawa M. Maternal consumption of dairy products, calcium, and vitamin D during pregnancy and infantile allergic disorders. Ann Allergy Asthma Immunol. 2014;113:82–7. 10.1016/j.anai.2014.04.023
20 Sasaki S, Yanagibori R, Amano K. Self-administered diet history questionnaire developed for health education: A relative validation of the test-version by comparison with 3-day diet record in women. J Epidemiol. 1998;8:203–15. 10.2188/jea.8.203
21 Sasaki S, Ushio F, Amano K, Morihara M, Todoriki O, Uehara Y, et al. Serum biomarker-based validation of a self-administered diet history questionnaire for Japanese subjects. J Nutr Sci Vitaminol (Tokyo). 2000;46:285–96. 10.3177/jnsv.46.285
22 Science and Technology Agency. Standard tables of food composition in Japan. 5th revised and enlarged ed. Tokyo, Japan: Printing Bureau of the Ministry of Finance, 2005 (in Japanese).
23 Kuo IH, Yoshida T, De Benedetto A, Beck LA. The cutaneous innate immune response in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):266–78. 10.1016/j.jaci.2012.12.1563
24 Boguniewicz M, Leung DY. Atopic dermatitis: A disease of altered skin barrier and immune dysregulation. Immunol Rev. 2011;242(1):233–46. 10.1111/j.1600-065X.2011.01027.x
25 Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: The skin barrier and beyond. Br J Dermatol. 2019;180(3):464–74. 10.1111/bjd.16934
26 Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12):1136–43. 10.1056/NEJMra2023911
27 Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143(1):1–11. 10.1016/j.jaci.2018.10.032
28 Gambling L, Charania Z, Hannah L, Antipatis C, Lea RG, McArdle HJ. Effect of iron deficiency on placental cytokine expression and fetal growth in the pregnant rat. Biol Reprod. 2002;66(2):516–23. 10.1095/biolreprod66.2.516
29 Thibault H, Galan P, Selz F, Preziosi P, Olivier C, Badoual J, et al. The immune response in iron-deficient young children: Effect of iron supplementation on cell-mediated immunity. Eur J Pediatr. 1993;152(2):120–4. 10.1007/BF02072487
30 Jason J, Archibald LK, Nwanyanwu OC, Bell M, Jensen RJ, Gunter E, et al. The effects of iron deficiency on lymphocyte cytokine production and activation: Preservation of hepatic iron but not at all cost. Clin Exp Immunol. 2001;126(3):466–73. 10.1046/j.1365-2249.2001.01707.x
31 Weiss G. Iron and immunity: A double-edged sword. Eur J Clin Invest. 2002;32 Suppl 1:70–8. 10.1046/j.1365-2362.2002.0320s1070.x
32 Statistic Bureau, Ministry of Public Management, Home Affairs, Posts and Telecommunications. 2000 Population Census of Japan, Vol. 3-2-40, Labour Force Status of Population, Industry (Major Groups) of Employed Persons, and Education: Fukuoka-ken. Tokyo: Statistic Bureau, Ministry of Public Management, Home Affairs, Posts and Telecommunications; 2002 [in Japanese].
33 Kjellsson G, Clarke P, Gerdtham UG. Forgetting to remember or remembering to forget: A study of the recall period length in health care survey questions. J Health Econ. 2014;35:34–46. 10.1016/j.jhealeco.2014.01.007
34 Strina A, Barreto ML, Cunha S, de Fátima S P de Oliveira M, Moreira SC, Williams HC, et al. Validation of epidemiological tools for eczema diagnosis in Brazilian children: The ISAAC’s and UK Working Party’s criteria. BMC Dermatol. 2010;10:11. 10.1186/1471-5945-10-11
2 World Health Organization. Anaemia. Revised 2023 May 1. [Internet]. [Accessed 2024 Aug 16]. Available from: https://www.who.int/news-room/fact-sheets/detail/anaemia
3 Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public Health Nutr. 2001;4(2B):537–45. 10.1079/PHN2001139
4 Centers for Disease Control and Prevention. Recommendations to prevent and control iron deficiency in the United States. MMWR Recomm Rep. 1998;47(RR-3):1–29.
5 World Health Organization. Prevalence of anaemia in pregnant women (aged 15–49). Revised 2021 Apr 19. [Internet]. [Accessed 2024 Aug 16]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-pregnant-women-(-)
6 Jwa SC, Fujiwara T, Yamanobe Y, Kozuka K, Sago H. Changes in maternal hemoglobin during pregnancy and birth outcomes. BMC Pregnancy Childbirth. 2015;15:80. 10.1186/s12884-015-0516-1
7 Habe S, Haruna M, Yonezawa K, Usui Y, Sasaki S, Nagamatsu T, et al. Factors associated with anemia and iron deficiency during pregnancy: A prospective observational study in Japan. Nutrients. 2024;16:418. 10.3390/nu16030418
8 Shi H, Chen L, Wang Y, Sun M, Guo Y, Ma S, et al. Severity of anemia during pregnancy and adverse maternal and fetal outcomes. JAMA Netw Open. 2022;5(2):e2147046. 10.1001/jamanetworkopen.2021.47046
9 Drukker L, Hants Y, Farkash R, Ruchlemer R, Samueloff A, Grisaru-Granovsky S. Iron deficiency anemia at admission for labor and delivery is associated with an increased risk for Cesarean section and adverse maternal and neonatal outcomes. Transfusion. 2015;55(12):2799–806. 10.1111/trf.13252
10 Steer P, Alam MA, Wadsworth J, Welch A. Relation between maternal haemoglobin concentration and birth weight in different ethnic groups. BMJ. 1995;310(6978):489–91. 10.1136/bmj.310.6978.489
11 Smith C, Teng F, Branch E, Chu S, Joseph KS. Maternal and perinatal morbidity and mortality associated with anemia in pregnancy. Obstet Gynecol. 2019;134(6):1234–44. 10.1097/AOG.0000000000003557
12 Wiegersma AM, Dalman C, Lee BK, Karlsson H, Gardner RM. Association of prenatal maternal anemia with neurodevelopmental disorders. JAMA Psychiatry. 2019;76(12):1294–304. 10.1001/jamapsychiatry.2019.2309
13 Shaheen SO, Macdonald-Wallis C, Lawlor DA, Henderson AJ. Haemoglobin concentrations in pregnancy and respiratory and allergic outcomes in childhood: Birth cohort study. Clin Exp Allergy. 2017; 47(12):1615–24. 10.1111/cea.13034
14 Nwaru BI, Hayes H, Gambling L, Craig LC, Allan K, Prabhu N, et al. An exploratory study of the associations between maternal iron status in pregnancy and childhood wheeze and atopy. Br J Nutr. 2014;112(12):2018–27. 10.1017/S0007114514003122
15 Shaheen SO, Newson RB, Henderson AJ, Emmett PM, Sherriff A, Cooke M; ALSPAC Study Team. Umbilical cord trace elements and minerals and risk of early childhood wheezing and eczema. Eur Respir J. 2004;24(2):292–7. 10.1183/09031936.04.00117803
16 Yang L, Sato M, Saito-Abe M, Irahara M, Nishizato M, Sasaki H, et al. Association of hemoglobin and hematocrit levels during pregnancy and maternal dietary iron intake with allergic diseases in children: The Japan Environment and Children’s Study (JECS). Nutrients. 2021;13(3):810. 10.3390/nu13030810
17 Hung YH, Liu HY, Chang R, Huang JY, Wu CD, Yen MS, et al. Association between parental autoimmune disease and childhood atopic dermatitis varied by sex: a nationwide case-control study. Arch Dermatol Res. 2023;315:2011–21. 10.1007/s00403-023-02582-w; 10.1007/s00403-023-02732-0
18 Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121(4):947–54.e15. 10.1016/j.jaci.2007.11.004
19 Miyake Y, Tanaka K, Okubo H, Sasaki S, Arakawa M. Maternal consumption of dairy products, calcium, and vitamin D during pregnancy and infantile allergic disorders. Ann Allergy Asthma Immunol. 2014;113:82–7. 10.1016/j.anai.2014.04.023
20 Sasaki S, Yanagibori R, Amano K. Self-administered diet history questionnaire developed for health education: A relative validation of the test-version by comparison with 3-day diet record in women. J Epidemiol. 1998;8:203–15. 10.2188/jea.8.203
21 Sasaki S, Ushio F, Amano K, Morihara M, Todoriki O, Uehara Y, et al. Serum biomarker-based validation of a self-administered diet history questionnaire for Japanese subjects. J Nutr Sci Vitaminol (Tokyo). 2000;46:285–96. 10.3177/jnsv.46.285
22 Science and Technology Agency. Standard tables of food composition in Japan. 5th revised and enlarged ed. Tokyo, Japan: Printing Bureau of the Ministry of Finance, 2005 (in Japanese).
23 Kuo IH, Yoshida T, De Benedetto A, Beck LA. The cutaneous innate immune response in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):266–78. 10.1016/j.jaci.2012.12.1563
24 Boguniewicz M, Leung DY. Atopic dermatitis: A disease of altered skin barrier and immune dysregulation. Immunol Rev. 2011;242(1):233–46. 10.1111/j.1600-065X.2011.01027.x
25 Tsakok T, Woolf R, Smith CH, Weidinger S, Flohr C. Atopic dermatitis: The skin barrier and beyond. Br J Dermatol. 2019;180(3):464–74. 10.1111/bjd.16934
26 Ständer S. Atopic dermatitis. N Engl J Med. 2021;384(12):1136–43. 10.1056/NEJMra2023911
27 Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143(1):1–11. 10.1016/j.jaci.2018.10.032
28 Gambling L, Charania Z, Hannah L, Antipatis C, Lea RG, McArdle HJ. Effect of iron deficiency on placental cytokine expression and fetal growth in the pregnant rat. Biol Reprod. 2002;66(2):516–23. 10.1095/biolreprod66.2.516
29 Thibault H, Galan P, Selz F, Preziosi P, Olivier C, Badoual J, et al. The immune response in iron-deficient young children: Effect of iron supplementation on cell-mediated immunity. Eur J Pediatr. 1993;152(2):120–4. 10.1007/BF02072487
30 Jason J, Archibald LK, Nwanyanwu OC, Bell M, Jensen RJ, Gunter E, et al. The effects of iron deficiency on lymphocyte cytokine production and activation: Preservation of hepatic iron but not at all cost. Clin Exp Immunol. 2001;126(3):466–73. 10.1046/j.1365-2249.2001.01707.x
31 Weiss G. Iron and immunity: A double-edged sword. Eur J Clin Invest. 2002;32 Suppl 1:70–8. 10.1046/j.1365-2362.2002.0320s1070.x
32 Statistic Bureau, Ministry of Public Management, Home Affairs, Posts and Telecommunications. 2000 Population Census of Japan, Vol. 3-2-40, Labour Force Status of Population, Industry (Major Groups) of Employed Persons, and Education: Fukuoka-ken. Tokyo: Statistic Bureau, Ministry of Public Management, Home Affairs, Posts and Telecommunications; 2002 [in Japanese].
33 Kjellsson G, Clarke P, Gerdtham UG. Forgetting to remember or remembering to forget: A study of the recall period length in health care survey questions. J Health Econ. 2014;35:34–46. 10.1016/j.jhealeco.2014.01.007
34 Strina A, Barreto ML, Cunha S, de Fátima S P de Oliveira M, Moreira SC, Williams HC, et al. Validation of epidemiological tools for eczema diagnosis in Brazilian children: The ISAAC’s and UK Working Party’s criteria. BMC Dermatol. 2010;10:11. 10.1186/1471-5945-10-11
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Jan 1, 2025
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Yamashita, N., Tanaka, K., & Miyake, Y. (2025). Association between maternal anemia during pregnancy and risk of eczema in early childhood: A cohort study in Japan. Allergologia Et Immunopathologia, 53(1), 106-111. https://doi.org/10.15586/aei.v53i1.1194
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How to Cite
Yamashita, N., Tanaka, K., & Miyake, Y. (2025). Association between maternal anemia during pregnancy and risk of eczema in early childhood: A cohort study in Japan. Allergologia Et Immunopathologia, 53(1), 106-111. https://doi.org/10.15586/aei.v53i1.1194