Effects of pregnancy and lactation prebiotics supplementation on infant allergic disease: A randomized controlled trial - 12/09/24

Doi : 10.1016/j.jaci.2024.08.009

Debra J. Palmer, PhD ^a,^b,^⁎ , Alana R. Cuthbert, PhD ^c, Thomas R. Sullivan, PhD ^c,^d, Rachelle A. Pretorius, PhD ^a,^b, Johan Garssen, PhD ^e,^f, Kristina Rueter, MD, PhD ^b,^g, Maria C. Jenmalm, PhD ^h, Jeffrey A. Keelan, PhD ^b,ⁱ, Desiree Silva, MD, PhD ^a,^b,^j,^k, Susan L. Prescott, MD, PhD ^a,^b,^g,^l
^a Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
^b School of Medicine, The University of Western Australia, Crawley, Australia
^c SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
^d School of Public Health, The University of Adelaide, Adelaide, Australia
^e Division of Pharmacology Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
^f Nutricia Research, Utrecht, The Netherlands
^g Department of Immunology and Dermatology, Perth Children’s Hospital, Nedlands, Australia
^h Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
ⁱ School of Biomedical Sciences, The University of Western Australia, Crawley, Australia
^j Joondalup Health Campus, Joondalup, Australia
^k Edith Cowan University, Perth, Australia
^l Nova Institute for Health, Baltimore, Md

^∗Corresponding author: Debra J. Palmer, PhD, Telethon Kids Institute, The University of Western Australia, 15 Hospital Ave, Nedlands, WA 6009, Australia.Telethon Kids InstituteThe University of Western Australia15 Hospital AveNedlandsWA6009Australia

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 12 September 2024

Abstract

Background

Ingestion of prebiotics during pregnancy and lactation may have immunomodulatory benefits for the developing fetal and infant immune system and provide a potential dietary strategy to reduce the risk of allergic diseases.

Objective

We sought to determine whether maternal supplementation with dietary prebiotics reduces the risk of allergic outcomes in infants with hereditary risk.

Methods

We undertook a double-blind randomized controlled trial in which pregnant women were allocated to consume prebiotics (14.2 g daily of galacto-oligosaccharides and fructo-oligosaccharides in the ratio 9:1) or placebo (8.7 g daily of maltodextrin) powder from less than 21 weeks’ gestation until 6 months postnatal during lactation. Eligible women had infants with a first-degree relative with a history of medically diagnosed allergic disease. The primary outcome was medically diagnosed infant eczema by age 1 year, and secondary outcomes included allergen sensitization, food allergy, and recurrent wheeze by age 1 year.

Results

A total of 652 women were randomized between June 2016 and November 2021 (329 in the prebiotics group and 323 in the placebo group). There was no significant difference between groups in the percentage of infants with medically diagnosed eczema by age 1 year (prebiotics 31.5% [103 of 327 infants] vs placebo 32.6% [105 of 322 infants]; adjusted relative risk, 0.98; 95% CI, 0.77-1.23; P = .84). Secondary outcomes and safety measures also did not significantly differ between groups.

Conclusions

We found little evidence that maternal prebiotics supplementation during pregnancy and lactation reduces the risk of medically diagnosed infant eczema by age 1 year in infants who are at hereditary risk of allergic disease.

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Key words : Allergy prevention, eczema, infant, maternal diet, prebiotics, pregnancy, lactation, randomized controlled trial

Abbreviations used : aRR, BMI, RR