Pregnancy & eczema

What is the risk that my baby will develop eczema?

There is no definite way of predicting if your child will have eczema. We know that genetic (inherited) factors are important. A family history of atopy (eczema asthma or hay fever) is definitely the most important risk factor for the development of these conditions in children.

So, genetic factors probably make a child more susceptible to developing eczema, asthma, hay fever. But there are also a number of factors in the environment that will trigger eczema or asthma in a susceptible child.

• If you as parents, and any other of your children, do not have eczema, asthma or hay fever, there is probably a 1:10 chance that your baby could develop eczema

• If only one parent has eczema, asthma or hay fever, there is a 1:4 chance that your baby could develop eczema

• If both parents have eczema, asthma or hay fever, there is a 1:2 chance that your baby could develop eczema

• If another child has eczema, asthma or hay fever, there is a 1:2 chance that you baby could develop eczema

• If your child is going to get eczema, they are most likely to develop it in the first 2 years of life

Practical measures

We don’t know what parts of a mother’s microbiome affect an infant’s immune development.

A number of convincing studies have supported the concept of a critical window of exposure to allergens early in infancy — and perhaps even in prenatal life — in the prevention of allergic diseases.

Most experts support maintaining a well-balanced diet throughout pregnancy and lactation, as specific restrictions of key allergens haven’t been shown to prevent the future development of allergic disease in children.

There is no need to avoid food allergens during pregnancy, which is in line with current guidelines. All pregnant women should ideally consume a healthy, varied diet if possible.

Research shows that taking probiotics (particular types of “good” bacteria) during pregnancy and breastfeeding may help to reduce eczema in babies.

Environmental factors

• Indoor Pollution. Tobacco smoke and gas fumes from cooking have been implicated in contributing to atopic eczema development in some studies, but the exact role of indoor pollution is still unclear.

• Smoking. Even though there is little evidence that smoking in pregnancy has an effect on allergic sensitisation, we know that it does negatively affect the development of the lungs. In addition, children whose mothers smoke are four times more likely to develop wheezing illnesses in the first year of life.

• Outdoor pollution. Higher levels of eczema have been shown in people living close (under 50 km) to busy roads, although the importance of outdoor pollution has not been confirmed in all studies. High levels of sulphur dioxide, nitrous oxides and diesel particles from car emissions can potentially irritate the skin and may lower the threshold for developing eczema or worsen established eczema. Pollution can also play a role, more as a trigger rather than a cause.

House Dust Mites

A number of research studies have looked at the question of whether house-dust-mite avoidance during pregnancy and early childhood may reduce the number of children who go on to develop eczema.

House dust mite avoidance is most likely to be beneficial if there is a family history of atopic diseases. If you are redecorating a nursery, this is the ideal time to provide the best environment for your baby.

Take the following simple house-dust reduction measures:

• Remove soft furnishing and carpets and keep things simple

• Vacuum daily, when the baby is not in the room. Remember to empty the bag regularly

• Use a cotton or plastic play mat that can be washed easily, rather than allowing play on the carpet

• Fit blinds at the window or curtains that can be washed regularly

• Use bedding that can be washed in very hot water

• Covers for the bed need to cover the bed completely and be washable and durable. Covers are available for pillows and quilts too

• Damp dust

• Wash soft toys weekly at a high temperature in a lingerie bag or pillowcase to reduce the chance of damage to the toy. Alternatively, tumble dry on hot for 30 minutes in the dryer. Or, you could keep only a couple of favourite ones in the bedroom

• Air the room well, open windows and keep the room cool

• Remember to take note of the pollen count and try not to open the windows at times of day when pollen counts are at the highest (early morning and dusk)

Pets

Pets such as cats and dogs are known to be a potential trigger of eczema symptoms, and should be kept out of the bedroom. Nevertheless, there is some evidence that early exposure to pets (particularly cats) may actually be protective. In relation to eczema, there is no evidence on the effects of avoiding animal contact on the severity of atopic eczema.

Mother's skin care

It is important to also take care of your own skin, especially if you have had eczema in the past. Many women find their eczema either flares or completely clears during pregnancy.

• Protect your hands from direct soaps, detergents, scouring powders and similar irritating chemicals by wearing waterproof, cotton-lined, gloves.

• When washing use lukewarm water and a soap free wash. On the hands, rings often worsen eczema by trapping irritating materials beneath them. Remove your rings when doing housework and before washing your hands

• When outdoors, in cold or windy weather, wear gloves and long loose clothing to protect your skin and hands from drying and chapping

• Use moisturiser at least twice a day.

• If you have a flare, visit your health professional for more help.

If after taking some of the above measures, your baby does develop some patches of eczema, don’t feel guilty - you might still have reduced the severity of their condition. If you are worried, consult your health professional.

Article supplied by Eczema Association of Australasia.