The presence of atopic eczema and food allergies in the family is the strongest factor predisposing to the development of these diseases in children. However, genes are not everything, environmental factors also play an extremely important role (1). The genetic material we inherit from our parents can be compared to a loaded gun – but often it is the environment that ultimately pulls the trigger. Maternal diet during pregnancy is one of the environmental factors affecting the risk of eczema and food allergies in children. So, what to eat to reduce the risk of eczema in offspring? Should you exclude the most common allergens? Do you need to use probiotics? You will find the answers to these and other questions in this article.

Elimination diet during pregnancy

First of all, the elimination of the most common food allergens during pregnancy in order to prevent eczema and allergies in the child has no scientific justification. Of course, if a pregnant woman suffers from allergies or food intolerances, the triggering foods should be eliminated. It is worth noting that it is possible that during pregnancy, negative reactions to previously tolerated products begin to occur. The reason for this is the increase in estrogen levels, which can lead to increased susceptibility to allergic reactions, including skin reactions (2). However, using an elimination diet only to prevent eczema and allergies in a child does not make any sense and may lead to negative effects, such as maternal malnutrition. If you are interested in how pregnancy affects eczema symptoms, take a look at this article.

Allergy Prevention Diet

However, there is a diet that has been described in scientific studies as an 'allergy prevention diet’. This concept comes from a study published in 2022 that analyzed data from 1,410 pregnant women (3). The results of this study showed that consumption of vegetables and yogurt reduced the risk of allergic diseases (including eczema), while red meat, fried potatoes, rice, cereals (processed, low-fiber) and 100% fruit juice were associated with an increased risk. These results were partially confirmed in two other studies (4, 5).

According to the authors, the results of this study most likely confirm the important role of the intestinal microbiome in the pathogenesis of eczema and allergy. Probiotic-rich yoghurt and fibre-rich vegetables contribute to the formation of healthy intestinal microflora in mothers and their offspring. It is worth remembering that the mother’s microbiome serves as the foundation for the child’s microbiome – not only during (vaginal) delivery, but perhaps also during pregnancy (6).

In addition, higher consumption of vegetables and yogurt early in life is associated with higher levels of butyrate (a product of beneficial bacteria), which is thought to protect against the development of allergies (7). Butyrate can promote the development of regulatory T lymphocytes (responsible for suppressing an excessive or self-reactive immune response), and ensure the proper development of the immune system in fetal life (8,9). Unfortunately, there are no studies analyzing the effect of butyrate during pregnancy on the risk of eczema in offspring yet. I’m looking forward to reading them in the future.

The authors also suggest that the consumption of foods rich in advanced glycation end products (such as fried meats and potatoes) has been associated with a suboptimal composition of the gut microbiome (10). However, a study analyzing the same data in terms of the impact of glycation end products on the risk of eczema and allergy showed no relationship (11). Therefore, it is not clear how fried foods increase the risk of eczema and allergies. Perhaps this will be clarified in the future – for now, I advise you to eat fried products (especially deep-fried) in moderation, because they are simply not very healthy. At the same time, I see no reason to eliminate red meat completely, as it is an excellent source of iron. We know that iron deficiency during pregnancy can increase the risk of eczema – more on this later in the text.

Nevertheless, the negative effects associated with the consumption of rice, (processed) cereals and fruit juices, are surprising, also for the authors of the study. These findings probably result not so much from the presence of these products in the diet, but from what these diets lack. For example, by choosing white bread instead of whole grain, we miss an opportunity to provide intestinal bacteria with a solid portion of fiber. Of course, the conclusion of this study should not be 'white bread is toxic’ or 'fruit juice causes allergies’. We should always look at the diet as a whole – it may contain white bread, but maybe the right amount of fiber is provided from other sources and the bacteria are doing well. Moreover, instead of focusing on what should be excluded from the diet, it is worth considering what can be added to it. In light of this study, increasing the consumption of vegetables, unsweetened yogurt and minimally processed foods seems to be a very good idea.

Micronutrients

Maternal malnutrition in itself may increase the risk of eczema in the offspring. I repeat ad nauseam how important it is to provide a diet rich in nutrients for people suffering from inflammatory skin diseases, especially during pregnancy and breastfeeding. In the context of eczema prevention in offspring, adequate intake of iron seems to be the most important (12). As the need for iron increases significantly during pregnancy, it is worth considering supplementation after consulting a doctor or dietician. Other nutrients to look out for during pregnancy include most omega 3 fatty acids, vitamin D and zinc.

Probiotics

According to a meta-analysis from 2018, supplementation with probiotics containing Lactobacillus rhamnosus started between 36 and 38 weeks of pregnancy and continued for 3 to 6 months of breastfeeding may reduce the risk of eczema in the child (13). Lactobacillus is a bacterial species that dominates the mother’s gut microbiome during pregnancy to prevent infection and to create a healthy microbiome of the baby (14). Therefore, supplementation with this species seems to be the best and least invasive choice. There is also a lot of evidence for the protective effect of Bifidobacterium species (14), often in combination with Lactobacillus.

However, it should be noted that some studies indicate the lack of effectiveness of probiotics during pregnancy. Contradictions in human microbiome research are inevitable because the composition of the gut microbiota is extremely individual. It is impossible to develop a recipe for the perfect microbiome, which is why it is difficult to come up with universal recommendations. Nevertheless, in 2015 the World Allergy Organization recommended the use of probiotics during pregnancy if there is a high risk of developing allergies and eczema in the child (15). The report did not specify which strains to choose, but it was noted that most studies indicate the effectiveness of Lactobacillus and Bifidobacterium.

Looking at all the available data, I believe that it is worth supplementing with probiotics of the Lactobacillus species (especially Lactobacillus rhamnosus) during pregnancy, if there are atopic diseases or food allergies in the family. The use of probiotics during pregnancy is safe and may reduce the risk of atopic diseases in children at risk. It is also worth including fermented products in the diet, such as fermented vegetables, natural yoghurts or kefir, and products rich in fiber.

Alcohol

You should absolutely not drink alcohol while pregnant. Increasing the risk of atopic diseases in offspring is just one of the negative effects of alcohol consumption during pregnancy (15,16). Interestingly, we know that alcohol has a negative impact on the condition of the intestinal microflora (17) – perhaps this is yet another argument for the key role of the microbiome in the pathogenesis of eczema and food allergies.

Stress

Finally, a few words about stress. There are studies showing that stress during pregnancy may increase the risk of eczema in the child (18). Why am I mentioning this in an article about diet? Because dietary changes, especially restrictive diets, can lead to increased stress levels. Remember – eating is supposed to be fun. As I emphasized earlier – it is worth focusing on what you can add to your diet, and not necessarily on what you have to give up. The obsessive pursuit of the perfect diet can do more harm than good.

Summary

So, how should the diet look like during pregnancy to reduce the risk of eczema and food allergies in the baby? In my opinion, it is worth focusing on a few key elements:

  1. Eat plenty of vegetables and whole grains (sources of fibre)
  2. Ensure adequate supply of all nutrients from your diet, especially iron (supplementation may be necessary)
  3. No alcohol consumption during pregnancy!
  4. Supplement with a probiotic containing Lactobacillus and/or include low-sugar fermented products in your diet.
  5. Supplement omega 3 fatty acids (2g of EPA+DHA) and vitamin D3 (dose depends on individual needs).
  6. Do not use elimination diets to prevent eczema and allergies in a child! Follow a varied, balanced and tasty diet, which will contribute the physical and mental well-being of you and your child.

Bibliography

  1. Nutten S. (2015). Atopic dermatitis: global epidemiology and risk factors. Annals of nutrition & metabolism, 66 Suppl 1, 8–16.
  2. Kanda, N., Hoashi, T., & Saeki, H. (2019). The Roles of Sex Hormones in the Course of Atopic Dermatitis. International journal of molecular sciences, 20(19), 4660.
  3. Venter C, Palumbo MP, Glueck DH, Sauder KA, O’Mahony L, Fleischer DM, et al. The maternal diet index in pregnancy is associated with offspring allergic diseases: The Healthy Start study. Allergy. 2022 Jan 1;77(1):162–72.
  4. Venter C, Palumbo MP, Sauder KA, Glueck DH, O’Mahony L, Yang I, et al. Associations between child filaggrin mutations and maternal diet with the development of allergic diseases in children. Pediatric Allergy and Immunology. 2022 Mar 1;33(3).
  5. enter, C., Palumbo, M. P., Glueck, D. H., Sauder, K. A., Perng, W., O’Mahony, L., Pickett, K., Greenhawt, M., Fleischer, D. M., & Dabelea, D. (2022). Comparing the Diagnostic Accuracy of Measures of Maternal Diet During Pregnancy for Offspring Allergy Outcomes: The Healthy Start Study. The journal of allergy and clinical immunology. In practice, S2213-2198(22)00944-8. Advance online publication.
  6. Walker, R. W., Clemente, J. C., Peter, I., & Loos, R. J. F. (2017). The prenatal gut microbiome: are we colonized with bacteria in utero?. Pediatric obesity, 12 Suppl 1(Suppl 1), 3–17.
  7. Roduit C, Frei R, Ferstl R, Loeliger S, Westermann P, Rhyner C, et al. High levels of butyrate and propionate in early life are associated with protection against atopy. Allergy. 2019 Apr 1;74(4):799–809.
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  11. Venter, C., Pickett, K., Starling, A., Maslin, K., Smith, P. K., Palumbo, M. P., O’Mahony, L., Ben Abdallah, M., & Dabelea, D. (2021). Advanced glycation end product intake during pregnancy and offspring allergy outcomes: A Prospective cohort study. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 51(11), 1459–1470.
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  14. Walker, R. W., Clemente, J. C., Peter, I., & Loos, R. J. F. (2017). The prenatal gut microbiome: are we colonized with bacteria in utero?. Pediatric obesity, 12 Suppl 1(Suppl 1), 3–17.
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