Table 2.
Recent studies evaluating maternal diet including or excluding allergenic foods during lactation (+/− pregnancy) and FA/sensitization in offspring
| Citation, location | Number of subjects§ | General population or high risk for atopy | Exposure | Outcome | Adequate statistical adjustment† | Study Design | Impact of intake during pregnancy | Impact of intake during lactation | Comments |
|---|---|---|---|---|---|---|---|---|---|
| Peanut | |||||||||
| Du Toit 200866, UK and Israel | 176 | General population | Infant and maternal consumption vs no consumption between countries (Israel vs UK) (grams and frequency monthly) | FA (self-report followed by SPT, IgE, or OFC) | No | Retrospective | No association | Protective | Early infant exposure to peanut showed strongest protective effect |
| Fox 2009 63, UK UK |
443 | 2 control groups; a general population group and a high risk (egg allergy) group | Maternal consumption vs no consumption (g/week) | FA (≥95% predictive value on SPT, IgE or OFC) | Yes | Case-control | No association | No association | Maternal effect disappeared when adjusted for household peanut exposure |
| Des Roches 2010 67, Canada Canada |
403 | General population | Maternal consumption (frequency) | FA (clinical history plus positive SPT or IgE) | Yes | Case-Control | Increased risk | Increased risk | |
| Sicherer 2010 64, USA | 503 | High risk | Maternal consumption (≥2 times per week vs < 2 times per week) | High level sensitization (IgE ≥ 5 kU/L) | Yes | Retrospective | Increased risk | No association | |
| Frazier 2014 72, USA | 8205 | General population | Maternal consumption (servings per week) of peanuts and tree nuts during peripregnancy period (exposure captured via survey completed closest to index birth) | Physician reviewed self-report FA diagnosis | Prospective cohort | Protective | Did not evaluate lactation and pregnancy separately. Greatest benefit seen in mothers without peanut/tree nut allergy | ||
| Pitt 2017 65, Canada Canada |
342 | High risk | Maternal consumption while lactating (ever vs never) | Sensitization (positive SPT) | Yes | Prospective cohort (nested) | Not assessed | Protective# | |
| Cow’s milk, egg and others | |||||||||
| Herrmann 199668, Germany Germany |
99 -120 | High risk | Maternal unrestricted vs restricted diet (cow’s milk and egg) during pregnancy and lactation, vs lactation only | Sensitization (IgE ≥0.35kU/L) | No | Non-randomized comparison | No association | No association | |
| Hattevig 199969, Sweden Sweden |
115 | High risk | Maternal unrestricted diet during lactation vs restricted diet (cow’s milk, egg, fish) | Sensitization (SPT and IgE ≥0.35PRU/ml) | Yes | Non-randomized comparison | Not assessed | No association | |
| Nwaru 201170, Finland (DIPP Nutrition study, 1998 – 2000) | 1018 | High risk for type 1 diabetes (all with HLA-DQB1) | Maternal consumption of foods (z-scores) during lactation (milk and egg) | Cow’s milk, egg and wheat sensitization (IgE ≥0.35kU/L) | Yes | Prospective cohort | Not assessed | No association | |
| Tuokkola 201671, Finland (DIPP Nutrition study, 1997-2004 | 2820 | High risk for type 1 diabetes (all with HLA-DQB1) | Maternal consumption of milk during pregnancy and lactation (quartiles – 1st vs 2nd and 3rd, 4th vs 2nd and 3rd) | Cow’s milk allergy‡ (physician diagnosis or self-report) | Yes | Prospective cohort | Protective | No association | Using the same cohort as above study does |
Abbreviations: FA - FA, SPT - skin prick test, IgE - immunoglobulin E, OFC - oral food challenge, NS = not significant
N included in lactation specific analyses
Includes (at minimum) adjustment for atopic status of family and/or subject if different between comparison groups
Among group with maternal peanut consumption during lactation and introduction to infants before 12 months, no adjusted effect estimate reported for peanut consumption during lactation without interaction with direct ingestion because this was highly significant (p = 0.003).
Registry-obtained physician diagnosis used to justify cost of non-cow’s milk formula, or self-report if breastfed or diagnosed at > 1 year of life
DIPP Study - The Finnish Type 1 Diabetes Prediction and Prevention Study