Associations between active maternal atopy in pregnancy and offspring asthma risk: Effect modification by prenatal dietary long-chain polyunsaturated fatty acid intake

Active maternal atopy in pregnancy is associated with increased offspring asthma risk. Prenatal long-chain polyunsaturated fatty acid (LC-PUFA) intake of the n6(ω6) and n3 series may modify risk. Mother-child dyads (n=553) in the PRogramming of Intergenerational Stress Mechanisms (PRISM) cohort were evaluated in pregnancy and followed postnatally. Women reported active atopy (asthma/hay fever/eczema) during pregnancy. Prenatal LC-PUFA intake and n-6/n-3 ratios were ascertained from a food frequency questionnaire. Physician diagnosis of child asthma was reported at postnatal follow-ups. Multivariable logistic regression was used to estimate associations between active maternal atopy and childhood asthma, overall and by prenatal PUFA intake (high vs. low based on the median). Mothers were mostly Black (37.5%) and Hispanic (32.6%); 41.4% reported active atopy in pregnancy. Active atopy was significantly associated with higher pre-pregnancy BMI and C-section delivery. Children were 3.05±2.12 years of age; 6.0% were diagnosed with asthma. Prenatal active atopy was associated with higher risk of childhood asthma (OR=2.29, 95% CI=1.07-4.90). Compared to non-atopic mothers with low n-6/n-3 intake, the OR for childhood asthma for non-atopic mothers with high n-6/n-3 intake was 3.52 (95% CI=1.20-10.35); in mothers with active atopy, the OR for asthma for low n-6/n-3 was 1.54 (95% CI=0.49-4.81) and for high n-6/n-3 was 2.30 (95% CI=0.75-7.02). Maternal active atopy in pregnancy predicted increased early childhood asthma risk. A higher n-6/n-3 ratio was more strongly associated with asthma in children born to women without active atopy. Future analyses will consider higher order interactions with child sex and race/ethnicity.