Pregnancy Eczema: Can it be transmitted to the unborn baby?

Pregnancy eczema, also known as gravida eczema, is a skin condition that develops in some women during pregnancy. It is estimated that about one third of skin problems encountered by pregnant women are due to eczema. Pregnancy eczema affects women who have previously had eczema in their life and those who have never been affected by this dermatosis. It is estimated that 20 to 40% of pregnant women suffering from eczema have had flare-ups before, which does not even represent half.

While further research is still required to understand the biological mechanisms behind pregnancy eczema, it appears that pregnancy alters immunity and triggers a TH2 type immune response. This type of immune response is typically associated with atopy, which could explain the prevalence of eczema in pregnant women. As a reminder, atopy refers to a genetic predisposition to develop common allergies.

The symptoms of eczema experienced by pregnant women are the same as for the rest of the population. These include intense itching and skin lesions, which can appear as redness, papules, vesicles or plaques on various parts of the body, including the stomach, arms, legs and breasts.

Firstly, it's important to note that eczema is a skin disease that is non-contagious and therefore cannot be transmitted through physical contact, whether direct or indirect. Regarding the risk of transmitting pregnancy eczema to the unborn baby, however, the situation is slightly different and this depends on the form of eczema.

• Case No.1: Pregnancy eczema is of allergic origin, that is to say, it is "contact" eczema.

  Contact eczema is caused by an allergic reaction of the skin to a specific allergen. The red patches only appear on areas that have come into contact with the irritating substance. Contact eczema cannot be passed on to a future baby, as it is an acquired form.

• Case No. 2: Pregnancy eczema is of hereditary origin, that is to say, "atopic".

  In this instance, pregnancy eczema is due to genetic mutations, often on the genes coding for filaggrin and other proteins necessary for the integrity of the stratum corneum. This results in a deficient skin barrier that easily allows allergens to penetrate. Atopic eczema is a congenital form that can unfortunately be passed on to the future baby. Indeed, the baby inherits half of its genes from its mother. Moreover, if both parents have an atopic predisposition, the risk for the child to develop eczema is between 50 to 70%. However, this transmission is not automatic and the risks are not greater if the mother's eczema flare-ups occur during her pregnancy or before.

Today, there are methods validated by European studies to limit the risk of transmission of atopic dermatitis to the future baby. This involves the intake of pro and prebiotics during pregnancy. Prebiotics are compounds found in our diet (mainly from fibres) that serve as food for the intestinal microbiota. They notably ensure the survival of probiotics, which are foreign bacteria to the body but their presence will trigger a number of beneficial effects on health.

To prevent eczema in the future baby, the probiotics used are bacteria from the Lactobacilli family, and more specifically the species Lactobacillus rhamnosus. Studies show that the intake of pre and probiotics during pregnancy can reduce the risk of eczema by up to 50%, in cases where the pregnant woman had an atopic predisposition. Furthermore, this intake is safe for the expectant mother and her baby. Pre and probiotics can be taken throughout the duration of pregnancy and breastfeeding, if applicable.

To alleviate thepregnancy eczema, it is crucial tomoisturise the skin daily to counteract its dryness caused by eczema. Applying emollient-rich and fatty treatments such as balms or lotions once to several times a day is highly recommended to restore its skin barrier.

Furthermore, it is recommended to apply a topical corticosteroid as soon as the first symptoms of eczema appear, such as redness, patches and itching. Presenting no contraindications for the mother and baby, local cortisone is prescribed by dermatologists to alleviate pregnancy-related atopic eczema.

• REYNOLDS N. & al. Eczema and pregnancy. The British Medical Journal (2007).

• CRANE J. & al. The probiotics in pregnancy study (PiP Study): rationale and design of a double-blind randomised controlled trial to improve maternal health during pregnancy and prevent infant eczema and allergy. BMC Pregnancy and Childbirth (2016).