Ask an answerable question (PICO)：
Atopic dermatitis is a chronic and recurrent skin condition commonly seen in infants. In clinical practice, medication is the main treatment for atopic dermatitis in infants. One pregnant woman expressed that she heard probiotics could help prevent the development of atopic dermatitis in infants. She then asked if she could take probiotics during her pregnancy to prevent giving birth to a baby with atopic dermatitis. The query triggered the present study. Through literature search and exploration of relevant PICO questions, this study was aimed to explore whether the pregnant women (P) take probiotics (I) can prevent development of atopic dermatitis in infants (O).
Atopic dermatitis is a chronic and recurrent skin condition commonly observed in infants. In clinical practice, medication serves as the primary treatment for atopic dermatitis. A pregnant woman recently inquired about the potential preventive benefits of probiotics against the development of atopic dermatitis in infants. By addressing pertinent PICO questions and conducting a thorough systematic literature search, the study aims to investigate whether pregnant women (P) taking probiotics (I) can prevent the development of atopic dermatitis in infants (O).
The Method and Analysis of Literature Review：
A PICO question was established through empirical steps: Can a pregnant woman take probiotics to prevent development of atopic dermatitis in infants. This study used keywords and synonyms to set P as pregnancy woman, pregnant women, maternal; I as probiotic*, prebiotic*, synbiotics, Lactobacillus, Bifidobacterium; O as atopic dermatitis, atopic eczema, allergic eczema, infant*, newborn*, ansd bab*. Boolean Logic was used to form a union through OR and an intersection through AND. Four electronic journal databases, which were Cochrane Library, PubMed, Embase, and Airiti Library were searched for relevant evidence. The scope was limited to studies regarding humans, randomized controlled trial, systematic review, and meta-analysis written in English or Chinese. The publication years were limited to within the recent 5 years (from 2018 to 2022). The inclusion criteria were set to be studies corresponding to keywords. After literature screening, two systematic review and meta-analysis studies were selected for critical appraisal.
The keywords and synonyms were used for literature esarch, with P (pregnancy woman, pregnant women, maternal); I (probiotic*, prebiotic*, synbiotics, Lactobacillus, Bifidobacterium); and O (atopic dermatitis, atopic eczema, allergic eczema, infant*, newborn*, ansd bab*). Boolean Logic was employed to create a union through OR and an intersection through AND. Cochrane Library, PubMed, Embase, and Airiti Library were systematically searched for relevant evidence. We restricted the studies involving humans, randomized controlled trials, systematic reviews / meta-analyses, and written in English or Chinese. The publication years were limited to the most recent 5 years (from 2018 to 2022). Finally, two systematic review and meta-analysis studies were selected for critical appraisal.
Critical Appraisal：
Two systematic review and meta-analysis studies were selected for critical appraisal. The 2018 version of Critical Appraisal Skill Programme (CASP), namely, CASP Systematic Review Checklist (2018) was adopted. The levels of evidence of the studies were based on the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. The levels of evidence of the two studies were both Level 1. After critical appraisal, the studies were of Level A according to Oxford suggestions.
Two systematic review and meta-analysis studies were selected for critical appraisal. The Critical Appraisal Skills Programme (CASP) Systematic Review Checklist (2018) was utilized. The levels of evidence for the studies were determined following the Oxford Centre for Evidence-based Medicine (2011). Both studies assessed were categorized as Level 1 evidence.
Results, Conclusions and Recommendations：
The evidence-based appraisal results revealed that when pregnant women begin taking probiotics during pregnancy and continue to take probiotics to the 6th month after delivery, the odds of infants in the control group developing atopic dermatitis were 0.51 times that of the experimental group (OR 0.51; 95% CI 0.32-0.84), reached a statistically significant difference (p=.008). As a result of that atopic dermatitis can be prevented in infants when probiotics are absorbed through breastfeeding. The selected studies involved mixed use of probiotic strains to prevent atopic dermatitis in infants. The effectiveness of mixed use of strains was more significant than that of a single strain of probiotics. In addition, the results of the systematic review and meta-analysis by Jiang et al. (2020), the incidence of atopic dermatitis in infants can be reduced if pregnant women start to take probiotics in the third trimester and continue to take them until 6 months after delivery.
The results shown that pregnant women take probiotic intake during pregnancy and continue until the sixth month after delivery, the odds of infants in the control group developing atopic dermatitis were 0.51 times that of the experimental group (OR 0.51; 95% CI 0.32-0.84), demonstrating a statistically significant difference (p=.008). Additionally, according to Jiang et al. (2020) study, the incidence of atopic dermatitis in infants can be reduced if pregnant women start taking probiotics in the third trimester and continue until 6 months after delivery.
However, the two studies undergoing critical appraisal had different probiotic strains and doses. In addition, although probiotics are prescribed medicines in hospitals, but it is a kind of health food in the over-the-counter medications, which can be purchased from general pharmacies. Due to the diverse content of probiotics, the effects may vary. In the future, more studies should explore the effectiveness of different strains of probiotics on preventing and treating atopic dermatitis for providing clinical reference.
However, the included studies employed different probiotic strains and doses. Furthermore, the probiotics are also available as health food over-the-counter medications, purchasable from general pharmacies. Due to the diverse content of probiotics, the effects may vary. Therefore, future studies explore the effectiveness of different strains and doses of probiotics in preventing atopic dermatitis among infants are needed.
