Prenatal PM2.5 affects atopic dermatitis depending on maternal anxiety and gender: COCOA study
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Background: The prevalence of atopic dermatitis (AD) is increasing worldwide. Prenatal particulate matter with an aerodynamic diameter <2.5 μm (PM 2.5) and maternal anxiety during pregnancy has been suggested as a potential causes of AD. This study investigated the effects of prenatal PM 2.5 and maternal anxiety on AD and identified the critical period of PM 2.5 exposure for AD in infants. Methods: This study included 802 children from the COCOA birth cohort study with follow‐up data at 1 year of age. PM 2.5 was estimated by land‐use regression models and prenatal anxiety was measured with a questionnaire. AD was diagnosed by doctor at 1 year of age. Logistic regression analysis and Bayesian distributed lag interaction models were applied. Results: Higher PM 2.5 during the first trimester of pregnancy, higher prenatal maternal anxiety, and male gender were associated with AD at 1 year of age (adjusted odds ratio [aOR] and 95% confidence interval [CI]: 1.86 [1.08–3.19], 1.58 [1.01–2.47], and 1.54 [1.01–2.36], respectively). Higher PM 2.5 during the first trimester and higher maternal anxiety during pregnancy showed an additive effect on the risk of AD (aOR: 3.13; 95% CI: 1.56–6.28). Among boys exposed to higher maternal anxiety during pregnancy, gestational weeks 5–8 were the critical period of PM 2.5 exposure for the development of AD. Conclusions: Higher PM 2.5 exposure during gestational weeks 5–8 increased the probability of AD in infancy, especially in boys with higher maternal anxiety. Avoiding PM 2.5 exposure and maternal anxiety from the first trimester may prevent infant AD.
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Studies based on similar populations, but with different periods, study designs and/or statistical analysis, obtained contrasting results.
“Accordingly, studies based on similar populations, but with different periods, study designs and/or statistical analysis, obtained contrasting results [41, 44, 47, 53, 55, 61, 90, 91, 94, 95].”
From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [90]
The Results (page not available) report different associations across pregnancy periods in a birth cohort: first-trimester PM2.5 exposure was associated with atopic dermatitis, whereas exposure during the entire pregnancy or later trimesters was not. The Discussion says the first-trimester finding was consistent with previous COCOA studies; our copy does not establish that studies of similar populations obtained contrasting results because of differences in period, design, or analysis. (LLM, conf=0.75)
Experimental — accuracy not yet measuredAn additive effect of higher PM2.5 (first trimester) and higher maternal anxiety was observed during pregnancy on the risk of atopic dermatitis, particularly in boys at gestational weeks 5-8.
“An additive effect of higher PM2.5 (first trimester) and higher maternal anxiety was observed during pregnancy on the risk of AD, particularly in boys at gestational weeks 5–8 [90].”
From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [90]
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Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence
Singh, N., Schikowski, T., & Krutmann, J. (2026) · American Journal of Clinical Dermatology · doi:10.1007/s40257-026-01006-5 · Cited by 4 · see citing works
“An additive effect of higher PM 2.5 (first trimester) and higher maternal anxiety was observed during pregnancy on the risk of AD, particularly in boys at gestational weeks 5–8 [90].”
Influential
- Authors
- Kim, S., Yang, S., Lim, H., Lee, S., Park, M. J., Song, K., Choi, E. J., Oh, H. Y., Kim, H., Shin, Y., Lee, K., Choi, K. Y., Suh, D. I., Shin, Y. H., Kim, K. W., Ahn, K., & Hong, S.
- Affiliations
- Asan Medical Center (KR)
- Hallym University Sacred Heart Hospital (KR)
- Eulji University Uijeongbu Eulji Medical Center (KR)
- Inha University (KR)
- Yonsei University (KR)
- Hanshin University (KR)
- Department of Environmental Energy Engineering Anyang University Anyang Republic of Korea
- Seoul National University (KR)
- Samsung Medical Center (KR)
- Corresponding author
- Hong, Soo‐Jong
- ORCID
- Venue
- Clinical and Translational Allergy
- Publisher
- Wiley
- Published
- 2021-10
- Volume
- 11
- Issue
- 8
- Pages
- e12070-e12070
- ISSN
- 2045-7022 (ISSN-L)
- PMC
- PMC8519998
- OpenAlex
- W3207245958
- Cited by
- 13
- References
- 7
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 1
- FWCI
- 0.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Clinical and Translational Allergy (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Korea National Institute of Health (2008‐E33030‐00, 2009‐E33033‐00, 2011‐E33021‐00, 2012‐E33012‐00, 2013‐E51003‐00, 2014‐E51004‐00, 2014‐E51004‐01, 2014‐E51004‐02, 2017‐E67002‐00, 2017‐E67002‐01, 2017‐E67002‐02, 2019‐ER671000, 2019‐ER671001)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Keywords
- atopic dermatitis, maternal anxiety, air pollution, first trimester, infant allergy, sex differences
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