Emollients for prevention of atopic dermatitis; 5‐year findings from the BEEP randomised trial

Background The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years. Methods 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy. Results Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever. Conclusions Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever

The effect of anxiety and depression during pregnancy on obstetric complications

Objective To investigate the effects of anxiety and depression during pregnancy on obstetric complications using the data collected from the St George's Birthweight Study.Design Prospective population study.Setting District general hospital in inner London.Subjects A consecutive series of 1860 white women booking for delivery were approached. Of these, 136 refused and 209 failed to complete the study for other reasons, leaving a sample of 1515.Main outcome measure Data were obtained by research interviewers at booking, 17, 28, and 36 weeks gestation and from the structured antenatal and obstetric record. The predictor variables were the anxiety and depression scores measured using the General Health Questionnaire. The outcome variables were five obstetric complications: preterm delivery; nonspontaneous onset of labour; major analgesia in the first and second stages of labour; and nonspontaneous vaginal deliveries. The possible confounding effects of 35 socio-economic, psychological and personal variables were investigated using logistic regression.Results The factors that had the strongest relation with the outcomes were parity and maternal age. Depression during pregnancy was unrelated to the obstetric complications. Anxiety was weakly related to analgesia/anaesthesia in the second stage of labour ( P= 0.04 ). However, anxiety accounted for only 0.1 % of the variance in use of major analgesia/anaesthesia. The most effective model, that for analgesia/anaesthesia in the first stage of labour, accounted for only 7.3% of the variance.Conclusions In the general population of pregnant women, anxiety and depression during pregnancy, while undesirable in themselves, are of little importance in the evolution of obstetric complications