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Pro- and synbiotic supplementation during pregnancy and infancy to prevent atopic eczema: a systematic review and individual participant data meta-analysis
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Content: Atopic eczema (AE) is a chronic inflammatory skin disease particularly common in early childhood. Previous aggregate data meta-analyses have suggested that prenatal or infancy exposure to pro- and synbiotics may prevent atopic eczema, but evidence is inconsistent and heterogeneous.
To assess the effectiveness and quality of pro- and symbiotic supplementation during pregnancy or infancy in preventing AE in infants using individual participant data (IPD) meta-analysis.
PubMed, EMBASE and Cochrane CENTRAL were searched up to 10/2025 without restrictions on language or publication year. Randomized controlled trials (RCTs) evaluating probiotics or synbiotics for the prevention of AE in pregnant and lactating people, and infants up to 12 months were eligible. Two independent reviewers screened titles and abstracts against predefined criteria and will assess the eligible full texts. The primary outcome is AE, assessed using a predefined outcome hierarchy (investigator assessment, physician diagnosis, and patient- or parent-reported eczema) when multiple measures were reported. Trial investigators will be contacted for de-identified IPD. If IPD cannot be obtained, aggregate data will be extracted from publications. A two-stage IPD meta-analysis is planned. Continuous outcomes will be summarized using mean differences or standardized mean differences, and dichotomous outcomes using risk ratios, with 95% confidence intervals. We will use random-effects models in stage two to estimate the pooled treatment effect across studies. Heterogeneity will be assessed using τ² and I² statistics, and if at least ten studies are available, publication bias will be explored using funnel plots and Peter’s test.
The search identified 48,727 records. After de-duplication 22,770 records were screened at the title and abstract level. Of these, 185 studies met the eligibility criteria for full-text assessment. Full-text screening is ongoing. Initial outreach to trialists has begun to assess interest in data sharing and participation in the project. Formal IPD requests will be sent following completion of full-text screening.
This IPD meta-analysis will offer the possibility to look more closely at the participant-level data allowing consistent outcome definition and flexible participant level analyses.
The results are expected to provide more robust evidence on the potential of pro- and synbiotic intervention in the prevention of AE.
Competing interests: Prof. Dr. Christian Apfelbacher ist PI und Sprecher der Forschungsgruppe HELICAP und zugleich im Kongresspräsidium der DGSMP.
Im Rahmen von HELICAP ist dieser Abstract/dieses Symposium entstanden.
Die eingereichten Abstracts wurden unabhängig erstellt. Es bestand kein Einfluss auf Auswahl- oder Begutachtungsprozesse; entsprechende Maßnahmen zur Wahrung der Unabhängigkeit und Objektivität wurden eingehalten.
