Disrupted Prenatal Maternal Cortisol, Maternal Obesity, and Childhood Wheeze. Insights into Prenatal Programming

Abstract

Maternal prenatal cortisol disruption and obesity were independently associated with children's wheeze. Obese women with adverse cortisol profiles were most likely to have children with repeated wheeze.

Maternal Obesity in Pregnancy, Gestational Weight Gain, and Risk of Childhood Asthma

“…Of these, 14 studies with a total of 108 321 mother-child pairs were included in the meta-analysis [16][17][18][20][21][22][23][24][25][26][27][28][29][30] (Table 1). There was complete agreement on 469 of 474 articles after title and abstract screening (interreader agreement k = .90) and on 40 of 42 articles after full-text screening (k = .89).…”

“…However, as with any meta-analysis, we were limited to the covariates available to us from the original articles. Finally, maternal obesity is also a risk factor for childhood obesity, and the elevated risk of asthma could result partly from the child's own obesity; however, such confounding is unlikely given that most of the included studies adjusted for birth weight 16,17,22,23,25,26,29,30 or for the child's weight or BMI at the time of assessment of the outcome. 17,23,25,27,29 …”

“…Twelve studies reported maternal BMI (continuous or categorical) closely before or at the beginning of pregnancy [16][17][18][20][21][22][23][25][26][27]29,30 and were included in the analysis of MOP; 5 studies were included in the analysis of GWG. 20,21,23,24,28 Although many studies categorized MOP and GWG in different ways, response from the authors of the original studies was very positive, and the majority of them provided us with estimates for continuous BMI 18,[20][21][22][23]27 and GWG (in kilograms) 20,21 (or kindly responded that continuous data were…”

“…50 ) 21 Outcomes reported varied and included wheezing (ever, current, transient, or persistent) and asthma (ever or current); 12 studies used self-report (of which 3 studies specified "report of physician-diagnosed asthma" 20,21,27 ), and 2 studies reported using physician diagnosis or medical record review. 22,24 For comparability purposes, we grouped (when possible) the outcomes into 2 broader categories: "asthma/wheeze ever" 17,18,[20][21][22][25][26][27][28][29][30] and "current asthma/wheeze." 21,[23][24][25][26]29 Maternal Obesity During Pregnancy Table 1 shows the original studies with the MOP as reported (categorical or continuous) and the reported outcomes.…”

Update in Asthma 2013

“…Taken together these studies suggest that abdominal obesity is a stronger predictor of asthma and that the effect is independent of the metabolic syndrome. Wright and colleagues investigated the link between maternal obesity and cortisol disruption on repeated childhood wheezing and showed that maternal obesity and cortisol disruption had independent influences on childhood wheezing in a cross-sectional analysis of pregnant mothers (14). Yet, a subgroup of obese mothers with adverse cortisol profiles characterized by abnormally elevated cortisol levels later in the day were most likely to have children with repeated wheeze.…”