Low-Normal Gestational Age as a Predictor of Asthma at 6 Years of Age

Abstract

ABSTRACT. Background. Perinatal factors, including gestational age and birth weight, influence the development of atopy in early life. However, the role of these factors in the development of asthma in later life among children who do not develop perinatal respiratory disease remains unclear.Methods. Four hundred fifty-four infants who had a history of allergy or asthma in at least 1 parent, were born in the 36th week of gestation or later, and did not develop perinatal respiratory distress were monitored for at least 6 years. Associations between predictor variables and asthma and wheeze were assessed with multivariate logistic regression and repeated-event analyses.Results. Although we previously observed a relationship between low birth weight and persistent wheeze in the first 1 year of life, we did not observe similar associations between low birth weight and asthma at 6 years of age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 0.40 -2.73). However, a strong relationship was found between low-normal gestational age and asthma at 6 years of age (OR: 4.7; 95% CI: 2.1-10.5). The effects of low-normal gestational age were significantly greater among boys than among girls (boys: OR: 8.15; 95% CI: 2.98 -22.3; girls: OR: 1.90; 95% CI: 0.38 -13.83). Longitudinal analysis of the relationship between gestational age and wheeze during the 6 years of observation confirmed these gender differences.Conclusions. Among children at high risk of developing atopic disease, late prematurity might be an important additional determinant of asthma later in life, and these effects are gender specific. Pediatrics 2004; 114:e327-e332. URL: http://www.pediatrics.org/cgi/ content/full/114/3/e327; asthma, gestational age, birth weight, longitudinal studies.ABBREVIATIONS. IgE, immunoglobulin E; OR, odds ratio; CI, confidence interval. T here is substantial evidence that perinatal factors contribute to the development of both atopic disease and asthma. Although it is well established that prematurity is a major risk factor for the development of chronic lung disease, as a result of bronchopulmonary dysplasia, 1,2 and that extremely premature infants more frequently demonstrate persistent airway hyperresponsiveness in early childhood, 3 the influence of less extreme prematurity on the development of asthma among otherwise healthy children remains unresolved. Both low birth weight and prematurity were directly associated with the development of wheeze or asthma in several studies, 4-7 whereas other studies either failed to demonstrate an association [8][9][10][11] or demonstrated inverse relationships. 12 Although several of those studies were prospective, 6,8 most of the studies that demonstrated important effects included very premature infants (Ͻ36 weeks of gestation) in their analyses, making it difficult to separate the effects of prematurity from those associated with mechanical ventilation and respiratory distress syndrome. Moreover, few of those studies examined gender-differing effects, despite evidence of important gende...

Association of Late-Preterm Birth With Asthma in Young Children: Practice-Based Study

“…12,13 Our findings also suggest that lownormal gestational ages of 37 to 38 weeks might confer increased risk of early childhood asthma, compared with gestational ages of Ն39 weeks, as suggested in other studies. 25,26 This association is noteworthy, given recent epidemiological trends in gestational length for US births. Since the 1990s, the distribution of gestational ages has shifted downward; 39, rather than 40, weeks is now the most common length of gestation.…”

“…In addition, we examined the association of asthma with low-normal gestational age (37-38 weeks), which has not been well studied to date. 26 Given the significant health and societal costs related to childhood asthma, a better understanding of the association between asthma and gestational age is critical for understanding the true impact of late prematurity on health and health care costs.…”

Childhood Asthma and Extreme Values of Body Mass Index: The Harlem Children’s Zone Asthma Initiative

“…18 Our analyses of a more recent cohort of children assessed in [2002][2003][2004] reveal that an association between underweight and asthma appears to occur early on in the life course, and was even stronger among 2-5 year old boys than among 6-11 year old boys. Furthermore, studies such as those demonstrating a U-shaped association between ponderal index at birth (birth weight divided by length cubed) and adult asthma and atopy 32 and increased risk of asthma among low-normal gestational age boys 33 point to the role of perinatal and early life factors in the development of asthma and atopy. It is possible that among some of the children in our sample, nutritional and growth restriction occurring during these periods could have contributed to abnormal lung growth and asthma.…”

Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy

“…Birth weight and gestational age were used as continuous and categorical variables. 20 Head circumference data was missing for 21% of the participating children and was thus not included in the analysis.…”

“…Additional variables considered for inclusion in the multivariate analysis included sex, annual household income 21 , child's ethnicity 21 , number of older siblings, maternal age at delivery, gestational age 20 , maternal asthma (ever and current), paternal asthma (ever and current), in utero smoke exposure, average number of cigarettes smoked by adults in the household per day, breast feeding 22 , day care attendance in the first year of life 23 , antibiotic use in the first year of life 24 , bottle feeding in the crib or bed prior to sleep 22 , physician-diagnosed illnesses of the upper (sinusitis and recurrent [≥3 episodes] of nasal catarrh) and lower (pneumonia, bronchiolitis, bronchitis, and croup) respiratory tract in the first year of life 25 , and levels of dust mite allergen and endotoxin in house dust at age 2 to 3 months 26 . The methods used to collect house dust samples and quantify levels of dust mite allergen (in the child's bed) and endotoxin (in the family/living room) have been previously described [26][27][28][29] .…”