Maternal body mass index before pregnancy is associated with increased bronchodilator dispensing in early childhood: A cross‐sectional study

Abstract

Rationale Maternal prepregnancy obesity has been associated with early wheeze and childhood asthma in their offspring. Some of these studies have been in minority, urban, and disadvantaged populations using parental recall and questionnaires. The association of maternal prepregnancy obesity with bronchodilator dispensing to their offspring, in a primarily insured, non-urban, White population in the United States is unknown. Objectives and Methods We conducted a retrospective cohort study using pharmacy dispensing data from the electronic medical records of a large United States health maintenance organization to examine the relationship between maternal prepregnancy body mass index (BMI) and inhaled bronchodilator dispensing in the offspring to four years of age. We included infants ≥ 37 weeks’ gestation with birth weight ≥ 2.5 kg which yielded 6,194 mother-baby pairs. Maternal prepregnancy BMI was categorized as underweight (< 18.5 kg/m2), normal (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), or obese (≥ 30 kg/m2). Results In the entire cohort, 27.6% of the offspring received a bronchodilator dispensing. This ranged from 19.2% in the offspring of underweight mothers to 31.3% of those born to obese mothers. In the fully adjusted model using normal BMI as the referent, children of obese mothers had a 22% higher rate of bronchodilator dispensing (adjusted OR = 1.22; 95% CI 1.05–1.41; p=0.008). Conclusions In this insured, non-urban, White population, maternal prepregnancy obesity was associated with bronchodilator dispensing in the offspring in early life. These results extend previous data and reaffirm the potential widespread public health impact that prepregnancy obesity may have on subsequent childhood respiratory health.

Maternal high‐fat diet in mice leads to innate airway hyperresponsiveness in the adult offspring

“…Thus, our finding demonstrates a direct causal relationship between maternal HFD and the clinically relevant finding of AHR in adult offspring consuming a NFD. This supports observational studies associating maternal obesity and early life wheezing and asthma risk in children if a diet high in saturated fats significantly contributes to maternal obesity (Macdonald et al 2013;Pike et al 2013;Forno et al 2014;MacDonald et al 2016).…”

“…Multiple studies demonstrate associations between maternal pregnancy body mass index >30 m/kg 2 and increased incidence of childhood wheezing and asthma symptoms in the offspring. A sample of over 6k mother-baby pairs clearly showed increased bronchodilator use in offspring of obese pregnancies (MacDonald et al 2016). In a prospective study, Pike et al (2013) reported associations between obese pregnancy and increased wheezing history in offspring thru age 5 years but no association with asthma or atopy.…”

“…A sample of over 6k mother‐baby pairs clearly showed increased bronchodilator use in offspring of obese pregnancies (MacDonald et al. ). In a prospective study, Pike et al.…”

Wheezing in children

“…In the nonurban, white population, maternal prepregnancy obesity was associated with a 22% increase in bronchodilator dispensing in offspring in early life. Maternal prepregnancy obesity is also a prevalent risk factor for respiratory morbidity in urban, nonwhite populations [90,91].…”

Maternal high-fat diet alters lung development and function in the offspring

“…The fetal consequences of maternal exposure to obesity may result from direct intrauterine influence on organ development and metabolism or from subtle perturbations, including epigenetic alterations. Infants born to mothers with obesity are more likely to develop pulmonary pathologies such as chronic lung disease, reactive airways, and respiratory infections, and have altered glucose and fatty acid delivery to the lungs for surfactant production (9,21,23,24,27). In addition, infants born to mothers with obesity have altered metabolic function, which includes disruption of the hypothalamic pituitary adrenal (HPA) axis, increased leptin levels, insulin resistance, and increased blood pressure (11,31).…”