Maternal Complications and Procedures in Pregnancy and at Birth and Wheezing Phenotypes in Children

Abstract

Rationale: There is increasing interest in the potential influence of fetal and early life conditions on childhood wheezing. Objectives: To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children. Methods: We studied 15,609 children, aged 6-7 yr, enrolled in a population-based study. Standardized questionnaires were completed by the children's mothers. AT A GLANCE COMMENTARY Scientific Knowledge on the SubjectMaternal smoking in pregnancy influences lung development and is associated with wheezing in childhood; other prenatal and perinatal factors (maternal infections, obstetric conditions) have been inconclusively associated with wheezing among offspring. What This Study Adds to the FieldAn association was found between maternal hypertension, diabetes, and urinary tract infections during pregnancy and exposure to antibiotics at delivery with wheezing disorders, in particular wheezing of early onset.(1). The most studied in utero environmental influence on lung development is maternal smoking in pregnancy, which has been shown to be associated not only with wheezing in childhood (2-5) but also with a dose-related reduction in lung function in the newborn period. Fetal development seems therefore to represent a critical time of pulmonary vulnerability with respect to smoking exposure. More recently, some studies have also investigated the relationships between exposure to maternal infections in pregnancy (6-8), maternal obstetric conditions (hyperemesis, hypertension, and preeclampsia) (9-11), uterine factors (antepartum hemorrhage, preterm contractions, placental insufficiency, and uterine growth restriction) (9-11), malposition or malpresentation of the fetus (11), mode of delivery (11)(12)(13)(14)(15)(16)(17)(18), and the development of asthma among offspring. However, the findings of these studies have been inconsistent.In a report published in 1999 (19), we found associations between a number of pre-, peri-, and early postnatal factors and different wheezing phenotypes in a large multicenter crosssectional population-based study, the SIDRIA (Italian Studies of Respiratory Disorders in Childhood and the Environment) phase 1 study, an extension of the International Study on Asthma and Allergies in Childhood (ISAAC) phase 1 study (20). The enrolled children were categorized, on the basis of criteria derived from Martinez and coworkers (21), as transient early wheezers (children with wheezing in the first 2 yr of life but not at school age), persistent wheezers (children who continued to wheeze at school age), late-onset wheezers (children who did not wheeze in the first years of life but who wheezed when 6-7 yr

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).…”

“…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.…”

Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study

“…Environmental triggers, such as maternal allergen exposure or maternal infections during pregnancy, along with maternal antibodies and intra-uterine cytokine profile, have been suspected to promote the skewing towards the expression of a Th2-type immunity in the fetus [1,[24][25][26][27][28]. In addition, the influence of genetic factors on asthma susceptibility is known to be important [23].…”

“…As up to 55% of patients suffering from asthma with moderate-to-severe severity may have experienced asthma exacerbations at least once during pregnancy [17,18], this could be proposed as an important feature in the development of childhood asthma. Moreover, potential explanatory hypotheses include impaired lung development, which may result from maternal hypoxia occurring among moderate-to-severe asthmatic females experiencing uncontrolled asthma during pregnancy, or may be due to the fact that those females may have characteristics enhancing the propensity of a child to develop a T-lymphocyte helper (Th) type 2-biased immunity [10,[19][20][21][22][23][24][25][26][27][28].…”