Low-normal gestational age as a predictor of asthma at 6 years of age

Harvard University, Cambridge, Massachusetts, United States
PEDIATRICS (Impact Factor: 5.47). 10/2004; 114(3):e327-32. DOI: 10.1542/peds.2003-0838-L
Source: PubMed


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.
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.
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.
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.

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Available from: Benjamin A Raby, Dec 11, 2014
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    • "No studies investigating the correlation between birth weight and future asthma have been randomized, double-blinded controlled trials (RCT) due to the fact such randomization is ethically and biologically impossible. Most studies are based on data collected retrospectively 7,9,11,19,24,26,29 or prospectively 8,10,13,15,16,21,22. Retrospective study designs have collected data about birth weight in different ways, such as registers or questionnaires 7,9,11,19,24,26,29. "
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    ABSTRACT: Early genetic and environmental factors have been discussed as potential causes for the high prevalence of asthma and allergic disease in the western world, and knowledge on fetal growth and its consequence on future health and disease development is emerging. This review article is an attempt to summarize research on fetal growth and risk of asthma and allergic disease. Current knowledge and novel findings will be reviewed and open research questions identified, to give basic scientists, immunologists and clinicians an overview of an emerging research field. PubMed-search on pre-defined terms and cross-references. Several studies have shown a correlation between low birth weight and/or gestational age and asthma and high birth weight and/or gestational age and atopy. The exact mechanism is not yet clear but both environmental and genetic factors seem to contribute to fetal growth. Some of these factors are confounders that can be adjusted for, and twin studies have been very helpful in this context. Suggested mechanisms behind fetal growth are often linked to the feto-maternal circulation, including the development of placenta and umbilical cord. However, the causal link between fetal growth restriction and subsequent asthma and allergic disease remains unexplained. New research regarding the catch-up growth following growth restriction has posited an alternative theory that diseases later on in life result from rapid catch-up growth rather than intrauterine growth restriction per se. Several studies have found a correlation between a rapid weight gain after birth and development of asthma or wheezing in childhood. Asthma and allergic disease are multifactorial. Several mechanisms seem to influence their development. Additional studies are needed before we fully understand the causal links between fetal growth and development of asthma and allergic diseases.
    Full-text · Article · Oct 2012 · Clinical & Experimental Allergy
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    • "1994–1996 Sweden Wheeze 4 years 2869 No association for birth weight Birth length ≥ 90th centile OR any wheeze 0.4 [0.21, 0.77] [29] 1994–1996 USA Physician diagnosed plus wheeze in the last year 6 years 454 at risk for asthma No association Birth weight < 2.5 kg OR asthma 1.05 [0.40, 2.73]. Gestation < 38.5 weeks assoc with increased asthma (OR 4.7 [2.1, 10.5]) [17] 1994–2000 Denmark History of asthma 3-9 years 8280 twin pairs Negative Asthma assoc with 122 g lower birth weight [85] [160] "
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    ABSTRACT: The "fetal origins hypothesis" or concept of "developmental programming" suggests that faltering fetal growth and subsequent catch-up growth are implicated in the aetiology of cardiovascular disease. Associations between reduced birth weight, rapid postnatal weight gain, and asthma suggest that there are fetal origins to respiratory disease. The present paper first summarises the literature relating birth weight and post natal growth trajectories to asthma outcomes. Second, issues regarding the interpretation of antenatal fetal ultrasound measurements are discussed. Finally, recent reports linking antenatal measurement and growth trajectory to early childhood asthma outcomes are discussed. Understanding the nature and timing of factors which influence antenatal growth may give important insight into the antecedents of early-onset asthma with implications for interventions.
    Full-text · Article · Feb 2012 · Clinical and Developmental Immunology

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