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Zazara DE, Giannou O, Schepanski S, Pagenkemper M, Giannou AD, Pincus M, Belios I, Bonn S, Muntau AC, Hecher K, Diemert A, Arck PC. Fetal lung growth predicts the risk for early-life respiratory infections and childhood asthma. World J Pediatr 2024; 20:481-495. [PMID: 38261172 PMCID: PMC11136800 DOI: 10.1007/s12519-023-00782-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Early-life respiratory infections and asthma are major health burdens during childhood. Markers predicting an increased risk for early-life respiratory diseases are sparse. Here, we identified the predictive value of ultrasound-monitored fetal lung growth for the risk of early-life respiratory infections and asthma. METHODS Fetal lung size was serially assessed at standardized time points by transabdominal ultrasound in pregnant women participating in a pregnancy cohort. Correlations between fetal lung growth and respiratory infections in infancy or early-onset asthma at five years were examined. Machine-learning models relying on extreme gradient boosting regressor or classifier algorithms were developed to predict respiratory infection or asthma risk based on fetal lung growth. For model development and validation, study participants were randomly divided into a training and a testing group, respectively, by the employed algorithm. RESULTS Enhanced fetal lung growth throughout pregnancy predicted a lower early-life respiratory infection risk. Male sex was associated with a higher risk for respiratory infections in infancy. Fetal lung growth could also predict the risk of asthma at five years of age. We designed three machine-learning models to predict the risk and number of infections in infancy as well as the risk of early-onset asthma. The models' R2 values were 0.92, 0.90 and 0.93, respectively, underscoring a high accuracy and agreement between the actual and predicted values. Influential variables included known risk factors and novel predictors, such as ultrasound-monitored fetal lung growth. CONCLUSION Sonographic monitoring of fetal lung growth allows to predict the risk for early-life respiratory infections and asthma.
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Affiliation(s)
- Dimitra E Zazara
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Germany
- University Children's Hospital, UKE, Hamburg, Germany
| | - Olympia Giannou
- Computer Engineering and Informatics Department, Polytechnic School, University of Patras, Patras, Greece
| | - Steven Schepanski
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Germany
- Institute of Developmental Neurophysiology, Center for Molecular Neurobiology Hamburg (ZMNH), UKE, Hamburg, Germany
| | | | - Anastasios D Giannou
- Department of General, Visceral and Thoracic Surgery, UKE, Hamburg, Germany
- Section of Molecular Immunology and Gastroenterology, I. Department of Medicine, UKE, Hamburg, Germany
| | - Maike Pincus
- Pediatrics and Pediatric Pneumology Practice, Berlin, Germany
| | - Ioannis Belios
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Germany
| | - Stefan Bonn
- Institute of Medical Systems Biology, ZMNH, UKE, Hamburg, Germany
- Hamburg Center for Translational Immunology, UKE, Hamburg, Germany
| | - Ania C Muntau
- University Children's Hospital, UKE, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, UKE, Hamburg, Germany
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, UKE, Hamburg, Germany
| | - Petra Clara Arck
- Division for Experimental Feto-Maternal Medicine, Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20251, Hamburg, Germany.
- Hamburg Center for Translational Immunology, UKE, Hamburg, Germany.
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Knutson AO, Watters JJ. All roads lead to inflammation: Is maternal immune activation a common culprit behind environmental factors impacting offspring neural control of breathing? Respir Physiol Neurobiol 2019; 274:103361. [PMID: 31874263 DOI: 10.1016/j.resp.2019.103361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 12/12/2022]
Abstract
Despite numerous studies investigating how prenatal exposures impact the developing brain, there remains very little known about how these in utero exposures impact the life-sustaining function of breathing. While some exposures such as alcohol and drugs of abuse are well-known to alter respiratory function, few studies have evaluated other common maternal environmental stimuli, such as maternal infection, inhalation of diesel exhaust particles prevalent in urban areas, or obstructive sleep apnea during pregnancy, just to name a few. The goals of this review article are thus to: 1) highlight data on gestational exposures that impair respiratory function, 2) discuss what is known about the potential role of inflammation in the effects of these maternal exposures, and 3) identify less studied but potential in utero exposures that could negatively impact CNS regions important in respiratory motor control, perhaps by impacting maternal or fetal inflammation. We highlight gaps in knowledge, summarize evidence related to the possible contributions of inflammation, and discuss the need for further studies of life-long offspring respiratory function both at baseline and after respiratory challenge.
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Affiliation(s)
- Andrew O Knutson
- Molecular and Environmental Toxicology Training Program and Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Jyoti J Watters
- Molecular and Environmental Toxicology Training Program and Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI 53706, United States.
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Torjussen TM, Munthe-Kaas MC, Mowinckel P, Carlsen KH, Undlien DE, Lødrup Carlsen KC. Childhood lung function and the association with β2-adrenergic receptor haplotypes. Acta Paediatr 2013; 102:727-31. [PMID: 23463918 DOI: 10.1111/apa.12221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 02/14/2013] [Accepted: 02/26/2013] [Indexed: 11/27/2022]
Abstract
AIM To determine associations between ADRB2 polymorphisms and lung function through childhood, and possible modification by gender, pet keeping or tobacco smoke. METHODS Four ADRB2 single nucleotide polymorphisms (rs1042711, rs1042713, rs1042714 and rs1800888) were genotyped in 953 children from the prospective birth cohort 'Environment and Childhood Asthma' study and analysed for association with flow-volume parameters at birth (tidal breathing) and at 10 years of age (maximally forced), stratified by environmental exposures. RESULTS The risk of reduced lung function was reduced in 10-year-old children carrying the most common ADRB2 haplotype (CGGC) (OR 0.45 (95% CI 0.25, 0.82)), whereas there was no association between lung function at birth and ADRB2 haplotypes. Tobacco smoke exposure, gender and pet keeping did not significantly interact with the haplotypes in influencing lung function. CONCLUSION This study demonstrates a possible protective effect by the ADRB2 haplotype I (CGGC) on reduced FEV1 in 10-year-old children, whereas no ADRB2 geno-/haplotypes were significantly associated with neonatal lung function. The ADRB2 gene thus appears to contribute to lung function development in childhood, independently of smoking, pets and gender.
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Affiliation(s)
- Tale M Torjussen
- Department of Paediatrics; Women and Children's Division; Oslo University Hospital; Oslo; Norway
| | | | - Petter Mowinckel
- Department of Paediatrics; Women and Children's Division; Oslo University Hospital; Oslo; Norway
| | | | - Dag E Undlien
- Department of Medical Genetics; Oslo University Hospital and University of Oslo; Oslo; Norway
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Eyers S, Weatherall M, Jefferies S, Beasley R. Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis. Clin Exp Allergy 2011; 41:482-9. [PMID: 21338428 DOI: 10.1111/j.1365-2222.2010.03691.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is evidence to suggest that the risk of asthma might be increased with exposure to paracetamol in the intrauterine environment, infancy, later childhood and adult life. OBJECTIVE To review the evidence from studies investigating the association between paracetamol use in pregnancy and childhood asthma. METHODS A systematic review and meta-analysis was undertaken of studies reporting the association between paracetamol use in pregnancy and subsequent asthma in childhood. The primary outcome variable was wheeze in the last 12 months. For tabulated raw data, not adjusted for confounders, random effects odds ratios (OR) were pooled by the inverse variance weighted method. RESULTS There were six studies identified that were included in the meta-analysis. The age of children studied ranged from 30 to 84 months. The pooled random effects OR for the risk of current wheeze in the children of women who were exposed to any paracetamol during any stage of pregnancy was 1.21 (95% confidence interval 1.02-1.44). Features of the studies variably included an association with paracetamol use during all trimesters of pregnancy and an association with persistent asthma, severe asthma, and with atopy. CONCLUSION AND CLINICAL RELEVANCE The use of paracetamol during pregnancy is associated with an increased risk of childhood asthma. More research is urgently required to determine the impact of paracetamol during pregnancy on the risk of wheezing in offspring so that appropriate public health recommendations can be made.
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Affiliation(s)
- S Eyers
- Medical Research Institute of New Zealand, Wellington, New Zealand.
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Affiliation(s)
- Andrew Bush
- F.R.C.P., Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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