Birth weight and prematurity with lung function at ~17.5 years: "Children of 1997" birth cohort

Association Between Lung Function of Children and Their Socioeconomic Conditions: A Systematic Review

Objective

This study aims to evaluate the association between socioeconomic conditions and the lung function of children below 18 years old.

Design

Systematic review.

Methods

PRISMA guidelines were followed to browse relevant studies from 2013 to 2023. Data from the included studies were extracted after the Newcastle-Ottawa risk of bias tool was applied.

Main Outcome

Forced expiratory volume in the first second (FEV1) liters.

Results

20 papers with 89,619 participants were included. Logistic regression model for FEV1 based on multiple SES indices, suggested a positive association between lower respiratory function and a lower SES, with an interquartile odds ratio (OR) of 1.67 (95% CI 1.03-1.34).

Conclusion

Children from a lower socioeconomic status (SES) do exhibit lower lung function and addressing the causes of this can contribute to developing preventive public health strategies.

Limitations

Lack of appropriate reference values and varied indicators of socioeconomic status in the studies contributed to significant statistical differences.

Prospero Registration Number

CRD 42020197658.

Maternal pesticide exposure and risk of preterm birth: A systematic review and meta-analysis

BACKGROUND

Maternal pesticide exposure might be associated with adverse pregnancy outcomes through triggering inflammation and oxidative stress and disrupting endocrine functions. Yet the association between prenatal pesticide exposure and risk of preterm birth remains inconclusive.

OBJECTIVES

To conduct a systematic review and meta-analysis of human observational studies using the Office of Health Assessment and Translation (OHAT) framework to explore the association of per ten-fold increase of pesticide concentrations in maternal biological samples during pregnancy with risk of preterm birth and length of gestational age at birth.

DATA SOURCE

Five English (PubMed, Embase, Cochrane Library, Web of Science and Scopus) and 3 Chinese databases (China national knowledge infrastructure (CNKI), Wanfang Data, and Chinese Biomedical Literature Database (CBM)) were searched till Jan 18th, 2023.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS

To be included, pesticide exposure should be measured in maternal biological samples during pregnancy and in log-transformed forms. The primary outcome was preterm birth and the secondary outcome was gestational age at birth.

STUDY APPRAISAL, SYNTHESIS METHODS AND CONFIDENCE ASSESSMENT

Quality of studies was evaluated using OHAT Risk of Bias Tool. Evidence was quantitatively synthesized with Correlated and Hierarchical Effects (CHE) model. The confidence rating in the body of evidence was done using OHAT.

RESULTS

A total of 21 studies reported by 18 papers were included, with 7 studies for preterm birth and 19 for gestational age at birth. The meta-analysis found a ten-fold increase of pesticide concentrations was potentially associated with risk of preterm birth (pooled OR = 1.28; 95%CI: 0.93, 1.78) and shortened gestational age at birth (β = -0.10; 95%CI: -0.21, 0.01). Sampling biospecimens in different trimesters was identified as a potential modifier in the association between pesticide exposure and length of gestational age (F = 2.77, P < 0.05). For studies that collected samples at any time during pregnancy, pesticide exposure was found to be associated with shortened length of gestational age (β = -0.43; 95%CI: -0.81, -0.06). The confidence rating in the body of evidence was "moderate" and "very low" for preterm birth and gestational age at birth, respectively.

CONCLUSION

Our result suggested moderate evidence of an association between pesticide exposure and higher risk of preterm birth. Yet more studies are still needed with larger sample size and careful considerations of confounders and accuracy of outcome measurements. Attention is also required on other pesticide compounds in addition to organochlorine and organophosphorus pesticides, and on windows of susceptibility.

Does recurrent gestational diabetes mellitus increase the risk of preterm birth? A population-based cohort study

AIMS

To investigate whether recurrent gestational diabetes mellitus (GDM) is associated with an increased risk of preterm birth.

METHODS

We conducted a prospective population-based cohort study covering all live singleton births born to nulliparous and multiparous mothers aged 20 years and older in Qingdao, from 2018 to 2020 (n = 105,528). Preterm birth (<37 gestational weeks) was classified into moderate preterm birth (32-36 weeks of gestation) and very preterm birth (<32 weeks). Logistic regression analysis was performed to estimate the risk and severity of prematurity in relation to parity among mothers with previous GDM, current GDM, and recurrent GDM (previous and current GDM), using mothers without GDM as the reference group. Z-test and ratio of odds ratios (ROR) were used to determine subgroup differences.

RESULTS

Maternal GDM increased the risk of preterm birth in both nullipara (OR_adj = 1.28, 95 %CI: 1.14-1.45) and multipara (OR_adj = 1.26, 95 %CI: 1.14-1.40). However, the risk of premature delivery in multiparous mothers with recurrent GDM and those with current GDM did not differ significantly, with a ROR of 0.89 (95 %CI: 0.71-1.12). The risk of recurrent GDM on preterm birth was most pronounced among multiparous mothers with pre-pregnancy BMI above 30 kg/m² (OR_adj = 2.18, 95 %CI: 1.25-3.82) as compared with those with current GDM alone (ROR = 2.20, 95 %CI: 1.07-4.52). The risk of GDM for moderate preterm birth was similar to that of overall preterm birth. In contrast, GDM was not associated with very preterm birth irrespective of parity (all P values > 0.05).

CONCLUSIONS

Maternal GDM increased the risk of preterm birth in nullipara and multipara, whereas recurrent GDM was not associated with a further increase in the risk of prematurity in multiparous mothers. Maternal GDM did not contribute to very preterm birth irrespective of parity. Our findings can be useful for facilitating more targeted preventive strategies for adverse pregnancy outcomes.

Lifelong Lung Sequelae of Prematurity

The clinical, functional, and structural pattern of chronic lung disease of prematurity has changed enormously in last years, mirroring a better perinatal management and an increasing lung immaturity with the survival of increasingly premature infants. Respiratory symptoms and lung function impairment related to prematurity seem to improve over time, but premature birth increases the likelihood of lung function impairment in late childhood, predisposing to chronic obstructive pulmonary disease (COPD). It is mandatory to identify those individuals born premature who are at risk for developing long-term lung disease through a better awareness of physicians, the use of standardized CT imaging scores, and a more comprehensive periodic lung function evaluation. The aim of this narrative review was to provide a systematic approach to lifelong respiratory symptoms, lung function impairment, and lung structural anomalies in order to better understand the specific role of prematurity on lung health.

nnLong-Term Respiratory Outcomes in Early Term Born Offspring: A Systematic Review and Meta-Analysis

OBJECTIVE

Newborns exhibit the lowest immediate respiratory morbidity rates when born at full term (39-40) completed weeks of gestation. We evaluated whether early-term deliveries (37^0/7-38^6/7 weeks of gestation) bare a significant impact on overall and specific long-term respiratory outcomes of offspring up to the age of 18 years, as compared to offspring born at full term or later.

DATA SOURCES

PubMed/Medline, EMBASE, and relevant reference lists from January 2012 to May 2020.

STUDY ELIGIBILITY CRITERIA

This systematic review and meta-analysis was conducted according to the PRISMA guidelines and was registered in PROSPERO. Any observational or randomized human trials addressing the association between early term delivery and long-term respiratory outcomes in the offspring, restricted to studies published in English, were included. Search included terms relating to gestational age, pediatric morbidity, and respiratory outcomes. We included studies assessing long term respiratory disease (1-18 years) of offspring born during early term as compared to full term and later.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two independent reviewers extracted data and assessed risk of bias. Using a random-effect meta-analysis, pooled relative risk with their 95% confidence intervals and heterogeneity were determined. Publication bias was assessed by Funnel plots with Eggers regression line and contours, and sensitivity analyses were performed using Baujat plots.

RESULTS

Fourteen studies were included following a screen of nearly 2500 abstracts. These studies included nearly eight million patients, and were subjected to qualitative and quantitative analyses. Early term delivery significantly increased the risk of total respiratory morbidity in the offspring (RR= 1.20, 95% CI= 1.16, 1.26) as compared to full term delivery. The increased respiratory morbidity was attributed to obstructive airway diseases (RR=1.19, 95% CI= 1.12, 1.27) and infectious respiratory diseases (RR= 1.22, 95% CI= 1.17, 1.29). Most studies were of acceptable quality.

CONCLUSION

This comprehensive meta-analysis suggests that early term delivery poses a risk for long term pediatric respiratory morbidity, as compared to full term delivery. Notably, other factors over the years cannot be accounted for. This adds an important perspective to be considered when balancing the fetal, maternal, and neonatal risks associated with delivery timing.

Can birth weight predict offspring's lung function in adult age? Evidence from two Swedish birth cohorts

BACKGROUND

Associations between birth weight (BW) and adult lung function have been inconsistent and limited to early adulthood. We aimed to study this association in two population-based cohorts and explore if BW, adjusted for gestational age, predicts adult lung function. We also tested adult lung function impairment according to the mis-match hypothesis-small babies growing big as adults.

METHODS

We included 3495 individuals (aged 46.4 ± 5.4 years) from the Malmo Preventive Project (MPP), Sweden, born between 1921 and 1949, and 1401 young to middle-aged individuals (aged 28.6 ± 6.7 years) from the Malmo Offspring Study (MOS) with complete data on BW and gestational age. Adult lung function (forced vital capacity [FVC], forced expiratory volume in one second [FEV1] and the FEV1/FVC-ratio) were analysed as level of impairment (z-score), using multiple linear and logistic regressions.

RESULTS

BW (z-score) did not predict adult lung function in MPP, whereas BW was a significant (p = 0.003) predictor of FEV1 following full adjustment in MOS. For every additional unit increase in BW, children were 0.77 (95% CI 0.65-0.92) times less likely to have impaired adult lung function (FEV1). Moreover, adults born with lower BW (< 3510 g) showed improved lung function (FEV1 and FEV1/FVC in MOS and MPP, respectively) if they achieved higher adult body weight.

CONCLUSIONS

Adults born with lower birth weight, adjusted for gestational age, are more likely to have impaired lung function, seen in a younger birth cohort. Postnatal growth pattern may, however, compensate for low birth weight and contribute to better adult lung function.

Comparing Biological Age Estimates Using Domain-Specific Measures From the Canadian Longitudinal Study on Aging

Many studies have shown that estimates of biological age (BA) can predict health-related outcomes in older adults. Often, researchers employ multiple measures belonging to a variety of biological/physiological systems, and assess the validity of BA estimates by how well they approximate chronological age (CA). However, it is not clear whether this is the best approach for judging a BA estimate, or whether certain groups of measures are more informative to this end. Using data from the Canadian Longitudinal Study on Aging, we composed panels of biological measures based on the physiological systems/domains they belong to (blood, organ function, physical/cognitive performance), and also composed a panel of measures that optimized the association of BA with CA. We then compared BA estimates for each according to their association with CA and health-related outcomes, including frailty, multimorbidity, chronic condition domains, disability, and health care utilization. Although BA estimated using all 40 measures (r = 0.74) or our age-optimized panel (r = 0.77) most closely approximated CA, the strength of associations to health-related outcomes was comparable or weaker than that of our panel composed only of physical performance measures (CA r = 0.59). All BA estimates were significantly associated to the outcomes considered, with exception to the neurological and musculoskeletal disease domains, and only varied slightly by sex. In summary, while the approximation of CA is important to consider when estimating BA, the strength of associations to prospective outcomes may be of greater importance. Hence, the context in which BA is estimated should be influenced by an investigator's specific research goals.

Perinatal Nutritional and Metabolic Pathways: Early Origins of Chronic Lung Diseases

Lung development is not completed at birth, but expands beyond infancy, rendering the lung highly susceptible to injury. Exposure to various influences during a critical window of organ growth can interfere with the finely-tuned process of development and induce pathological processes with aberrant alveolarization and long-term structural and functional sequelae. This concept of developmental origins of chronic disease has been coined as perinatal programming. Some adverse perinatal factors, including prematurity along with respiratory support, are well-recognized to induce bronchopulmonary dysplasia (BPD), a neonatal chronic lung disease that is characterized by arrest of alveolar and microvascular formation as well as lung matrix remodeling. While the pathogenesis of various experimental models focus on oxygen toxicity, mechanical ventilation and inflammation, the role of nutrition before and after birth remain poorly investigated. There is accumulating clinical and experimental evidence that intrauterine growth restriction (IUGR) as a consequence of limited nutritive supply due to placental insufficiency or maternal malnutrition is a major risk factor for BPD and impaired lung function later in life. In contrast, a surplus of nutrition with perinatal maternal obesity, accelerated postnatal weight gain and early childhood obesity is associated with wheezing and adverse clinical course of chronic lung diseases, such as asthma. While the link between perinatal nutrition and lung health has been described, the underlying mechanisms remain poorly understood. There are initial data showing that inflammatory and nutrient sensing processes are involved in programming of alveolarization, pulmonary angiogenesis, and composition of extracellular matrix. Here, we provide a comprehensive overview of the current knowledge regarding the impact of perinatal metabolism and nutrition on the lung and beyond the cardiopulmonary system as well as possible mechanisms determining the individual susceptibility to CLD early in life. We aim to emphasize the importance of unraveling the mechanisms of perinatal metabolic programming to develop novel preventive and therapeutic avenues.

Pulmonary Outcomes in Children Born Extremely and Very Preterm at 11 Years of Age

Background: There is increasing evidence of prematurity being a risk factor for long-term respiratory outcomes regardless the presence of bronchopulmonary dysplasia (BPD). Aim: To assess the effect of prematurity on respiratory outcomes in children born ≤32 weeks of gestational age at 11 years of age. Materials and Methods: Fifty five ex-preterm children (≤ 32 weeks of gestational age), born in Chieti between January 1, 2006 and December 31, 2007, performed lung function and diffusing capacity test (DLCO) at 11 years of age. Furthermore, allergy evaluation by skin prick test (SPT), eosinophil blood count and assessment of eosinophilic airways inflammation by exhaled nitric oxide (FeNO) were performed. The ex-preterm group was compared to an age- and sex-matched group of term children. Results: No difference for atopic and respiratory medical history was found between ex-preterm children and term controls, except for preschool wheezing that resulted more frequent in ex-preterm children. No difference neither in school-aged asthma frequency nor in lung function assessment at 11 years of age was found between the two groups. Lower DLCO values in ex-preterm children compared to term controls regardless the presence of BPD were found; furthermore, we showed a positive association between DLCO and gestational age. Eosinophil blood count, positive SPTs and FeNO values were similar between the two groups. Conclusions: Diffusing lung capacity was decreased in ex-preterm children at 11 years of age in the absence of lung function impairment and eosinophil airway inflammation, suggesting a non-eosinophilic pattern underlying pulmonary alterations. It could be desirable to include the diffusing capacity assessment in follow-up evaluation of all ex-preterm children.