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Li J, Pan Y, Zheng Q, Chen X, Jiang X, Liu R, Zhu Y, Huang L. Risk factors and glycaemic control in small-for-gestational-age infants born to mothers with gestational diabetes mellitus: a case-control study using propensity score matching based on a large population. BMJ Open 2024; 14:e078325. [PMID: 38199619 PMCID: PMC10806598 DOI: 10.1136/bmjopen-2023-078325] [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: 07/30/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Small for gestational age (SGA) poses a significant concern for newborns, being linked to neonatal complications and potential metabolic disorders in adulthood, especially when born to mothers with gestational diabetes mellitus (GDM), elevating their risk of complications and mortality. However, the pregnancy risk factors and glycaemic control associated with SGA infants born to mothers with GDM remain unclear. AIM To identify the pregnancy risk factors and glycaemic control associated with SGA infants born to mothers with GDM. METHOD This case-control study was conducted among 1910 women with GDM in China. Data were collected by the integrated electronic medical record system. Using 1:4 propensity score matching analysis, we adjusted for gestational age as confounder. Univariate and multivariate analyses were performed to identify risk factors. RESULTS Risk factors for SGA born to mothers with GDM included a history of low birth weight, gestational hypertension, oligohydramnios, short maternal height, underweight pre-pregnancy body mass index and inadequate weight growth. While SGA was protected by weakly positive ketonuria levels in the first trimester, multiparous, anaemia and previous uterine scar were protective factors for SGA. Moreover, 2-hour postprandial glucose and haemoglobin A1c in the second trimester, as well as the 0-hour and 2-hour 75 g oral glucose tolerance test (OGTT) were linked to risk of SGA. CONCLUSIONS SGA infants are the result of multifactorial interactions among GDM pregnant women. Notably, glycaemic control levels were associated with SGA. There is a need for enhanced perinatal monitoring and antenatal care to reduce SGA.
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Affiliation(s)
- Jianing Li
- Fujian Medical University School of Nursing, Fuzhou, Fujian, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Yuqing Pan
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Qingxiang Zheng
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Xiaoqian Chen
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Xiumin Jiang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Rulin Liu
- Fujian Medical University School of Nursing, Fuzhou, Fujian, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Yu Zhu
- Fujian Medical University School of Nursing, Fuzhou, Fujian, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
| | - Ling Huang
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetric & Gynecology and Pediatrics, Fuzhou, Fujian, China
- Fujian University of Traditional Chinese Medicine School of Nursing, Fuzhou, Fujian, China
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2
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Conti‐Ramsden F, Fleminger J, Lanoue J, Chappell LC, Battersby C. The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012-2020 and opportunities to avoid admission: A population-based study using the National Neonatal Research Database. BJOG 2024; 131:88-98. [PMID: 37337344 PMCID: PMC10767760 DOI: 10.1111/1471-0528.17574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE To quantify maternal hypertensive disorder of pregnancy (HDP) prevalence in late preterm and term infants admitted to neonatal units (NNU) and assess opportunities to avoid admissions. DESIGN A retrospective population-based study using the National Neonatal Research Database. SETTING England and Wales. POPULATION Infants born ≥34 weeks' gestation admitted to NNU between 2012 and 2020. METHODS Outcomes in HDP infants are compared with non-HDP infants using regression models. MAIN OUTCOME MEASURES Hypertensive disorder of pregnancy, primary reason for admission, clinical diagnoses and resource use. RESULTS 16 059/136 220 (11.8%) of late preterm (34+0 to 36+6 weeks' gestation) and 14 885/284 646 (5.2%) of term (≥37 weeks' gestation) admitted infants were exposed to maternal HDP. The most common primary reasons for HDP infant admission were respiratory disease (28.3%), prematurity (22.7%) and hypoglycaemia (16.4%). HDP infants were more likely to be admitted with primary hypoglycaemia than were non-HDP infants (odds ratio [OR] 2.1, 95% confidence interval [CI] 2.0-2.2, P < 0.0001). 64.5% of HDP infants received i.v. dextrose. 35.7% received mechanical or non-invasive ventilation. 8260/30 944 (26.7%) of HDP infants received intervention for hypoglycaemia alone (i.v. dextrose) with no other major intervention (respiratory support, parenteral nutrition, central line, arterial line or blood transfusion). CONCLUSIONS The burden of maternal HDP on late preterm and term admissions to NNU is high, with hypoglycaemia and respiratory disease being the main drivers for admission. Over one in four were admitted solely for management of hypoglycaemia. Further research should determine whether maternal antihypertensive agent choice or postnatal pathways may reduce NNU admission.
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Affiliation(s)
| | - Jessica Fleminger
- Department of Women and Children's HealthKing's College LondonLondonUK
| | - Julia Lanoue
- Neonatal Medicine, School of Public Health, Faculty of MedicineImperial College LondonLondonUK
| | - Lucy C. Chappell
- Department of Women and Children's HealthKing's College LondonLondonUK
| | - Cheryl Battersby
- Neonatal Medicine, School of Public Health, Faculty of MedicineImperial College LondonLondonUK
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Dassios T, Selvadurai L, Hickey A, Sleight E, Long L, Penna L, Wallen-Mitchell V, Bhat R, Greenough A. Multiprofessional cross-site working between a level 1 and a level 3 neonatal unit: a retrospective cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001581. [PMID: 36645761 PMCID: PMC9511588 DOI: 10.1136/bmjpo-2022-001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To assess the association of short-term neonatal outcomes with cross-site working of multiple healthcare professional teams between a level 3 and a level 1 neonatal unit. DESIGN Retrospective cohort study. SETTING A level 1 neonatal unit in London. PATIENTS All infants admitted to the neonatal unit, between 2010 and 2021. INTERVENTIONS The clinical service was rearranged in 2014 with the introduction of cross-site working between the level 1 unit and a level 3 unit of neonatal doctors, nurses and allied healthcare professionals. MAIN OUTCOME MEASURES Admission of infants with a temperature less than 36°C, length of stay and time to first consultation by a senior team member. RESULTS A total of 4418 infants were admitted during the study period. The percentage of infants delivered at a gestation below 32 weeks was higher in the pre-cross-site period (8.9%) compared with the cross site period (3.6%, p<0.001). The percentage of infants with an Apgar score less than 8 at 10 min was higher in the pre-cross-site period (6.2%) compared with the cross-site period (3.4%, p=0.001). More infants were admitted with a temperature less than 36°C in the pre-cross site period (12.3%) compared with the cross site period (3.7%, p<0.001). The median (IQR) duration of time to first consultation by a senior team member was higher in the pre-cross-site period (1 (0.5-2.6) hours) compared with the cross-site period (0.5 (0.2-1.3) hours) (p<0.001). The median (IQR) length of stay was 4 (2-11) days in the pre-cross-site period and decreased to 2 (1-4) days in the cross-site period (p<0.001). CONCLUSIONS Cross-site working was associated with lower rates of admission hypothermia, shorter duration of stay and earlier first senior consultation.
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Affiliation(s)
- Theodore Dassios
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK .,Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Lucksini Selvadurai
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Ann Hickey
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Elizabeth Sleight
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Lisa Long
- Department of Obstetrics and Gynaecology, King's College Hospital NHS Foundation Trust, London, UK
| | - Leonie Penna
- Department of Obstetrics and Gynaecology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Ravindra Bhat
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.,NIHR Biomedical Research Centre at Guy's and Saint Thomas' NHS Foundation Trust and King's College, London, UK
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Laing D, Walsh E, Alsweiler JM, Hanning SM, Meyer MP, Ardern J, Cutfield WS, Rogers J, Gamble GD, Chase JG, Harding JE, McKinlay CJ. Oral diazoxide versus placebo for severe or recurrent neonatal hypoglycaemia: Neonatal Glucose Care Optimisation (NeoGluCO) study - a randomised controlled trial. BMJ Open 2022; 12:e059452. [PMID: 35977769 PMCID: PMC9389093 DOI: 10.1136/bmjopen-2021-059452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Infants with severe or recurrent transitional hypoglycaemia continue to have high rates of adverse neurological outcomes and new treatment approaches are needed that target the underlying pathophysiology. Diazoxide is one such treatment that acts on the pancreatic β-cell in a dose-dependent manner to decrease insulin secretion. METHODS AND ANALYSIS Phase IIB, double-blind, two-arm, parallel, randomised trial of diazoxide versus placebo in neonates ≥35 weeks' gestation for treatment of severe (blood glucose concentration (BGC)<1.2 mmol/L or BGC 1.2 to <2.0 mmol/L despite two doses of buccal dextrose gel and feeding in a single episode) or recurrent (≥3 episodes <2.6 mmol/L in 48 hours) transitional hypoglycaemia. Infants are loaded with diazoxide 5 mg/kg orally and then commenced on a maintenance dose of 1.5 mg/kg every 12 hours, or an equal volume of placebo. The intervention is titrated from the third maintenance dose by protocol to target BGC in the range of 2.6-5.4 mmol/L. The primary outcome is time to resolution of hypoglycaemia, defined as the first point at which the following criteria are met concurrently for ≥24 hours: no intravenous fluids, enteral bolus feeding and normoglycaemia. Groups will be compared for the primary outcome using Cox's proportional hazard regression analysis, expressed as adjusted HR with a 95% CI. ETHICS AND DISSEMINATION This trial has been approved by the Health and Disability Ethics Committees of New Zealand (19CEN189). Findings will be disseminated in peer-reviewed journals, to clinicians and researchers at local and international conferences and to the public. TRIAL REGISTRATION NUMBER ACTRN12620000129987.
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Affiliation(s)
- Don Laing
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Eamon Walsh
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Sara M Hanning
- School of Pharmacy, The University of Auckland, Auckland, New Zealand
| | - Michael P Meyer
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Julena Ardern
- Kidz First Neonatal Care, Counties Manukau District Health Board, Auckland, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, The University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Jenny Rogers
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - J Geoffrey Chase
- College of Engineering, University of Canterbury, Christchurch, New Zealand
| | - Jane E Harding
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Christopher Jd McKinlay
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Kidz First Neonatal Care, Counties Manukau District Health Board, Auckland, New Zealand
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Oren MS, Barkhuff WD, Stefanescu A, Stefanescu BM, DuPont TL. The impact of the Baby Friendly Hospital Initiative on neonatal hypoglycemia. J Perinatol 2020; 40:1828-1833. [PMID: 32963302 DOI: 10.1038/s41372-020-00822-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 08/17/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess Neonatal Intensive Care Unit (NICU) admissions for hypoglycemia after the introduction of the Baby Friendly Hospital Initiative (BFHI), followed by implementation of American Academy of Pediatrics recommended hypoglycemia guidelines. STUDY DESIGN Retrospective review of NICU admissions for hypoglycemia. Eligible subjects were healthy infants >35 weeks gestation transferred to a NICU for hypoglycemia. Infants admitted with other pathologies were excluded. NICU admissions from 3 different 18-month epochs (1 = pre-BFHI; 2 = post-BFHI; 3 = post-BFHI+hypoglycemia guidelines) were compared. RESULTS After implementation of BFHI there was a statistically significant increase in admissions for hypoglycemia (Epoch 2 = 1.23% vs Epoch 1 = 0.55%, p < 0.001). Followed by a decrease in admissions after the implementation of hypoglycemia guidelines (Epoch 2 = 1.23% vs Epoch 3 = 0.76%, p = 0.03). CONCLUSION NICU admissions for hypoglycemia increased with the BFHI. Hypoglycemia guidelines decreased NICU admissions, but not to the pre-BFHI baseline.
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Affiliation(s)
- Marina S Oren
- Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Whittney D Barkhuff
- Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA.,Department of Pediatrics, Division of Neonatology, University of Vermont, Burlington, VT, USA
| | - Andrei Stefanescu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Beatrice M Stefanescu
- Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA.,Department of Pediatrics, Division of Neonatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tara L DuPont
- Department of Pediatrics, Division of Neonatology, University of New Mexico School of Medicine, Albuquerque, NM, USA. .,Department of Pediatrics, Division of Neonatology University of Utah Health Science Center, Salt Lake City, UT, USA.
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6
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Kennedy LML, Crawford TM, Andersen CC, Stark MJ. Does umbilical cord blood glucose extraction discriminate the risk of early neonatal hypoglycaemia in at-risk newborns? J Paediatr Child Health 2019; 55:1476-1480. [PMID: 30968510 DOI: 10.1111/jpc.14473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 02/05/2019] [Accepted: 03/17/2019] [Indexed: 11/30/2022]
Abstract
AIM Despite targeting newborns at risk of hypoglycaemia based on clinical characteristics, blood glucose measured at 1 and 4 h of age is frequently normal. Identification of at-risk newborns at the greatest risk of hypoglycaemia would allow more targeted, earlier intervention. We aimed to determine the ability of calculated umbilical cord blood glucose extraction to discriminate hypoglycaemia in at-risk newborns in the first 4 h of life. METHODS Newborns with paired arterial and venous cord blood glucose and 1 ± 4 h capillary or venous blood glucose measured using a blood gas analyser (radiometer) were retrospectively identified (n = 154). Hypoglycaemia was defined as a blood glucose ≤2.0 mmol/L. The ability of calculated umbilical cord blood glucose extraction to discriminate risk of hypoglycaemia was determined by an receiver operating characteristic (ROC) curve. RESULTS Twenty-seven newborns (18%) had a blood glucose ≤2.0 mmol/L at either time point. Neither arterial nor venous cord blood glucose predicted early hypoglycaemia better than chance. The area under the ROC curve for umbilical cord blood glucose extraction (area under the ROC curve = 0.74, (95% confidence interval, 0.65-0.82)) was significantly better than chance and arterial or venous cord blood glucose. An umbilical cord blood glucose extraction of 16% had the best sensitivity (80%) and specificity (55%) for discriminating the risk of early hypoglycaemia. CONCLUSIONS Umbilical cord blood glucose extraction discriminates the risk of early hypoglycaemia at 1 or 4 h of age. However, the clinical utility of this test is limited due to the low sensitivity and specificity. Its predictive value may be greater in specific subsets of at-risk newborns and warrants further investigation.
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Affiliation(s)
- Lydia M L Kennedy
- Department of Neonatal Medicine, Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Tara M Crawford
- Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Chad C Andersen
- Department of Neonatal Medicine, Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Michael J Stark
- Department of Neonatal Medicine, Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia.,Robinson Research Institute, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Kozen K, Dassios T, Kametas N, Kapoor RR, Greenough A. Transient neonatal hyperinsulinaemic hypoglycaemia: perinatal predictors of length and cost of stay. Eur J Pediatr 2018; 177:1823-1829. [PMID: 30232594 DOI: 10.1007/s00431-018-3242-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/26/2022]
Abstract
Admission to neonatal care causes separation of infants from their parents, can adversely affect breast-feeding and is associated with painful procedures. Our aim was to identify perinatal factors and cost of care associated with transient neonatal hyperinsulinaemic hypoglycaemia (HH). Infants born after 35 weeks of gestation admitted because of hypoglycaemia were studied. The neonates were divided into two groups (HH and non-HH), and their length and cost of care were compared and perinatal factors predicting those outcomes explored. Forty of the 474 infants admitted with hypoglycaemia were diagnosed with HH. The HH group had a lower median (IQR) glucose level on admission compared to the non-HH group (p < 0.001). The median (IQR) cost of stay was higher in the HH group (p < 0.001). In the HH group, the GIRmax was significantly correlated with cost of stay (p < 0.001). GIRmax predicted a cost of stay > £9140 with an area under the ROC curve of 0.956. GIRmax > 13.9 mg/kg/min predicted admission cost > £9140 with 86% sensitivity and 93% specificity.Conclusion: Transient neonatal HH was associated with a higher length and cost of stay in infants admitted for hypoglycaemia. The GIRmax can predict the length and cost of stay. What is Known: • Neonatal hypoglycaemia is the leading cause of term and late preterm neonatal admissions. • Hyperinsulinism (HH) is the commonest cause of persistent hypoglycaemia, and delay in the diagnosis and management can have a detrimental impact on long-term development. What is New: • We have demonstrated prior to NICU admission that blood glucose concentrations were lower in infants with HH compared to those without. • The maximum GIR had a stronger correlation with total length and cost of hospital stay compared to insulin levels in HH infants.
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Affiliation(s)
- Kazune Kozen
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodore Dassios
- Neonatal Intensive Care Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Nick Kametas
- Harris Birthright Centre for Fetal Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Ritika R Kapoor
- Paediatric Endocrinology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- MRC-Asthma UK Centre in Allergic Mechanisms of Asthma, King's College London, London, UK.
- Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
- National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
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