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Ni M, Li B, Zhang Q, Zhao J, Li W, Qi S, Shen Q, Yao D, Chen Z, Wang T, Ding X, Lin Z, Cheng C, Liu Z, Chen H. Relationship Between Birth Weight and Asthma Diagnosis: A Cross-Sectional Survey Study Based on the National Survey of Children's Health in the U.S. BMJ Open 2023; 13:e076884. [PMID: 38040432 PMCID: PMC10693893 DOI: 10.1136/bmjopen-2023-076884] [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: 06/20/2023] [Accepted: 10/31/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To assess the association between birth weight and childhood asthma risk using data from the 2019-2020 National Survey of Children's Health database. DESIGN Cross-sectional study. SETTING The USA. PATIENTS A representative cohort of American children. EXPOSURE The exposure of this study was birth weight regardless of gestational age. Birth weight was divided into three groups: <1500 g, 1500-2500 g and >2500 g. MAIN OUTCOME MEASURES Primary outcomes were parent-reported diagnosis of asthma. METHOD The Rao-Scott χ2 test was used to compare the groups. The main analyses examined the association between birth weight and parent-report asthma in children using univariable and multivariable logistic models adjusting for preterm birth, age, sex, race, family poverty, health insurance, smoking, maternal age. Subgroup analysis was performed based on interaction test. RESULTS A total of 60 172 children aged 3-17 years were enrolled in this study; of these, 5202 (~8.6%) had asthma. Children with asthma were more likely to be born preterm, with low birth weight (LBW) or very LBW (VLBW). The incidence of asthma was the highest in VLBW children at 20.9% and showed a downward trend with an increase in birth weight class, with rates of 10.7% and 8.1% in the LBW and normal birthweight groups, respectively. Children with VLBW (OR 1.97; 95% CI 1.29 to 3.01) had higher odds of developing asthma in the adjusted analysis model. However, VLBW was only shown to be a risk factor for asthma among Hispanics, black/African-Americans and children between the ages of 6 and 12 years, demonstrating racial and age disparities. CONCLUSIONS VLBW increases the risk of childhood asthma; however, racial and age disparities are evident.
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Affiliation(s)
- Meng Ni
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Baihe Li
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianqian Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Jiuru Zhao
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Wei Li
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Sudong Qi
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Qianwen Shen
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Dongting Yao
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Ze Chen
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Tao Wang
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Xiya Ding
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Zhenying Lin
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Chunyu Cheng
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital, School of Medicine,Shanghai Jiao Tong University, Shanghai, China
- International Peace Maternity and Child Health Hospital of China Welfare Institution, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Disease, Shanghai, China
| | - Hao Chen
- Departments of Neonatology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Ziou M, Gao CX, Wheeler AJ, Zosky GR, Stephens N, Knibbs LD, Williamson GJ, Melody SM, Venn AJ, Dalton MF, Dharmage SC, Johnston FH. Primary and pharmaceutical care usage concurrent associations with a severe smoke episode and low ambient air pollution in early life. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 883:163580. [PMID: 37100138 DOI: 10.1016/j.scitotenv.2023.163580] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/10/2023] [Accepted: 04/15/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Due to climate change, landscape fires account for an increasing proportion of air pollution emissions, and their impacts on primary and pharmaceutical care are little understood. OBJECTIVES To evaluate associations between exposure in two early life periods to severe levels of PM2.5 from a mine fire, background PM2.5, and primary and pharmaceutical care. METHODS We linked records of births, general practitioner (GP) presentations and prescription dispensing for children born in the Latrobe Valley, Australia, 2012-2014, where a severe mine fire occurred in February-March 2014 in an area with otherwise low levels of ambient PM2.5. We assigned modelled exposure estimates for fire-related (cumulative over the fire and peak 24-hour average) and annual ambient PM2.5 to residential address. Associations with GP presentations and dispensing of prescribed medications in the first two years of life (exposure in utero) and in the two years post-fire (exposure in infancy) were estimated using two-pollutant quasi-Poisson regression models. RESULTS Exposure in utero to fire-related PM2.5 was associated with an increase in systemic steroid dispensing (Cumulative: IRR = 1.11, 95%CI = 1.00-1.24 per 240 μg/m3; Peak: IRR = 1.15, 95%CI = 1.00-1.32 per 45 μg/m3), while exposure in infancy was associated with antibiotic dispensing (Cumulative: IRR = 1.05, 95%CI = 1.00-1.09; Peak: IRR = 1.06, 95%CI = 1.00-1.12). Exposure in infancy to ambient PM2.5, despite relatively low levels from a global perspective (Median = 6.1 μg/m3), was associated with an increase in antibiotics (IRR = 1.10, 95%CI = 1.01-1.19 per 1.4 μg/m3) and in GP presentations (IRR = 1.05, 95%CI = 1.00-1.11), independently from exposure to the fire. We also observed differences in associations between sexes with GP presentations (stronger in girls) and steroid skin cream dispensing (stronger in boys). DISCUSSION Severe medium-term concentrations of PM2.5 were linked with increased pharmaceutical treatment for infections, while chronic low levels were associated with increased prescriptions dispensed for infections and primary care usage. Our findings also indicated differences between sexes.
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Affiliation(s)
- Myriam Ziou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Caroline X Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria 3052, Australia
| | - Amanda J Wheeler
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO) Oceans and Atmosphere, Aspendale, Victoria 3195, Australia
| | - Graeme R Zosky
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania 7000, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Nicola Stephens
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, NSW 2006, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Grant J Williamson
- School of Natural Sciences, University of Tasmania, Sandy Bay, Tasmania 7005, Australia
| | - Shannon M Melody
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Marita F Dalton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Carlton, Victoria 3052, Australia
| | - Fay H Johnston
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia.
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Liang Y, Zhang J, Bai S, Du S, Yang X, Wang Z. Short-term and long-term effects of cesarean section on asthma and wheezing: A cohort study and meta-analysis. Respir Med 2023:107300. [PMID: 37257787 DOI: 10.1016/j.rmed.2023.107300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/21/2023] [Accepted: 05/27/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe the short-term and long-term effects of cesarean section on childhood asthma and wheezing. METHOD Firstly, in the cohort study, 6640 infants were included in the cohort baseline from January 2018 to December 2019, in which 6501 children completed the follow-up study for respiratory diseases at age 2 years. The effect of cesarean section on asthma and wheezing was estimated by the logistic regression model. Secondly, we conducted a meta-analysis of studies with outcomes of childhood asthma and wheezing under 2 years of age and over 2 years of age, respectively, to investigate the short-term and long-term effects of cesarean section on asthma and wheezing. RESULTS In our cohort study, the cumulative incidence of asthma and wheezing was 1.3% (84/6501). 45.5% of children (2961/6501) were born by cesarean section. The adjusted odds ratio for the effect of cesarean section on asthma and wheezing in children under 2 years of age was 1.14 (95%CI 0.73-1.78). Combining previous studies (outcomes of asthma and wheezing under 2 years of age) with our results for a meta-analysis, the odds ratio was 1.15 (95%CI 1.05-1.25, I2 = 46.82%). Meanwhile, cesarean section had a long-term effect on asthma and wheezing in the child population over 2 years of age (OR = 1.17, 95%CI 1.11-1.24, P < 0.001, I2 = 79.38%). CONCLUSION Cesarean section had a short-term effect on asthma and wheezing before the age of 2, in addition, the long-term effect of cesarean section on asthma and wheezing persisted in the child population (under 18).
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Affiliation(s)
- Yuxiu Liang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Jiatao Zhang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shuoxin Bai
- Department of Epidemiology, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Shang Du
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China
| | - Xiwei Yang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
| | - Zhiping Wang
- Department of Occupational and Environmental Health, School of Public Health, Shandong University, 44 Wenhua Xi Road, Jinan, Shandong, 250012, PR China.
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Khan S, Ouaalaya EH, Chauveau AD, Scherer E, Reboux G, Millon L, Deschildre A, Marguet C, Dufourg MN, Charles MA, Raherison Semjen C. Whispers of change in preschool asthma phenotypes: Findings in the French ELFE cohort. Respir Med 2023; 215:107263. [PMID: 37224890 DOI: 10.1016/j.rmed.2023.107263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Abstract
RATIONALE Early life asthma phenotyping remains an unmet need in pediatric asthma. In France, severe pediatric asthma phenotyping has been done extensively; however, phenotypes in the general population remain underexplored. Based on the course and severity of respiratory/allergic symptoms, we aimed to identify and characterize early life wheeze profiles and asthma phenotypes in the general population. METHODS ELFE is a general population based birth cohort; which recruited 18,329 newborns in 2011, from 320 maternity units nationwide. Data was collected using parental responses to modified versions of ISAAC questionnaire on eczema, rhinitis, food allergy, cough, wheezing, dyspnoea and sleep disturbance due to wheezing at 3 time points: post-natal (2 months), infancy (age 1) and pre-school (age 5). We built a supervised trajectory for wheeze profiles and an unsupervised approach was used for asthma phenotypes. Chi squared (χ2) test or fisher's exact test was used as appropriate (p < 0.05). RESULTS Wheeze profiles and asthma phenotypes were ascertained at age 5. Supervised wheeze trajectory of 9161 children resulted in 4 wheeze profiles: Persistent (0.8%), Transient (12.1%), Incident wheezers at age 5 (13.3%) and Non wheezers (73.9%). While 9517 children in unsupervised clusters displayed 4 distinct asthma phenotypes: Mildly symptomatic (70%), Post-natal bronchiolitis with persistent rhinitis (10.2%), Severe early asthma (16.9%) and Early persistent atopy with late onset severe wheeze (2.9%). CONCLUSION We successfully determined early life wheeze profiles and asthma phenotypes in the general population of France.
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Affiliation(s)
- Sadia Khan
- Bordeaux University, INSERM, Bordeaux Population Health Research Center, Team: EPICENE, UMR1219, Bordeaux, France.
| | - El Hassane Ouaalaya
- High Institute of Nursing Professions and Health Techniques, ISPITS, Agadir, Morocco
| | | | | | | | - Laurence Millon
- Parasitology-Mycology Department, University Hospital of Besançon, Chrono-Environnement UMR 6249 CNRS, University of Bourgogne Franche-Comté, 25000, Besançon, France
| | | | | | | | | | - Chantal Raherison Semjen
- Bordeaux University, INSERM, Bordeaux Population Health Research Center, Team: EPICENE, UMR1219, Bordeaux, France
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Brew BK, Osvald EC, Gong T, Hedman AM, Holmberg K, Larsson H, Ludvigsson JF, Mubanga M, Smew AI, Almqvist C. Paediatric asthma and non-allergic comorbidities: A review of current risk and proposed mechanisms. Clin Exp Allergy 2022; 52:1035-1047. [PMID: 35861116 PMCID: PMC9541883 DOI: 10.1111/cea.14207] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome-wide association studies, gene expression-functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.
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Affiliation(s)
- Bronwyn K. Brew
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Clinical MedicineUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Emma Caffrey Osvald
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
| | - Tong Gong
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Anna M. Hedman
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Kirsten Holmberg
- Child Health and Parenting (CHAP), Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | - Henrik Larsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- Department of PediatricsOrebro University HospitalOrebroSweden
| | - Mwenya Mubanga
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Awad I. Smew
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's HospitalKarolinska University HospitalStockholmSweden
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Yang DH, Chin CS, Chao WC, Lin CH, Chen YW, Chen YH, Chen HH. Association of the Risk of Childhood Asthma at Age 6 With Maternal Allergic or Immune-Mediated Inflammatory Diseases: A Nationwide Population-Based Study. Front Med (Lausanne) 2021; 8:713262. [PMID: 34409053 PMCID: PMC8365169 DOI: 10.3389/fmed.2021.713262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This study aimed to assess the associations of the risk of asthma diagnosed in children aged 6 years or younger and having maternal immune-mediated inflammatory diseases (IMIDs), including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), inflammatory myositis, rheumatoid arthritis (RA), Sjögren's syndrome (SS), ankylosing spondylitis (AS), and autoimmune thyroiditis. Methods: A total of 628,878 singleton newborns documented in 2006-2009 and followed up for at least 6 years were identified. Overall, 153,085 (24.3%) children developed asthma at the age of ≤ 6 years. Two groups of maternal ages, i.e., <35 and ≥35 years, were evaluated. The associations of the risk of asthma occurring in children who were 6 years old or younger and had maternal IMIDs were examined. Results: The risk of asthma increased in children whose mothers had SLE [odds ratio (OR), 1.13; 95% confidence intervals (CI), 1.00-1.27; p = 0.04), RA (OR, 1.21; 95% CI, 1.07-1.38; p = 0.003), inflammatory myositis (OR, 1.41; 95% CI, 1.12-1.74; p = 0.003), asthma (OR, 1.58; 95% CI, 1.52-1.63), allergic rhinitis (OR, 1.30; 95% CI, 1.28-1.32), or atopic dermatitis (OR, 1.07; 95% CI, 1.02-1.12). Conversely, this increased risk was not observed in children whose mothers had AS (OR, 1.02; 95% CI, 0.87-1.20), SS (OR, 0.96; 95% CI, 0.86-1.07), SSc (OR, 1.28; 95% CI, 0.77-2.14), or autoimmune thyroiditis (OR, 1.01; 95% CI, 0.95-1.07). Other risk factors of childhood asthma included high urbanization level, preterm birth, and low birth weight. Conclusion: The risk of childhood asthma at 6 years of age increased in children whose mothers suffered from SLE, RA, inflammatory myositis, asthma, allergic rhinitis, and atopic dermatitis.
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Affiliation(s)
- Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan.,Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan
| | - Chun-Shih Chin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Hyperbaric Oxygen Therapy Center, Taichung Veterans General Hospital, Taichung, Taiwan.,Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Computer Science, Tunghai University, Taichung, Taiwan.,Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yun-Wen Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin-Hua Chen
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of General Internal Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
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Modelling maternal and perinatal risk factors to predict poorly controlled childhood asthma. PLoS One 2021; 16:e0252215. [PMID: 34043705 PMCID: PMC8158992 DOI: 10.1371/journal.pone.0252215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Asthma is the most common non-communicable pulmonary condition, affecting prepubertal boys more often than girls. This study explored how maternal and perinatal risk factors are linked to poorly controlled childhood asthma in a sex dependent manner. This single centre study was performed at a metropolitan teaching hospital in Western Sydney, Australia, using electronical obstetric records from 2000 to 2017 and electronical pediatric records from 2007 to 2018. The data of 1694 children with complete entries were retrospectively analysed. Risk factors for multiple hospital admission for asthma were selected by backward-eliminated Poisson regression modelling. Selection stability of these parameters was independently confirmed using approximated exhaustive search. Sex-specific regression models indicated that most notably parity (RR[95%CI] for parity = 3; 1.85[1.22-2.81]), birth length z-score (1.45[1.23-1.70]) and birth weight z-score (0.77[0.65-0.90]) contributed to multiple asthma admissions in girls, while boys were affected most prominently by maternal BMI (e.g. BMI 35-39.9; 1.92[1.38-2.67]) and threatened preterm labor (1.68[1.10-2.58]). Allergic status was a risk factors for both boys and girls (1.47[1.18-1.83] and 1.46[1.13-1.89]). Applying ROC analysis, the predictive modelling of risk factors for hospital admissions showed an incremental increase with an AUC of 0.84 and 0.75 for girls and boys respectively for >3 hospital admissions. Multiple hospital admissions for asthma are associated with maternal and perinatal risk factors in a sex and birth order dependent manner. Hence, prospective risk stratification studies aiming to improve childhood asthma control are warranted to test the clinical utility of these parameters. Furthermore, the influence of the early in utero environment on male-female differences in other communicable and non-communicable respiratory conditions should be considered.
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Furuhata M, Otsuka Y, Kaneita Y, Nakagome S, Jike M, Itani O, Ohida T. Factors Associated with the Development of Childhood Asthma in Japan: A Nationwide Longitudinal Study. Matern Child Health J 2021; 24:911-922. [PMID: 32342275 DOI: 10.1007/s10995-020-02944-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Many environmental factors are related to the development of asthma. However, the key factors of childhood asthma onset have not been sufficiently elucidated. Further, low-weight births have increased in Japan. The aim of this study was to examine the risk factors for the incidence of childhood asthma and to evaluate whether these risk factors differ according to birth weight in Japan. METHODS We used the National Longitudinal Survey from 2001 to 2010. Multiple logistic regression analyses were conducted to determine the effects of gender, birth weight, single vs. multiple births, birth order, nutrition, keeping pets in the home, place of residence, annual household income, and parent ages, smoking behaviors, and educational backgrounds on asthma-related hospital visits. RESULTS Overall, 45,060 children were analyzed. The rate of cumulative hospital visits until age 10 was 18.9%. Birth weight < 2500 g (adjusted odds ratio [AOR] = 1.14, 95% confidence interval [CI] 1.03-1.26), being a boy (AOR = 1.27, 95% CI 1.21-1.33), having older siblings (AOR = 1.07, 95% CI 1.02-1.14), parental smoking behavior, mother`s age, and low household income (AOR = 1.17, 95% CI 1.10-1.24) were associated with asthma-related hospital visits. DISCUSSION Parental smoking behavior is a key risk factor for the development of asthma. Among low birth weight infants, being a boy, having older siblings, and father`s smoking behavior were predictive factors for the development of asthma. However, low birth weight was not associated with the development of asthma after 6 years of age.
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Affiliation(s)
- Masakazu Furuhata
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuichiro Otsuka
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Yoshitaka Kaneita
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Sachi Nakagome
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Maki Jike
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Osamu Itani
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Takashi Ohida
- Division of Public Health, Department of Social Medicine, Nihon University School of Medicine, Tokyo, Japan
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9
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Evaluation of potential early life risk factors for ulcerative colitis. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.826501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Safar H, Elsary AY. Neonatal Jaundice: The Other Side of the Coin in the Development of Allergy. Am J Perinatol 2020; 37:1357-1363. [PMID: 31365932 DOI: 10.1055/s-0039-1693697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The current study aims to assess the association between different characteristics of neonatal jaundice and common types of allergic diseases in childhood (as bronchial asthma, acute urticaria, and allergic rhinitis). STUDY DESIGN A case-control study is conducted on 300 allergic children and 300 healthy children as a control group at Fayoum University Hospital. The study was conducted over a span of 2 years, from May 2016 to May 2018. Bronchial asthma, allergic rhinitis, and acute urticaria diagnoses were based on physician clinical examination using specific guidelines for each. For the data regarding children's demographic and maternal characteristics, a structured questionnaire was used. Regarding neonatal jaundice, data were collected from the patients' hospital records. RESULTS Children with neonatal jaundice are more likely to develop allergy with 57% higher than neonates without jaundice. Early onset jaundice and treatment by phototherapy have statistically significant association with the development of allergic diseases. CONCLUSION Different aspects of neonatal jaundice are associated with the development of common allergic diseases in children.
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Affiliation(s)
- Heba Safar
- Department of Pediatrics, Faculty of Medicine, Fayoum University, Fayoum Governorate, Egypt
| | - Asmaa Y Elsary
- Department of Public Health, Faculty of Medicine, Fayoum University, Fayoum Governorate, Egypt
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11
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Differences in maternal gene expression in Cesarean section delivery compared with vaginal delivery. Sci Rep 2020; 10:17797. [PMID: 33082495 PMCID: PMC7576122 DOI: 10.1038/s41598-020-74989-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/08/2020] [Indexed: 12/16/2022] Open
Abstract
Cesarean section (CS) is recognized as being a shared environmental risk factor associated with chronic immune disease. A study of maternal gene expression changes between different delivery modes can add to our understanding of how CS contributes to disease patterns later in life. We evaluated the association of delivery mode with postpartum gene expression using a cross-sectional study of 324 mothers who delivered full-term (≥ 37 weeks) singletons. Of these, 181 mothers had a vaginal delivery and 143 had a CS delivery (60 with and 83 without labor). Antimicrobial peptides (AMP) were upregulated in vaginal delivery compared to CS with or without labor. Peptidase inhibitor 3 (PI3), a gene in the antimicrobial peptide pathway and known to be involved in antimicrobial and anti-inflammatory activities, showed a twofold increase in vaginal delivery compared to CS with or without labor (adjusted p-value 1.57 × 10–11 and 3.70 × 10–13, respectively). This study evaluates differences in gene expression by delivery mode and provides evidence of antimicrobial peptide upregulation in vaginal delivery compared to CS with or without labor. Further exploration is needed to determine if AMP upregulation provides protection against CS-associated diseases later in life.
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12
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Akinkugbe AA, Brickhouse TH, Nascimento MM, Slade GD. Prenatal smoking and the risk of early childhood caries: A prospective cohort study. Prev Med Rep 2020; 20:101201. [PMID: 33083206 PMCID: PMC7554205 DOI: 10.1016/j.pmedr.2020.101201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/14/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction Dental caries is a chronic complex disease of multifactorial etiology that affects a quarter of U.S. children. This study evaluated the association between prenatal smoking and offspring caries experience and used a negative control exposure analysis to assess if the association is causal. Methods Data from 1429 mother-offspring participants of the 1991/92 Avon Longitudinal Study of Parents and Children conducted in Bristol, England were analyzed. Prenatal smoking (yes v. no) and quantity smoked (none, <half pack, ≥half pack) were self-reported while offspring caries experience was determined by clinical oral examinations at 3 time points. Discrete time hazards regression estimated hazard odds of first occurrence of offspring caries, and substituted partner smoking for prenatal smoking in a negative control exposure analysis. Results Overall, 22% smoked during pregnancy while 36% of partners smoked. The adjusted hazard odds of first occurrence of caries experience in the offsprings of prenatal smokers compared to the offsprings of non-smokers was 1.42 (95% CI: 1.08, 1.86). Relative to non-smoking, smoking <half pack/day and ≥half pack/day during pregnancy were associated with higher adjusted hazard odds of offspring caries experience: 1.10 (95% CI: 0.79, 1.54) and 1.38 (0.98, 1.95) respectively. Partner smoking was associated with 33% (95% CI: 1.07, 1.65) higher adjusted hazard odds of first offspring caries experience occurrence. Conclusions Prenatal and partner smoking appear associated with greater offspring caries experience. The positive association with partner smoking suggests either a shared genetic predisposition or unmeasured common environmental factors with the mother as opposed to a direct biological effect of the intrauterine environment.
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Affiliation(s)
- Aderonke A Akinkugbe
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - Tegwyn H Brickhouse
- Department of Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States.,Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - Marcelle M Nascimento
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, FL, United States
| | - Gary D Slade
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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13
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Lu HY, Chiu CW, Kao PH, Tsai ZT, Gau CC, Lee WF, Wu CY, Lan YT, Hung CC, Chang FY, Huang YW, Huang HY, Chang-Chien J, Tsai HJ, Yao TC. Association between maternal age at delivery and allergic rhinitis in schoolchildren: A population-based study. World Allergy Organ J 2020; 13:100127. [PMID: 32612736 PMCID: PMC7322179 DOI: 10.1016/j.waojou.2020.100127] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/23/2020] [Accepted: 04/28/2020] [Indexed: 12/01/2022] Open
Abstract
Background Some studies have shown associations of maternal age at delivery with asthma and food allergy in offspring. However, the relationship between maternal age at delivery and allergic rhinitis is largely unclear. This study aimed to investigate the association between maternal age at delivery and allergic rhinitis in a population sample of Asian children, and to explore potential effect modifiers. Methods A total of 1344 singleton-birth children (763 boys, 56.8%; mean age, 6.4 years) participating in the Longitudinal Investigation of Global Health in Taiwanese Schoolchildren (LIGHTS) cohort were evaluated by a modified International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire and interviewed by pediatricians. Allergic sensitization was determined by using Phadiatop Infant. Multiple logistic regression models with covariates adjustment were performed to investigate the association of maternal age at delivery with allergic rhinitis and allergic sensitization in offspring. Results Among 1344 study children, 793 (59%) had physician-diagnosed allergic rhinitis. Advanced maternal age at delivery (≥40 years) was significantly associated with increased odds of allergic rhinitis (adjusted odds ratio [AOR] = 4.58, 95% confidence interval [CI]: 1.90–11.03) and allergic sensitization (AOR = 2.86, 95% CI: 1.13–7.22) in offspring. A sex-stratified analysis revealed that the association of advanced maternal age with allergic rhinitis was statistically significant only in female offspring (AOR = 7.02, 95% CI: 1.89–26.14). Stratified analyses by birth order or environmental tobacco smoke exposure during pregnancy did not reveal any significant differences. Conclusion Advanced maternal age at delivery was associated with increased risk of allergic rhinitis in Asian children, probably more pronounced among girls.
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Key Words
- ANOVA, analysis of variance
- AOR, adjusted odds ratio
- ARIA, allergic rhinitis and its impact on asthma
- Allergic rhinitis
- Allergic sensitization
- CI, confidence interval
- Children
- EMR, electronic medical records
- ETS, environmental tobacco smoke
- ISAAC, International Study of Asthma and Allergies in Childhood
- IgE, immunoglobulin E
- LIGHTS, Longitudinal Investigation of Global Health in Taiwanese Schoolchildren
- Maternal age at delivery
- NTD, New Taiwan Dollar
- SD, standard deviation
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Affiliation(s)
- Hung-Yi Lu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Wei Chiu
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Po-Hsiang Kao
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Zhao-Ting Tsai
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chun-Chun Gau
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wan-Fang Lee
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Tung Lan
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chung-Chieh Hung
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fang-Yu Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Wen Huang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Yi Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ju Chang-Chien
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hui-Ju Tsai
- Institutes of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
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14
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Metsälä J, Hakola L, Lundqvist A, Virta LJ, Gissler M, Virtanen SM. Perinatal factors and the risk of type 1 diabetes in childhood and adolescence-A register-based case-cohort study in Finland, years 1987 to 2009. Pediatr Diabetes 2020; 21:586-596. [PMID: 32003515 DOI: 10.1111/pedi.12994] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/02/2020] [Accepted: 01/27/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Our aim was to clarify previously reported associations and to explore new ones between various maternal background and perinatal factors and the risk of type 1 diabetes in childhood. METHODS We identified all children born 1 January 1987 to 31 December 2008 in Finland and diagnosed with type 1 diabetes by age 16 years or end of 2009 from the Special Reimbursement Register (n = 6862). A 10% random sample from each birth year cohort was selected as a reference cohort (n = 127 216). Information on perinatal factors was obtained from the Finnish Medical Birth Register. RESULTS Maternal diabetes (hazard ratios [HR] = 6.43; 95% confidence interval [CI] 5.35, 7.73), maternal asthma (HR = 1.23; 95% CI 1.06, 1.43), child's high birth length for gestational age (HR = 1.35; 95% CI 1.22, 1.51 highest vs lowest quintile) and premature or early term birth (HR = 1.21; 95% CI 1.05, 1.39 gestational weeks 33-36 and HR = 1.17; 95% CI 1.09, 1.26 gestational weeks 37-38 vs gestational weeks 39-40) was associated with an increased risk of type 1 diabetes when adjusted for several potential confounders. Maternal smoking during pregnancy (HR = 0.72; 95% CI 0.66, 0.77), high number of previous live births (HR = 0.65; 95% CI 0.55, 0.76 ≥ 4 vs 0 live births), and the child being born small for gestational age (HR = 0.80; 95% CI 0.67, 0.96) was associated with a decreased risk of type 1 diabetes. CONCLUSIONS Findings on maternal asthma and high birth length for gestational age increasing the risk of type 1 diabetes are novel and need to be confirmed. Our findings indicate that perinatal factors may play a role in the development of type 1 diabetes.
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Affiliation(s)
- Johanna Metsälä
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Leena Hakola
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Annamari Lundqvist
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Lauri J Virta
- Research Department, Social Insurance Institution, Turku, Finland
| | - Mika Gissler
- Information Services Department, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Suvi M Virtanen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.,Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Tampere Center for Child Health Research, Tampere University and Tampere University Hospital, Finland.,Science Centre, Tampere University Hospital, Tampere, Finland
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15
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Ubags ND, Baker J, Boots A, Costa R, El-Merhie N, Fabre A, Faiz A, Heijink IH, Hiemstra PS, Lehmann M, Meiners S, Rolandsson Enes S, Bartel S. ERS International Congress, Madrid, 2019: highlights from the Basic and Translational Science Assembly. ERJ Open Res 2020; 6:00350-2019. [PMID: 32154289 PMCID: PMC7049707 DOI: 10.1183/23120541.00350-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/26/2020] [Indexed: 11/15/2022] Open
Abstract
In this review, the Basic and Translational Sciences Assembly of the European Respiratory Society (ERS) provides an overview of the 2019 ERS International Congress highlights. In particular, we discuss how the novel and very promising technology of single cell sequencing has led to the development of a comprehensive map of the human lung, the lung cell atlas, including the discovery of novel cell types and new insights into cellular trajectories in lung health and disease. Further, we summarise recent insights in the field of respiratory infections, which can aid in a better understanding of the molecular mechanisms underlying these infections in order to develop novel vaccines and improved treatment options. Novel concepts delineating the early origins of lung disease are focused on the effects of pre- and post-natal exposures on neonatal lung development and long-term lung health. Moreover, we discuss how these early life exposures can affect the lung microbiome and respiratory infections. In addition, the importance of metabolomics and mitochondrial function analysis to subphenotype chronic lung disease patients according to their metabolic program is described. Finally, basic and translational respiratory science is rapidly moving forward and this will be beneficial for an advanced molecular understanding of the mechanisms underlying a variety of lung diseases. In the long-term this will aid in the development of novel therapeutic targeting strategies in the field of respiratory medicine. Highlights of basic and translational science presented at #ERSCongress 2019 summarising latest research on the lung cell atlas, lung infections, early origins of lung disease and the importance of metabolic alterations in the lunghttp://bit.ly/2UbdBs4
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Affiliation(s)
- Niki D Ubags
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Lausanne, Switzerland
| | - Jonathan Baker
- Airway Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Agnes Boots
- Dept of Pharmacology and Toxicology, Maastricht University, Maastricht, the Netherlands
| | - Rita Costa
- Lung Repair and Regeneration Unit, Helmholtz-Zentrum Munich, Ludwig-Maximilians-University, University Hospital Grosshadern, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Natalia El-Merhie
- Early Life Origins of Chronic Lung Disease, Research Center Borstel, Leibniz Lung Center, Member of the DZL and the Airway Research Center North (ARCN), Borstel, Germany
| | - Aurélie Fabre
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin School of Medicine, Dublin, Ireland
| | - Alen Faiz
- University of Technology Sydney, Respiratory Bioinformatics and Molecular Biology (RBMB), School of Life Sciences, Sydney, Australia
| | - Irene H Heijink
- University of Groningen, University Medical Center Groningen, Depts of Pathology & Medical Biology and Pulmonology, Groningen, The Netherlands
| | - Pieter S Hiemstra
- Dept of Pulmonology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Mareike Lehmann
- Lung Repair and Regeneration Unit, Helmholtz-Zentrum Munich, Ludwig-Maximilians-University, University Hospital Grosshadern, Member of the German Center of Lung Research (DZL), Munich, Germany
| | - Silke Meiners
- Comprehensive Pneumology Center (CPC), University Hospital, Ludwig-Maximilians University, Helmholtz Zentrum München, Member of the DZL, Munich, Germany
| | - Sara Rolandsson Enes
- University of Vermont, Dept of Medicine, Larner College of Medicine, Burlington, VT, USA.,Lund University, Dept of Experimental Medical Science, Lund, Sweden
| | - Sabine Bartel
- University of Groningen, University Medical Center Groningen, Depts of Pathology & Medical Biology and Pulmonology, Groningen, The Netherlands
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16
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Darabi B, Rahmati S, HafeziAhmadi MR, Badfar G, Azami M. The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis. Allergy Asthma Clin Immunol 2019; 15:62. [PMID: 31687033 PMCID: PMC6820931 DOI: 10.1186/s13223-019-0367-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 08/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background Investigating the association between caesarean section (SC) and childhood asthma has shown contradictory results in different studies. The present study was conducted to determine the association between SC and childhood asthma. Material and method The present study was conducted based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All the steps of the study were conducted independently by two reviewers from the inception until February 1, 2019. In case of disagreement, the third reviewer resolved it. We searched international online databases, including Scopus, Cochrane Library, PubMed/Medline, Embase, Web of Science (ISI), Science Direct, and Google scholar. The results of studies were combined using random effects model, and heterogeneity was measured through I2 index and Cochran’s Q test. Comprehensive Meta-Analysis Software was used for meta-analysis. The significance level of all tests was considered to be P < 0.05. Results The heterogeneity rate was high (I2 = 67.31%, P < 0.001) in 37 studies. The results showed that SC increased the risk of childhood asthma (RR (relative risk) = 1.20 [95% CI 1.15–1.25, P < 0.001]). The association between emergency and elective SC and childhood asthma was significant with RR of 1.18 (95% CI 1.07–1.29, P < 0.001) in 13 studies and 1.23 (95% CI 1.20–1.26, P < 0.001) in 13 studies, respectively. The subgroup analysis for RR of childhood asthma in SC indicated that study design (P = 0.306), prospective/retrospective studies (P = 0.470), quality of studies (P = 0.514), continent (P = 0.757), age of diagnosis (P = 0.283) and year of publication (P = 0.185) were not effective in the heterogeneity of studies. Sensitivity analysis by removing one study at a time indicated that the overall estimate is robust. Conclusion According to the meta-analysis, SC (overall, elective, and emergency) increased the risk of childhood asthma. Therefore, it is hoped that developing clinical guidelines and implementing appropriate management plans would diminish the risk of asthma.
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Affiliation(s)
- Behzad Darabi
- 1Department of Pediatrics, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Shoboo Rahmati
- 2School of Public Heath, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Gholamreza Badfar
- Department of Pediatrics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Milad Azami
- 5School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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17
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Bergh C, Pinborg A, Wennerholm UB. Parental age and child outcomes. Fertil Steril 2019; 111:1036-1046. [PMID: 31155113 DOI: 10.1016/j.fertnstert.2019.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 10/26/2022]
Abstract
This review summarizes the impact of parental age on children's health outcomes beyond the perinatal period. In the last decades, delayed parenthood with both men and women has become a public health issue. For women, in particular, the size of this delay is substantial. For a few medical conditions, older parental age has a pronounced effect on child morbidity. For most other outcomes, a more modest effect is evident. Although these effects might be limited on an individual level, they have a substantial impact at the level of population health.
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Affiliation(s)
- Christina Bergh
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anja Pinborg
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla-Britt Wennerholm
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital East, Gothenburg, Sweden
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18
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Rusconi F, Gagliardi L. Pregnancy Complications and Wheezing and Asthma in Childhood. Am J Respir Crit Care Med 2019; 197:580-588. [PMID: 29064265 DOI: 10.1164/rccm.201704-0744pp] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Franca Rusconi
- 1 Epidemiology Unit, Anna Meyer Children's University Hospital, Florence, Italy; and
| | - Luigi Gagliardi
- 2 Pediatrics and Neonatology Division, Versilia Hospital, Azienda Toscana Nord Ovest, Pisa, Italy
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19
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Jasiulione JS, Jusiene R. Delivery Mode, Maternal Characteristics, and Developmental Trajectories of Toddlers’ Emotional and Behavioral Problems. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Magnus MC, Karlstad Ø, Parr CL, Page CM, Nafstad P, Magnus P, London SJ, Wilcox AJ, Nystad W, Håberg SE. Maternal history of miscarriages and measures of fertility in relation to childhood asthma. Thorax 2019; 74:106-113. [PMID: 30514789 PMCID: PMC6467238 DOI: 10.1136/thoraxjnl-2018-211886] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/08/2018] [Accepted: 09/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND It remains unclear what underlies the greater risk of asthma reported among children conceived by assisted reproductive technologies (ART). OBJECTIVE Our aim was to clarify the role of parental subfertility and unmeasured confounding on the association between ART and childhood asthma, and to examine the possibility for common mechanisms underlying parental subfertility and miscarriages influencing asthma pathogenesis. METHODS We used data from national Norwegian health registries (n=474 402) and the Norwegian Mother and Child Cohort Study (MoBa) (n=75 797). We used log-linear regression to estimate overall associations, and fixed-effects logistic regression to estimate associations within siblings. RESULTS ART offspring had greater asthma risk, the adjusted relative risk (aRR) was 1.20 (95% CI 1.09 to 1.32) in the registry-based cohort, and 1.42 (95% CI 1.14 to 1.76) in MoBa. The sibling analysis yielded similar associations, although the CI included the null value. The elevated asthma risk among ART offspring was attenuated when they were compared with spontaneously conceived offspring with time to conception >12 months, aRR 1.22 (95% CI 0.95 to 1.57). Asthma risk also increased with maternal history of early miscarriages (≤12 weeks), with an aRR of 1.07 (95% CI 1.03 to 1.11) for one, aRR 1.18 (95% CI 1.10 to 1.26) for two and aRR 1.24 (95% CI 1.12 to 1.37) for three or more. CONCLUSION Our findings indicate that both parental subfertility and characteristics related to the ART procedure itself might increase offspring asthma risk, although this needs to be confirmed in future studies, and further suggest that common mechanisms underlying parental subfertility and recurrent miscarriages might influence offspring asthma pathogenesis.
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Affiliation(s)
- Maria Christine Magnus
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Øystein Karlstad
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christine Louise Parr
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Nursing and Health Promotion, OsloMet-Oslo Metropolitan University, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Per Nafstad
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department for Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Allen J Wilcox
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - Wenche Nystad
- Division for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Siri Eldevik Håberg
- Centre for Fertility and Health (CeFH), Norwegian Institute of Public Health, Oslo, Norway
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Abstract
This article on exposome and asthma focuses on the interaction of patients and their environments in various parts of their growth, development, and stages of life. Indoor and outdoor environments play a role in pathogenesis via levels and duration of exposure, with genetic susceptibility as a crucial factor that alters the initiation and trajectory of common conditions such as asthma. Knowledge of environmental exposures globally and changes that are occurring is necessary to function effectively as medical professionals and health advocates.
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Affiliation(s)
- Ahila Subramanian
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA
| | - Sumita B Khatri
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA.
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22
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El-Heneidy A, Abdel-Rahman ME, Mihala G, Ross LJ, Comans TA. Milk Other Than Breast Milk and the Development of Asthma in Children 3 Years of Age. A Birth Cohort Study (2006⁻2011). Nutrients 2018; 10:E1798. [PMID: 30463252 PMCID: PMC6267177 DOI: 10.3390/nu10111798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 10/27/2018] [Accepted: 11/15/2018] [Indexed: 01/04/2023] Open
Abstract
Prevalence of asthma in Australian children is amongst the highest in the world. Although breastfeeding positively influences infant immunity, early introduction of Milk Other than Breast Milk (MOTBM) may also play an important role in the development of Asthma. The aim of this study was to investigate the association between the introduction of MOTBM in the first six months after birth and the development of reported persistent asthma in 3-year olds. A sample of 1121 children was extracted from the Environments for Healthy Living longitudinal birth cohort study. Introduction of MOTBM during the first six months after birth increased almost two-fold the risk of development of persistent asthma after adjusting for other covariates (Adjusted Relative Risk (ARR): 1.71, 95% CI: 1.03⁻2.83, p = 0.038). This study indicates that the introduction of MOTBM in the first six months of life is a risk factor for asthma incidence among 3-year old children. This result is important in explaining the benefits of breastfeeding as part of public health interventions to encourage mothers to increase breastfeeding initiation and duration, and avoid the introduction of MOTBM in the first six months after childbirth.
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Affiliation(s)
- Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Manar E Abdel-Rahman
- Department of Public Health, College of Health Sciences, Qatar University, Doha 2713, Qatar.
| | - Gabor Mihala
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
| | - Lynda J Ross
- Menzies Health Institute Queensland, Griffith University, QLD 4222, Australia.
| | - Tracy A Comans
- Centre for Applied Health Economics, School of Medicine, Menzies Health Institute Queensland, Griffith University, QLD 4111, Australia.
- Centre for Health Services Research, University of Queensland, Brisbane QLD 4072, Australia.
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23
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Dodson RB, Powers KN, Gien J, Rozance PJ, Seedorf G, Astling D, Jones K, Crombleholme TM, Abman SH, Alvira CM. Intrauterine growth restriction decreases NF-κB signaling in fetal pulmonary artery endothelial cells of fetal sheep. Am J Physiol Lung Cell Mol Physiol 2018; 315:L348-L359. [PMID: 29722560 DOI: 10.1152/ajplung.00052.2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Intrauterine growth restriction (IUGR) in premature newborns increases the risk for bronchopulmonary dysplasia, a chronic lung disease characterized by disrupted pulmonary angiogenesis and alveolarization. We previously showed that experimental IUGR impairs angiogenesis; however, mechanisms that impair pulmonary artery endothelial cell (PAEC) function are uncertain. The NF-κB pathway promotes vascular growth in the developing mouse lung, and we hypothesized that IUGR disrupts NF-κB-regulated proangiogenic targets in fetal PAEC. PAECs were isolated from the lungs of control fetal sheep and sheep with experimental IUGR from an established model of chronic placental insufficiency. Microarray analysis identified suppression of NF-κB signaling and significant alterations in extracellular matrix (ECM) pathways in IUGR PAEC, including decreases in collagen 4α1 and laminin α4, components of the basement membrane and putative NF-κB targets. In comparison with controls, immunostaining of active NF-κB complexes, NF-κB-DNA binding, baseline expression of NF-κB subunits p65 and p50, and LPS-mediated inducible activation of NF-κB signaling were decreased in IUGR PAEC. Although pharmacological NF-κB inhibition did not affect angiogenic function in IUGR PAEC, angiogenic function of control PAEC was reduced to a similar degree as that observed in IUGR PAEC. These data identify reductions in endothelial NF-κB signaling as central to the disrupted angiogenesis observed in IUGR, likely by impairing both intrinsic PAEC angiogenic function and NF-κB-mediated regulation of ECM components necessary for vascular development. These data further suggest that strategies that preserve endothelial NF-κB activation may be useful in lung diseases marked by disrupted angiogenesis such as IUGR.
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Affiliation(s)
- R Blair Dodson
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Kyle N Powers
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Jason Gien
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Paul J Rozance
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Gregory Seedorf
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Biochemistry and Molecular Genetics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - David Astling
- United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Kenneth Jones
- United Therapeutics, Regenerative Medicine Laboratory, Research Triangle Park, Durham, North Carolina
| | - Timothy M Crombleholme
- Laboratory for Fetal and Regenerative Biology, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Surgery, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Steven H Abman
- Pediatric Heart Lung Center, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado.,Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus , Aurora, Colorado
| | - Cristina M Alvira
- Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
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24
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Thomsen AML, Ehrenstein V, Riis AH, Toft G, Mikkelsen EM, Olsen J. The potential impact of paternal age on risk of asthma in childhood: a study within the Danish National Birth Cohort. Respir Med 2018; 137:30-34. [PMID: 29605209 DOI: 10.1016/j.rmed.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/28/2018] [Accepted: 01/29/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Advanced paternal age has been associated with offspring morbidity and mortality, possibly due to de novo mutations and epigenetic changes in male germ cells. Epigenetic changes in the cord blood cells have been linked to asthma symptoms in offspring, but the role of paternal age has been less studied. METHODS From the Danish National Birth Cohort, 48,785 children who completed the 7-year follow-up were included. Parental reports of physician-diagnosed asthma had been obtained by a posted or web-based questionnaire. Paternal age at delivery was obtained through linkage with maternal civil registration number in the Danish Civil Registration System and classified into four groups: ≤24, 25-34 (reference), 35-39, and >40 years. We calculated the prevalence proportion of asthma and prevalence ratios (PRs) with 95% confidence intervals (CIs) using log-binomial regression, adjusting for paternal smoking, paternal asthma, and paternal socioeconomic status. RESULTS At the 7-year follow-up, 5875 children (12%) had physician-diagnosed asthma. The prevalence of asthma in 7-year old children was higher with paternal age of ≤24 (adjusted PR 1.40; 95% CI: 1.26; 1.55) and lower with the paternal age of ≥35 years (adjusted PR 0.84; 95% CI: 0.78; 0.89) compared to the reference group. CONCLUSIONS Paternal age of ≥35 years was associated with a lower prevalence of asthma in childhood, and paternal age of ≤24 years with higher prevalence compared with paternal age of 25-34 years. The potential causes of higher asthma prevalence among offspring of young fathers warrant further investigation.
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Affiliation(s)
- Anne Marie L Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Anders Hammerich Riis
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Gunnar Toft
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, 8200 Aarhus N, Denmark
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25
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Genuttis N, Bolz M, Briese V. Can the Rate of C-sections Performed in a Level I Perinatal Center Be Reduced? - An Analysis of the University Gynecology Clinic Rostock, 2008 - 2014. Geburtshilfe Frauenheilkd 2017; 77:771-779. [PMID: 28757656 PMCID: PMC5514020 DOI: 10.1055/s-0043-112863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/23/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION In Germany the rate of deliveries by cesarean section is continually increasing. Many different reasons have been put forward to explain this trend. The aim of this study was to examine how the C-section rate developed at the University Gynecology Clinic Rostock, one of the biggest maternity hospitals and level I perinatal centers in Germany, based on various maternal and neonatal parameters. The aim was also to identify potential risk factors for C-sections. MATERIAL AND METHOD Various obstetric parameters were obtained from the birth cohort (2008 to 2014; n = 20 091) of the University Gynecology Clinic Rostock. The data was used to calculate parameter-specific C-section rates. Potential risk factors for C-section were identified by regression analysis. RESULTS The C-section rate dropped from 26.24% to 23.57%. The rate of repeat C-sections also declined. The mean age of the pregnant women increased. Nevertheless, the frequency of cesarean sections in pregnant women aged more than 35 years declined. Rates of being overweight or obese preconception increased. C-section rates increased as BMI values preconception increased. There was a perceptible trend towards attempting the vaginal delivery of children in breech presentation and of twins. The frequency of depressed neonates after vaginal delivery and after C-section decreased. Rates for mild and advanced acidosis increased after both C-sections and vaginal deliveries. Previous C-section, older maternal age, overweight and obesity prior to conception, breech presentation and multiple pregnancies all increased the risk of cesarean sections. CONCLUSION This study showed that reducing the rates of C-sections without a deterioration in neonatal outcomes can be achieved even in a large maternity hospital that cares for many high-risk pregnancies.
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Affiliation(s)
- Nele Genuttis
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
| | - Michael Bolz
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
| | - Volker Briese
- Universitätsfrauenklinik Rostock, Klinikum Südstadt Rostock, Rostock, Germany
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26
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Kashanian M, Mohtashami SS, Bemanian MH, Moosavi SAJ, Moradi Lakeh M. Evaluation of the associations between childhood asthma and prenatal and perinatal factors. Int J Gynaecol Obstet 2017; 137:290-294. [PMID: 28273340 DOI: 10.1002/ijgo.12141] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/13/2017] [Accepted: 03/03/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To identify prenatal and perinatal risk factors for childhood asthma. METHODS A retrospective case-control study was undertaken among children aged 7-14 years in Tehran, Iran, between March 2009 and November 2014. Data for children with asthma (Iranian nationality, non-smoking parents, and middle-class socioeconomic status) were compared with those for an equal number of age- and sex-matched non-asthmatic children. Prenatal and perinatal risk factors were evaluated via complete data sheets of maternal pregnancy and delivery. Forward logistic regression analysis was performed. RESULTS Both groups contained 134 children. Risk of asthma was shown to be associated with maternal history of asthma (adjusted odds ratio [aOR] 11.62, 95% confidence interval 1.38-96.93; P=0.024), vaginal bleeding during pregnancy (aOR 3.76, 95% CI 1.86-7.57; P<0.001), antibiotics during pregnancy (aOR 3.19, 95% CI 1.52-6.67; P=0.002), and maternal age 30 years or older (aOR 2.54, 95% CI 1.30-4.95; P=0.006). Breastfeeding was protective against childhood asthma (aOR 0.29, 95% CI 0.151-0.575; P<0.001). CONCLUSION History of maternal asthma was the most influential factor on development of childhood asthma, followed by vaginal bleeding during pregnancy, antibiotic exposure in utero, and older maternal age.
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Affiliation(s)
- Maryam Kashanian
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Seyyedeh Samaneh Mohtashami
- Department of Obstetrics and Gynecology, Iran University of Medical Sciences, Akbarabadi Teaching Hospital, Tehran, Iran
| | - Mohammad Hassan Bemanian
- Department of Pediatrics, Iran University of Medical Sciences, Hazrate Rasool Akram Teaching Hospital, Tehran, Iran
| | - Seyyed Ali Javad Moosavi
- Department of Internal Medicine, Iran University of Medical Sciences, Hazrate Rasool Akram Teaching Hospital, Tehran, Iran
| | - Maziar Moradi Lakeh
- Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
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27
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Dodson RB, Miller TA, Powers K, Yang Y, Yu B, Albertine KH, Zinkhan EK. Intrauterine growth restriction influences vascular remodeling and stiffening in the weanling rat more than sex or diet. Am J Physiol Heart Circ Physiol 2017; 312:H250-H264. [DOI: 10.1152/ajpheart.00610.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 12/19/2022]
Abstract
Intrauterine growth restriction (IUGR) increases the incidence of adult cardiovascular disease (CVD). The sex-specific developmental mechanisms for IUGR-induced and Western high-fat diet (HFD) modification of CVD remain poorly understood. We hypothesized a maternal HFD in the Sprague-Dawley rat would augment IUGR-induced CVD in the offspring through decreased cardiac function and increased extracellular matrix (ECM) remodeling and stiffness in a sex-specific manner. HFD or regular diet (Reg) was given from 5 wk before mating through postnatal day (PND) 21. IUGR was induced by uterine artery ligation at embryonic day 19.5 (term = 21.5 days). At PND 21, echocardiographic assessments were made and carotid arteries tested for vascular compliance using pressure myography. Arterial samples were quantified for ECM constituents or fixed for histologic evaluation. The insult of IUGR (IUGR + Reg and IUGR + HFD) led to increased mechanical stiffness in both sexes ( P < 0.05). The combination of IUGR + HFD increased diastolic blood pressure 47% in males (M) and 35% in females (F) compared with the Con + Reg ( P < 0.05). ECM remodeling in IUGR + HFD caused fewer (M = −29%, F = −24%) but thicker elastin bands (M = 18%, F = 18%) and increased total collagen (M = 49%, F = 34%) compared with Con + Reg arteries. Remodeling in IUGR + HFD males increased medial collagen and soluble collagen ( P < 0.05). Remodeling in IUGR + HFD females increased adventitial collagen and wall thickness ( P < 0.05) and decreased matrix metalloproteinase 2 (MMP-2), advanced glycosylation end products (AGE), and receptor AGE (RAGE; P < 0.05). In summary, both IUGR + Reg and IUGR + HFD remodel ECM in PND 21 rats. While IUGR + HFD increases blood pressure, IUGR but not HFD increases vascular stiffness suggesting a specific mechanism of vascular remodeling that can be targeted to limit future disease. NEW & NOTEWORTHY We report intrauterine growth restriction (IUGR) increases vascular stiffening in both male and female rats through increased collagen content and altered elastin structure more than a high-fat diet (HFD) alone. Our study shows the importance of stiffness supporting the hypothesis that there are physiologic differences and potential windows for early intervention targeting vascular remodeling mechanisms.
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Affiliation(s)
- R. Blair Dodson
- Department of Surgery, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
- Department of Bioengineering, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
- The Pediatric Heart Lung Center, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
- The Laboratory for Fetal and Regenerative Biology, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
| | - Thomas A. Miller
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Kyle Powers
- Department of Surgery, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
- The Pediatric Heart Lung Center, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
- The Laboratory for Fetal and Regenerative Biology, University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado
| | - Yueqin Yang
- Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Baifeng Yu
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Kurt H. Albertine
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | - Erin K. Zinkhan
- Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah
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28
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Wang R, Wiemels JL, Metayer C, Morimoto L, Francis SS, Kadan-Lottick N, DeWan AT, Zhang Y, Ma X. Cesarean Section and Risk of Childhood Acute Lymphoblastic Leukemia in a Population-Based, Record-Linkage Study in California. Am J Epidemiol 2017; 185:96-105. [PMID: 27986703 PMCID: PMC5253971 DOI: 10.1093/aje/kww153] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/11/2016] [Indexed: 01/07/2023] Open
Abstract
The relationship of mode of delivery to risk of childhood acute lymphoblastic leukemia (ALL) is uncertain. After linking birth records and cancer registry data from California, we conducted a population-based case-control study to investigate the role of delivery by cesarean section (C-section) in the etiology of childhood ALL. This study included 5,081 cases and 18,927 matched controls born in 1978-2009; more detailed data were available on type of C-section (i.e., elective vs. emergency) for a subset of 1,552 cases and 5,688 controls. No association was observed between C-section overall and childhood ALL risk (<15 years of age), but elective C-section was associated with a significantly elevated risk of ALL (odds ratio (OR) = 1.17, 95% confidence interval (CI): 1.01, 1.36). At the peak ages of ALL incidence (2-4 years), C-section was associated with an 11% higher risk of ALL (OR = 1.11, 95% CI: 1.01, 1.22) compared with vaginal delivery, and the magnitude of the association was larger for elective C-section (OR = 1.38, 95% CI: 1.11, 1.70). Emergency C-section was not associated with childhood ALL. Because of design features minimizing nonparticipation and inaccurate recall, this record linkage-based study is less prone to bias. Our results suggest that delivery by elective C-section was associated with a higher risk of childhood ALL, especially at the peak ages of incidence. It is important to evaluate possible mechanisms, because this potential risk factor is modifiable.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaomei Ma
- Correspondence to Dr. Xiaomei Ma, Yale School of Public Health, P.O. Box 208034, 60 College Street, New Haven, CT 06520-8034, United States (e-mail: )
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29
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Maternal Folic Acid Supplementation During Pregnancy and Early Childhood Asthma. Epidemiology 2016; 26:934-41. [PMID: 26360371 DOI: 10.1097/ede.0000000000000380] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Asthma is one of the most common chronic childhood diseases. While folic acid supplementation around conception helps prevent neural tube defects, an animal model suggests that it may be a risk factor for respiratory diseases, although epidemiologic studies have had conflicting results. We investigated the timing of folic acid-containing prescription filling during pregnancy and child asthma. METHODS In a retrospective cohort study of 104,428 children, born 1996-2005, and their mothers enrolled in Tennessee Medicaid, we investigated the association of filling folic acid-containing prescriptions during pregnancy and childhood asthma at ages 4.5-6 years. We categorized women into exposure groups based on prescription filling centered around the first trimester: no folic acid prescription exposure, exposure in first trimester only, exposure after first trimester, and exposure in first trimester and beyond. We defined asthma using asthma-specific healthcare visits and medication fills. Using logistic regression models, we investigated the relationship adjusting for potential confounders. RESULTS Overall 15% of children had asthma. Compared with children born to women with no folic acid prescription exposure, children born to women with exposures in the first trimester only or first trimester and later had increased relative odds of asthma (adjusted odds ratios = 1.2, 95% confidence interval = 1.1, 1.3, and 1.2, 95% confidence interval = 1.2, 1.3); no association was seen in children born to women exposed after the first trimester. CONCLUSION Timing of folic acid-containing prescription filling during pregnancy was associated with childhood asthma. Our findings contribute to understanding of the role of prenatal nutritional supplements on child respiratory health.
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30
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Abid Z, Oh SS, Hu D, Sen S, Huntsman S, Eng C, Farber HJ, Rodriguez-Cintron W, Rodriguez-Santana JR, Serebrisky D, Avila PC, Thyne SM, Kim KYA, Borrell LN, Williams LK, Seibold MA, Burchard EG, Kumar R. Maternal age and asthma in Latino populations. Clin Exp Allergy 2016; 46:1398-1406. [PMID: 27238356 DOI: 10.1111/cea.12765] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/02/2016] [Accepted: 05/16/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND Younger maternal age at birth is associated with increased risk of asthma in offspring in European descent populations, but has not been studied in Latino populations. OBJECTIVES We sought to examine the relationship between maternal age at birth and prevalence of asthma in a nationwide study of Latino children. METHODS We included 3473 Latino children aged 8-21 years (1696 subjects with physician-diagnosed asthma and 1777 healthy controls) from five US centres and Puerto Rico recruited from July 2008 through November 2011. We used multiple logistic regression models to examine the effect of maternal age at birth on asthma in offspring overall and in analyses stratified by ethnic subgroup (Mexican American, Puerto Rican and other Latino). Secondary analyses evaluated the effects of siblings, acculturation and income on this relationship. RESULTS Maternal age < 20 years was significantly associated with decreased odds of asthma in offspring, independent of other risk factors (OR = 0.73, 95% CI: 0.57-0.93). In subgroup analyses, the protective effect of younger maternal age was observed only in Mexican Americans (OR = 0.53, 95% CI: 0.36, 0.79). In Puerto Ricans, older maternal age was associated with decreased odds of asthma (OR = 0.65, 95% CI: 0.44-0.97). In further stratified models, the protective effect of younger maternal age in Mexican Americans was seen only in children without older siblings (OR = 0.44, 95% CI: 0.23-0.81). CONCLUSION AND CLINICAL RELEVANCE In contrast to European descent populations, younger maternal age was associated with decreased odds of asthma in offspring in Mexican American women. Asthma is common in urban minority populations but the factors underlying the varying prevalence among different Latino ethnicities in the United States is not well understood. Maternal age represents one factor that may help to explain this variability.
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Affiliation(s)
- Z Abid
- Division of Allergy-Immunology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - S S Oh
- Department of Medicine, University of California, San Francisco, CA, USA
| | - D Hu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - S Sen
- Department of Biostatistics, University of California, San Francisco, CA, USA
| | - S Huntsman
- Department of Medicine, University of California, San Francisco, CA, USA
| | - C Eng
- Department of Medicine, University of California, San Francisco, CA, USA
| | - H J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | - D Serebrisky
- Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY, USA
| | - P C Avila
- Division of Allergy-Immunology, Department of Medicine, Northwestern University, Chicago, IL, USA
| | - S M Thyne
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - K-Y A Kim
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - L N Borrell
- Department of Health Sciences, Lehman College, CUNY, New York, NY, USA
| | - L K Williams
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA.,Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - M A Seibold
- Center for Genes, Environment and Health, National Jewish Health, Denver, CO, USA
| | - E G Burchard
- Department of Medicine, University of California, San Francisco, CA, USA
| | - R Kumar
- Division of Allergy-Immunology, Department of Pediatrics, Northwestern University, Chicago, IL, USA. .,The Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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31
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Harju M, Keski-Nisula L, Georgiadis L, Heinonen S. Parental smoking and cessation during pregnancy and the risk of childhood asthma. BMC Public Health 2016; 16:428. [PMID: 27220514 PMCID: PMC4877729 DOI: 10.1186/s12889-016-3029-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 04/21/2016] [Indexed: 01/28/2023] Open
Abstract
Background To evaluate the association between maternal and paternal smoking during pregnancy, and asthma among offspring. Methods We conducted a hospital-based birth retrospective observational birth cohort study in a University-based Obstetrics and Gynecology Department, Kuopio University Hospital, Finland. 39 306 women, delivering between 1989 and 2006, were linked to the national register for asthma reimbursement for their offspring (2641 asthmatics). Pregnancy factors were recorded during pregnancy. Results The risk of asthma was significantly elevated if both parents smoked (aOR 3.7; 95 % Cl 3.2-4.4) and it remained high in only paternal smoking families (aOR 2.9; 95 % Cl 2.5-3.3) as well as only maternal smoking families (aOR 1.7; 95 % Cl 1.2-2.2). Paternal cessation of smoking during pregnancy seemed to reduce the risk of asthma regardless of maternal smoking (aOR 0.3-0.4). Conclusions Parental smoking, and especially paternal smoking, was significantly associated with the risk of asthma in offspring and paternal cessation of smoking during pregnancy was associated with a decreased risk of childhood asthma regardless of maternal smoking. The results indicate that both parents should be encouraged to quit smoking during pregnancy, since it is a relatively easy and cheap way to reduce the risk of asthma in offspring. Trial registration The study is registered in Kuopio University Hospital register (TUTKI): ID5302448
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Affiliation(s)
- Maijakaisa Harju
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box, 100, FI-70029, Kuopio, Finland.
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box, 100, FI-70029, Kuopio, Finland.,University of Eastern Finland, Faculty of Health Sciences, Kuopio, Finland.,Department of Environmental Health, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Leena Georgiadis
- Department of Obstetrics and Gynecology, Kuopio University Hospital, P.O. Box, 100, FI-70029, Kuopio, Finland
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Helsinki, Finland.,University Central Hospital, Helsinki, Finland
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32
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Ullemar V, Lundholm C, Almqvist C. Twins' risk of childhood asthma mediated by gestational age and birthweight. Clin Exp Allergy 2016; 45:1328-36. [PMID: 25845700 DOI: 10.1111/cea.12547] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/23/2015] [Accepted: 03/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children born with low gestational age (GA) or low birthweight (BW) are at increased risk of asthma. Twins as compared to singletons are on average more likely to be born with lower GA and BW and have been hypothesized to comprise a high-risk population for asthma. Many previous studies have not accounted for potential confounders or mediators. OBJECTIVE To investigate the association between twinship and childhood asthma or early life wheeze and identify potential mediators, such as GA/BW. METHODS The study population consisted of two cohorts including all children born in Sweden from 1 January 1993 to 1 June 2001 (n = 756,363 singletons, n = 22,478 twins) and 1 July 2005 to 31 December 2009 (n = 456,239 singletons, n = 12,872 twins). Asthma was defined using validated register-based outcomes of diagnosis or medication. The data were analysed using logistic (older cohort) and Cox regression (younger cohort). Adjusted models incorporated potential confounding or mediating factors including gestational age and birthweight. RESULTS In the younger cohort, the crude hazard ratio (HR) of asthma medication after 1.5 years of age was 1.12 (95% CI 1.01-1.23), and fully adjusted HR was 0.80, 95% CI 0.72-0.89. Crude HR of asthma diagnosis in the same age group was 1.14 (95% CI 0.99-1.30), fully adjusted 0.78 (0.68-0.98). Adjusted analyses in the older group yielded similar results. CONCLUSIONS Twins were at significantly higher unadjusted risk of asthma or early life wheeze compared to singletons in the younger, but not in the older cohort. Associations attenuated following adjustment for GA/BW, suggesting that GA/BW mediates the effect of twinship on asthma risk. After adjustments, twins were at lower risk of asthma outcomes, possibly due to unmeasured confounding.
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Affiliation(s)
- V Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Lung and Allergy Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Grieger JA, Clifton VL, Tuck AR, Wooldridge AL, Robertson SA, Gatford KL. In utero Programming of Allergic Susceptibility. Int Arch Allergy Immunol 2016; 169:80-92. [PMID: 27044002 DOI: 10.1159/000443961] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Around 30-40% of the world's population will experience allergy, the most common and earliest-onset noncommunicable disease. With a steady rise in the incidence of allergic disease over recent decades, up to 18% of children will suffer a respiratory, food or skin allergy before their 18th birthday. There is compelling evidence that the risk of developing allergy is influenced by early life events and particularly in utero exposures. METHODS A comprehensive literature review was undertaken which outlines prenatal risk factors and potential mechanisms underlying the development of allergy in childhood. RESULTS Exposures including maternal cigarette smoking, preterm birth and Caesarean delivery are implicated in predisposing infants to the later development of allergy. In contrast, restricted growth in utero, a healthy maternal diet and a larger family size are protective, but the mechanisms here are unclear and require further investigation. CONCLUSION To ameliorate the allergy pandemic in young children, we must define prenatal mechanisms that alter the programming of the fetal immune system and also identify specific targets for antenatal interventions.
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Affiliation(s)
- Jessica A Grieger
- Robinson Research Institute and School of Medicine, University ofAdelaide, Adelaide, S.A., Australia
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Chu S, Yu H, Chen Y, Chen Q, Wang B, Zhang J. Periconceptional and Gestational Exposure to Antibiotics and Childhood Asthma. PLoS One 2015; 10:e0140443. [PMID: 26488397 PMCID: PMC4619063 DOI: 10.1371/journal.pone.0140443] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Previous studies suggest that maternal antibiotics exposure during pregnancy may increase the risk of childhood asthma, but the results were inconsistent. Furthermore, most studies did not examine periconception period as an exposure window. We aim to assess the associations between maternal exposure to specific antibiotics before and during pregnancy and the risk of asthma in early childhood. Methods Data from the Collaborative Perinatal Project were used. Maternal exposure to antibiotics before and during pregnancy was recorded at each prenatal visit. A total of 39,907 singleton children were followed up to 7 years of age. Multilevel multiple logistic regression models were used to control for potential confounders and account for multiple pregnancies per woman. Results Maternal use of penicillin or chloramphenicol was associated with an increased risk of asthma in the offspring (adjusted odds ratio = 1.21, 95% confidence interval 1.08–1.36 for penicillin; 1.72 [1.14–2.59] for chloramphenicol). The risk was significantly increased if penicillin or chloramphenicol was used in the 1st trimester (1.09 [1.04–1.13] for penicillin and 1.23 [1.01–1.51] for chloramphenicol). Conclusion Maternal exposure to certain antibiotics is associated with childhood asthma by 7 years of age. Early pregnancy may be a sensitive window.
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Affiliation(s)
- Shuyuan Chu
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
- School of Public Health, Guilin Medical University, Guilin, 541004, China
| | - Hongping Yu
- School of Public Health, Guilin Medical University, Guilin, 541004, China
- * E-mail: (JZ); (HY)
| | - Yan Chen
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Qian Chen
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Bin Wang
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
- School of Public Health, Guilin Medical University, Guilin, 541004, China
- Collaborative Innovation Center of Systems Biomedicine, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- * E-mail: (JZ); (HY)
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Metsälä J, Lundqvist A, Virta LJ, Kaila M, Gissler M, Virtanen SM. Prenatal and post-natal exposure to antibiotics and risk of asthma in childhood. Clin Exp Allergy 2015; 45:137-45. [PMID: 24943808 DOI: 10.1111/cea.12356] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 05/09/2014] [Accepted: 06/09/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Evidence on the association between post-natal exposure to antibiotics and the development of asthma is extensive, but inconsistent and even less is known about prenatal exposure. OBJECTIVE The aim of this study was to examine the associations between prenatal and post-natal exposure to different antibiotics and the risk of childhood asthma in a population- and register-based nested case-control study. METHODS All children who were born in 1996-2004 in Finland and diagnosed with asthma by 2006 were identified from a national health register. For each case, one matched control was selected. Information on asthma diagnoses, purchased anti-asthmatic drugs and antibiotics as well as putative confounders was obtained from national health registries. The associations were analysed using conditional logistic regression for children diagnosed at the age of 3 years or later (n = 6 690 case-control pairs). RESULTS Maternal use of any antibiotics during pregnancy was associated with an increased risk of asthma in the offspring [adjusted odds ratio (OR) = 1.31 (95% confidence interval (CI): 1.21-1.42)]. Several maternal specific antibiotics were associated with the risk of asthma, and the strongest association was observed for cephalosporins [OR = 1.46 (95% CI 1.30-1.64)]. Child's use of antibiotics during the first year of life was associated with an increased risk of asthma [OR = 1.60 (95% CI 1.48-1.73)]. Child's use of cephalosporins [OR = 1.79 (95% CI 1.59-2.01)], sulphonamides and trimethoprim [OR = 1.65 (95% CI 1.34-2.02)], macrolides [OR = 1.61 (95% CI 1.46-1.78)] and amoxicillin [OR = 1.46 (95% CI 1.35-1.58)] was associated with an increased risk of asthma. CONCLUSIONS AND CLINICAL RELEVANCE Both prenatal and post-natal exposure to antibiotics was associated with an increased risk of asthma. The potential role of adverse effects of antibiotics on the gut microbiota and the development of asthma should be further explored.
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Affiliation(s)
- J Metsälä
- Department of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland; School of Health Sciences, University of Tampere, Tampere, Finland
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Johnson CC, Peterson EL, Joseph CL, Ownby DR, Breslau N. Birth weight and asthma incidence by asthma phenotype pattern in a racially diverse cohort followed through adolescence. J Asthma 2015; 52:1006-12. [PMID: 26374620 PMCID: PMC4831062 DOI: 10.3109/02770903.2015.1054405] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Low birth weight (LBW) has been shown to be an independent risk factor for asthma. We hypothesized that LBW would have its greatest impact on early onset disease. METHODS A racially diverse cohort of children born from 1983 to 1985 at two hospitals, one urban and one suburban in the same metropolitan area, and oversampled for babies weighing ≤2500 g, was identified retrospectively when the children were 6 years of age and followed periodically. At the age 17 years study visit, cohort members and their parent/guardians were separately interviewed face-to-face regarding the subject's history of asthma using the standardized ISAAC questionnaire. We measured the cumulative incidence of asthma from birth through adolescence defined by age of diagnosis and persistence/remittance. RESULTS Six-hundred and eighty teens (82.6% of the original cohort) were included in the analyses, 387 with LBW and 293 of normal birth weight. The prevalence of physician-diagnosed "Current Asthma" was associated with LBW (p = 0.003 for trend), with patterns stronger in males and whites. LBW was associated most strongly with Late Onset Persistent asthma (current asthma that was diagnosed after 8 years); p for trend 0.032. This trend was again most evident in males and whites. None of the asthma categories classified as "remittent" were statistically associated with LBW. CONCLUSIONS LBW was not associated with diagnosed asthma that remitted before age 17 years. LBW was associated with asthma diagnosis in mid-childhood that persisted through adolescence, suggesting that the asthmagenic effects of LBW can become evident post the early years of childhood and persist into adulthood.
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Affiliation(s)
| | - Edward L. Peterson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI
| | | | - Dennis R. Ownby
- Section of Allergy-Immunology, Georgia Regents University, Augusta, GA
| | - Naomi Breslau
- Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, MI
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Almqvist C, Olsson H, Ullemar V, D'Onofrio BM, Frans E, Lundholm C. Association between parental age and asthma in a population-based register study. J Allergy Clin Immunol 2015; 136:1103-5.e2. [PMID: 25979520 DOI: 10.1016/j.jaci.2015.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/04/2015] [Accepted: 04/10/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.
| | - Henrik Olsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Vilhelmina Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Ind
| | - Emma Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Voge GA, Katusic SK, Qin R, Juhn YJ. Risk of Asthma in Late Preterm Infants: A Propensity Score Approach. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:905-10. [PMID: 25944734 DOI: 10.1016/j.jaip.2015.03.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/25/2015] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of asthma, specifically in former late preterm infants, has not been well defined. Covariate imbalance and lack of controlling for this has led to inconsistent results in prior studies. OBJECTIVE The objective of this study was to determine the risk of asthma in former late preterm infants using a propensity score approach. METHODS The study was a population-based birth cohort study. Study subjects were all children born in Rochester, Minn, between 1976 and 1982. Asthma status during the first 7 years of life was assessed by applying predetermined criteria. The propensity score was formulated using 15 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks of gestation) to term infants (37 0/7 to 40 6/7 weeks of gestation) within a caliper of 0.2 standard deviation of logit of propensity score. RESULTS Of the eligible 7040 infants, 5915 children had complete data. Before propensity score matching, late preterm infants had a higher risk of asthma (20 of 262, 7.6%) compared with full-term infants (272 of 5653, 4.8%) (P = .039). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full-term infants (6.6% vs 7.7%, respectively, P = .61), and the result was consistent with covariate-adjustment Cox regression models controlling for significant covariates (P = .57). CONCLUSION A late preterm birth history is not independently associated with childhood asthma, as the reported risk of asthma among former late preterm infants appears to be due to covariate imbalance.
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Affiliation(s)
- Gretchen A Voge
- Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minn
| | - Slavica K Katusic
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Rui Qin
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
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Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta 2015; 451:88-96. [PMID: 25668229 DOI: 10.1016/j.cca.2015.01.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 01/22/2015] [Accepted: 01/25/2015] [Indexed: 02/07/2023]
Abstract
The microbial communities that reside in the human gut (microbiota) and their impact on human health and disease are nowadays one of the most exciting new areas of research. A well-balanced microbial intestinal colonization in early postnatal life is necessary for the development of appropriate innate and adaptive immune responses and to establish immune homeostasis later in life. Although the composition and functional characteristics of a 'healthy' gut microbiota remain to be elucidated, perturbations in the microbial colonization of an infant's gastrointestinal tract have been associated with an increased risk of short- and long-term immunologically mediated diseases. Emerging evidence suggests that gut microbiota biomodulators, such as probiotics, prebiotics, synbiotics, and postbiotics may support disease prevention in infants who tend to have a delayed and/or aberrant initial colonization with reduced microbiota diversity (delivery by caesarean section, premature delivery, and excessive use of perinatal antibiotics). Under these dysbiosis conditions probiotics could act as 'surrogate' colonizers to prevent immune-mediated diseases. This review focuses on the influence of delivery mode on the colonization of the infant gastro-intestinal tract. In particular, it examines the manipulation of the gut microbiota composition through the use of gut microbiota biomodulators, in the management of aberrant initial gut colonization and subsequent consequences for the health of the offspring.
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Magnus MC, Stigum H, Håberg SE, Nafstad P, London SJ, Nystad W. Peak weight and height velocity to age 36 months and asthma development: the Norwegian Mother and Child Cohort Study. PLoS One 2015; 10:e0116362. [PMID: 25635872 PMCID: PMC4312021 DOI: 10.1371/journal.pone.0116362] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 12/08/2014] [Indexed: 12/04/2022] Open
Abstract
Background The immediate postnatal period is the period of the fastest growth in the entire life span and a critical period for lung development. Therefore, it is interesting to examine the association between growth during this period and childhood respiratory disorders. Methods We examined the association of peak weight and height velocity to age 36 months with maternal report of current asthma at 36 months (n = 50,311), recurrent lower respiratory tract infections (LRTIs) by 36 months (n = 47,905) and current asthma at 7 years (n = 24,827) in the Norwegian Mother and Child Cohort Study. Peak weight and height velocity was calculated using the Reed1 model through multilevel mixed-effects linear regression. Multivariable log-binomial regression was used to calculate adjusted relative risks (adj.RR) and 95% confidence intervals (CI). We also conducted a sibling pair analysis using conditional logistic regression. Results Peak weight velocity was positively associated with current asthma at 36 months [adj.RR 1.22 (95%CI: 1.18, 1.26) per standard deviation (SD) increase], recurrent LRTIs by 36 months [adj.RR 1.14 (1.10, 1.19) per SD increase] and current asthma at 7 years [adj.RR 1.13 (95%CI: 1.07, 1.19) per SD increase]. Peak height velocity was not associated with any of the respiratory disorders. The positive association of peak weight velocity and asthma at 36 months remained in the sibling pair analysis. Conclusions Higher peak weight velocity, achieved during the immediate postnatal period, increased the risk of respiratory disorders. This might be explained by an influence on neonatal lung development, shared genetic/epigenetic mechanisms and/or environmental factors.
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Affiliation(s)
- Maria C. Magnus
- Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- * E-mail:
| | - Hein Stigum
- Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Siri E. Håberg
- Institute Management and Staff, Norwegian Institute of Public Health, Oslo, Norway
| | - Per Nafstad
- Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Stephanie J. London
- Epidemiology Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, United States of America
| | - Wenche Nystad
- Department of Chronic Diseases, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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Lin SC, Lin HW. Urbanization factors associated with childhood asthma and prematurity: a population-based analysis aged from 0 to 5 years in Taiwan by using Cox regression within a hospital cluster model. J Asthma 2014; 52:273-8. [PMID: 25171433 DOI: 10.3109/02770903.2014.958854] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Childhood asthma and premature birth are both common; however, no studies have reported urbanization association between asthma and prematurity and the duration of prematurity affect asthma development. We use Taiwan Longitudinal Health Insurance Database (LHID) to explore association between asthma and prematurity among children by using a population-based analysis. METHODS This is a retrospective cohort study with registration data derived from Taiwan LHID. We evaluated prematurely born infants and children aged <5 years (n = 532) and age-matched control patients (n = 60505) using Cox proportional hazard regression analysis within a hospital cluster model. Of the 61 037 examinees, 14 012 experienced asthma during the 5-year follow-up, including 161 (72.26 per 1000 person-years) infants and children born prematurely and 13 851 (40.27 per 1000 person-years) controls. RESULTS The hazard ratio for asthma during 5-year follow-up period was 1.95 (95% confidence interval = 1.67-2.28) among children born prematurely. Boys born prematurely aged 0-2 years were associated with higher asthma rates compared with girls in non-premature and premature groups. Living in urban areas, those born prematurely were associated with higher rates of asthma compared with non-prematurity. Those born prematurely lived in northern region had higher asthma hazard ratio than other regions. CONCLUSION Our analyses indicated that sex, age, urbanization level, and geographic region are significantly associated with prematurity and asthma. Based on cumulative asthma-free survival curve generated using the Kaplan-Meier method, infants born prematurely should be closely monitored to see if they would develop asthma until the age of 6 years.
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Affiliation(s)
- Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University , Taipei , Taiwan
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Gunawardhana LP, Baines KJ, Mattes J, Murphy VE, Simpson JL, Gibson PG. Differential DNA methylation profiles of infants exposed to maternal asthma during pregnancy. Pediatr Pulmonol 2014; 49:852-62. [PMID: 24166889 DOI: 10.1002/ppul.22930] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/29/2013] [Accepted: 08/13/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Asthma is a complex disease that involves both genetic factors and environmental exposures. Aberrant epigenetic modifications, such as DNA methylation, may be important in asthma development. Fetal exposure to maternal asthma during critical periods of in utero development may lead to epigenetic alterations that predispose infants to a greater risk of developing asthma themselves. We investigated alterations in the DNA methylation profile of peripheral blood from infants exposed to maternal asthma during pregnancy. METHODS Peripheral blood was collected from 12-month-old infants born to women with (n = 25) and without (n = 15) doctor diagnosed asthma during pregnancy. Genomic DNA was extracted, bisulfite converted, and hybridized to Infinium Methylation 27 arrays (Illumina), containing over27,000 CpGs from 14,495 genes. CpG loci in only autosomal genes were classified as differentially methylated at the 99% level (P < 0.01, |DiffScore| > 22 and delta beta >0.06). RESULTS There were 70 CpG loci, corresponding to 67 genes that were significantly differentially methylated. Twelve CpG loci (11 genes) showed greater than 10% comparative difference in DNA methylation, including hyper-methylated loci of FAM181A, MRI1, PIWIL1, CHFR, DEFA1, MRPL28, AURKA, and hypo-methylated loci of NALP1L5, MAP8KIP3, ACAT2, and PM20D1 in maternal asthma. Methylation of MAPK8IP3 was significantly negatively correlated with maternal blood eosinophils (r = -0.38; P = 0.022), maternal eNO (r = -0.44; P = 0.005), and maternal serum total IgE (r = -0.39, P = 0.015). Methylation of AURKA negatively correlated with maternal hemoglobin (r = -0.43; P = 0.008), infants height (r = -0.51; P < 0.001) and weight (r = -0.36; P = 0.021). Methylation of PM20D1 was lower in infants born to mothers with asthma on inhaled corticosteroid treatment. Methylation of PM20D1 was lower and MRI1 was higher in infants born to atopic mothers without asthma. CONCLUSIONS In an Australian study population, exposure to maternal asthma during pregnancy is associated with differential methylation profiles of infants' peripheral blood DNA, which may act as risk factors for future asthma development.
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Affiliation(s)
- Lakshitha P Gunawardhana
- Priority Research Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, The University of Newcastle, Sydney, NSW, Australia
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Huang L, Chen Q, Zhao Y, Wang W, Fang F, Bao Y. Is elective cesarean section associated with a higher risk of asthma? A meta-analysis. J Asthma 2014; 52:16-25. [PMID: 25162303 DOI: 10.3109/02770903.2014.952435] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Abstract Background: Recent meta-analyses indicate that children delivered by cesarean section have increased risk for asthma. However, the studies included in these previous meta-analyses showed significant heterogeneity. Furthermore, no previous meta-analysis has distinguished the association of elective and emergency CS, spontaneous and instrumental vaginal deliveries (VD) with the odds of asthma. OBJECTIVE To examine the association between specific mode of delivery and the prevalence of asthma. METHODS PUBMED, Google Scholar, EMBASE, and MEDLINE were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated from the prevalence of asthma in children born by elective CS, emergent CS, instrumental VD and spontaneous VD. Meta-analysis was then used to derive a combined OR. Heterogeneity between studies was also tested in the findings. RESULTS A total of 26 studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by CS (OR=1.16, 95% CI 1.14, 1.29), and no evidence of heterogeneity was found (I(2)=24.6%). Elective and emergency CS moderately increased the risk of asthma (OR=1.21, 95% CI 1.17, 1.25; I(2)=39.9%; OR=1.23, 95% CI 1.19-1.26). The risk of asthma was also higher in the children born by instrumental VD (OR=1.07, 95% CI, 1.04-1.11) but with evidence of heterogeneity (I(2)=54.9%). CONCLUSION About 20% increase in the subsequent risk of asthma was both found in children delivered by elective and emergency CS. The increasing rates of CS worldwide might partly explain the concomitant rise in asthma during the same time period.
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Affiliation(s)
- Lisu Huang
- MOE-Shanghai Key Laboratory of Children's Environmental Health and
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Franz MB, Poterauer M, Elhenicky M, Stary S, Birner P, Vinatzer U, Husslein P, Streubel B, Husslein H. Global and single gene DNA methylation in umbilical cord blood cells after elective caesarean: a pilot study. Eur J Obstet Gynecol Reprod Biol 2014; 179:121-4. [PMID: 24960239 DOI: 10.1016/j.ejogrb.2014.05.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/14/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate global and single gene methylation patterns as a sign for epigenetic modulation of the immune system in infants born by elective cesarean section (CS) and vaginal delivery (VD). STUDY DESIGN For this prospective pilot study a two step approach was chosen. Initially 41 newborn infants comprising 23 delivered by VD and 18 delivered by elective CS were included. Global DNA methylation of umbilical cord blood was determined. In a second step, methylation status of 96 single genes linked to T cell activation, cytokine production, inflammatory response, and stem cell transcription was evaluated in 48 newborn infants, 20 delivered by VD and 28 delivered by CS. RESULTS Global methylation did not differ significantly between CS and VD (p=0.732). The methylation status was low (threshold: ≤3%) for the majority of single genes (n=92) in both groups. FOXP3, CD7, ELA2, and IRF1 showed hypermethylation in both groups. In the CS group, ELA2 (p<0.001) and IRF1(p =0.017) showed significantly higher methylation compared to the VD group. CONCLUSION We found no difference in global methylation between newborn infants in the VD group compared to the elective CS group. Methylation of single genes was significantly higher in newborn infants delivered by elective CS. Further research is needed to determine the significance of theses findings.
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Affiliation(s)
- Maximilian B Franz
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Mariella Poterauer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Marie Elhenicky
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Susanne Stary
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Peter Birner
- Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria
| | - Ursula Vinatzer
- Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Peter Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Berthold Streubel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria.
| | - Heinrich Husslein
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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45
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Guibas GV, Moschonis G, Xepapadaki P, Roumpedaki E, Androutsos O, Manios Y, Papadopoulos NG. Conception via in vitro fertilization and delivery by Caesarean section are associated with paediatric asthma incidence. Clin Exp Allergy 2014; 43:1058-66. [PMID: 23957341 DOI: 10.1111/cea.12152] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/27/2013] [Accepted: 06/02/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between perinatal factors and asthma inception is under rigorous investigation. Nevertheless, evidence of a correlation between asthma, conception via in vitro fertilization (IVF) and delivery through Caesarean section (C-section) is inconclusive. OBJECTIVE We aimed to assess the relation of asthma incidence with IVF and C-section, after controlling for several potential confounding factors. METHODS Parent-reported wheeze in the last 12 months (current), wheeze ever, physician-diagnosed asthma, method of conception, and type of delivery were recorded from questionnaires filled in by the parents of 2016 Greek children aged 9-13, (the Healthy Growth Study population). Some perinatal data were recorded from children's medical records and others were reported by parents; anthropometric measurements were also conducted in children. RESULTS IVF was correlated with physician-diagnosed asthma (OR = 2.25; 95% CI = 1.11-4.56), but not with current/ever wheeze after adjustment for potential confounding factors. After adjustment, C-section was also associated with asthma (OR = 1.39; 95% CI = 1.04-1.87), but not with current/ever wheeze. When the association of both IVF and C-section with asthma was examined in the same multivariate logistic regression model, it was weakened to borderline significance (OR = 2.04; 95% CI = 1-4.15 and OR = 1.34; 95% CI = 1-1.81 respectively). CONCLUSIONS AND CLINICAL RELEVANCE Conception via IVF and delivery by C-section may predispose children to future asthma development. Either variable could also exert a confounding effect on the link of the other to asthma; this may partially be accountable for inconsistencies in the findings of pertinent studies.
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Affiliation(s)
- G V Guibas
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
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Abstract
A clinical diagnosis of asthma is often considered when a child presents with recurrent cough, wheeze and breathlessness. However, there are many other causes of wheeze in a young child. These range from recurrent viral infections to chronic suppurative lung disease, gastro-oesophageal reflux disease and rare structural abnormalities. Arriving at a diagnosis includes taking into consideration the symptomatology, triggers, atopic features, family history, absence of red flags and therapeutic trial, where indicated.
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Affiliation(s)
- Mark Chung Wai Ng
- SingHealth Family Medicine Residency Programme, 3 Second Hospital Avenue, Singapore 168937.
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47
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Liu X, Olsen J, Agerbo E, Yuan W, Cnattingius S, Gissler M, Li J. Birth weight, gestational age, fetal growth and childhood asthma hospitalization. Allergy Asthma Clin Immunol 2014; 10:13. [PMID: 24602245 PMCID: PMC3973844 DOI: 10.1186/1710-1492-10-13] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background Childhood asthma may have a fetal origin through fetal growth and development of the immunocompetence or respiratory organs. Objective We examined to which extent short gestational age, low birth weight and fetal growth restriction were associated with an increased risk of asthma hospitalization in childhood. Methods We undertook a cohort study based on several national registers in Denmark, Sweden and Finland. We included all live singleton born children in Denmark during 1979-2005 (N = 1,538,093), in Sweden during 1973-2004 (N = 3,067,670), and a 90% random sample of singleton children born in Finland during 1987-2004 (N = 1,050,744). The children were followed from three years of age to first hospitalization for asthma, emigration, death, their 18th birthday, or the end of study (the end of 2008 in Denmark, and the end of 2007 in Sweden or Finland), whichever came first. We computed the pseudo-values for each observation and used them in a generalized estimating equation to estimate relative risks (RR) for asthma hospitalization. Results A total of 131,783 children were hospitalized for asthma during follow-up. The risk for asthma hospitalization consistently increased with lower birth weight and shorter gestational age. A 1000-g decrease in birth weight corresponded to a RR of 1.17 (95% confidence interval (CI) 1.15-1.18). A one-week decrease in gestational age corresponded to a RR of 1.05 (95% CI 1.04-1.06). Small for gestational age was associated with an increased risk of asthma hospitalization in term but not in preterm born children. Conclusions Fetal growth and gestational age may play a direct or indirect causal role in the development of childhood asthma.
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Affiliation(s)
- Xiaoqin Liu
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark.
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48
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Kahr N, Naeser V, Stensballe LG, Kyvik KO, Skytthe A, Backer V, Bønnelykke K, Thomsen SF. Gene-environment interaction in atopic diseases: a population-based twin study of early-life exposures. CLINICAL RESPIRATORY JOURNAL 2014; 9:79-86. [PMID: 24444295 DOI: 10.1111/crj.12110] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/15/2013] [Accepted: 01/14/2014] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The development of atopic diseases early in life suggests an important role of perinatal risk factors. OBJECTIVES To study whether early-life exposures modify the genetic influence on atopic diseases in a twin population. METHODS Questionnaire data on atopic diseases from 850 monozygotic and 2279 like-sex dizygotic twin pairs, 3-9 years of age, from the Danish Twin Registry were cross-linked with data on prematurity, Cesarean section, maternal age at birth, parental cohabitation, season of birth and maternal smoking during pregnancy, from the Danish National Birth Registry. Significant predictors of atopic diseases were identified with logistic regression and subsequently tested for genetic effect modification using variance components analysis. RESULTS After multivariable adjustment, prematurity (gestational age below 32 weeks) [odds ratio (OR) = 1.93, confidence interval (CI) = 1.45-2.56], Cesarean section (OR = 1.25, CI = 1.05-1.49) and maternal smoking during pregnancy (OR = 1.70, CI = 1.42-2.04) significantly influenced the risk of asthma, whereas none of the factors were significantly associated with atopic dermatitis and hay fever. Variance components analysis stratified by exposure status showed no significant change in the heritability of asthma according to the identified risk factors. CONCLUSION In this population-based study of children, there was no evidence of genetic effect modification of atopic diseases by several identified early-life risk factors. The causal relationship between these risk factors and atopic diseases may therefore be mediated via mechanisms different from gene-environment interaction.
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Affiliation(s)
- Niklas Kahr
- Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
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49
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Harju M, Keski-Nisula L, Georgiadis L, Räisänen S, Gissler M, Heinonen S. The burden of childhood asthma and late preterm and early term births. J Pediatr 2014; 164:295-9.e1. [PMID: 24210922 DOI: 10.1016/j.jpeds.2013.09.057] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 08/29/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the association between gestational age at birth and the risk of subsequent development of asthma. STUDY DESIGN We conducted a retrospective observational hospital-based birth case-control study in a university-based obstetrics and gynecology department in Finland. A total of 44,173 women delivering between 1989 and 2008 were linked with the social insurance register to identify asthma reimbursements for their offspring (n = 2661). Pregnancy factors were recorded during pregnancy. Infants were categorized as moderately preterm (≤ 32 weeks), late preterm (33-36 weeks), early term (37-38 weeks), term (39-40 weeks), or late term and postterm (≥ 41 weeks). The main outcome measure was asthma among the infants. RESULTS Children born moderately preterm (≤ 32 weeks gestation) had a significantly increased risk of asthma (aOR, 3.9; 95% CI, 3.2-4.8). The risk of asthma was also increased in those born late preterm (aOR, 1.7; 95% CI, 1.4-2.0) and early term (aOR, 1.2; 95% CI, 1.1-1.4). In contrast, delivery at 41 weeks or later seemed to decrease the risk of asthma (aOR, 0.9; 95% CI, 0.8-1.0). The burden of asthma associated with preterm birth was associated mainly with early term infants, in whom 108 extra cases of asthma were observed. CONCLUSION Even though the individual risk of asthma was inversely correlated with gestational age at birth, the overall burden brought about by delivery before term was associated with late preterm and early term deliveries. Furthermore, delivery after term was protective against asthma.
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Affiliation(s)
- Maijakaisa Harju
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Leena Georgiadis
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Sari Räisänen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland; Nordic School of Public Health, Gothenburg, Sweden
| | - Seppo Heinonen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland; Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Huang L, Bao Y, Xu Z, Lei X, Chen Y, Zhang Y, Zhang J. Neonatal bilirubin levels and childhood asthma in the US Collaborative Perinatal Project, 1959-1965. Am J Epidemiol 2013; 178:1691-7. [PMID: 24186969 DOI: 10.1093/aje/kwt248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evidence shows that asthma originates in early life. Studies have found that phototherapy and/or neonatal jaundice may be associated with asthma. We investigated the association between neonatal bilirubin levels and childhood asthma without phototherapy intervention in the Collaborative Perinatal Project, a multicenter prospective cohort study conducted in the United States from 1959 to 1965. A total of 54,795 livebirths were included, and 40,063 children were followed up until 7 years of age or older. Total serum bilirubin (TSB) levels were examined at 48 hours postpartum in newborns with birthweights of 2,250 g or more. Information on asthma and other diseases through age 7 years was summarized and confirmed by a group of pediatricians and child neurologists. Among 28,807 term infants, the overall prevalence of asthma was 5.26%. Risks of asthma increased with both maximum TSB levels and TSB levels at 48 hours postpartum (P for trend < 0.01). Neonatal maximum TSB levels greater than 15 mg/dL were associated with a 61% increase in the risk of childhood asthma (odds ratio = 1.61, 95% confidence interval: 1.04, 2.08) after adjustment for confounders. In this prospective cohort study of infants born at a time when phototherapy was unavailable, neonatal hyperbilirubinemia was associated with an increased risk of childhood asthma.
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Affiliation(s)
- Lisu Huang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixiao Bao
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zongli Xu
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina
| | - Xiaoping Lei
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongjun Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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