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Bonaventure A, Kane E, Simpson J, Roman E. Maternal infections and medications in pregnancy: how does self-report compare to medical records in childhood cancer case-control studies? Int J Epidemiol 2023; 52:1187-1196. [PMID: 36847728 PMCID: PMC10396422 DOI: 10.1093/ije/dyad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Studies examining the potential impact of mothers' health during pregnancy on the health of their offspring often rely on self-reported information gathered several years later. To assess the validity of this approach, we analysed data from a national case-control study of childhood cancer (diagnosed <15 years) that collected health information from both interviews and medical records. METHODS Mothers' interview reports of infections and medications in pregnancy were compared with primary care records. Taking clinical diagnoses and prescriptions as the reference, sensitivity and specificity of maternal recall along with kappa coefficients of agreement were calculated. Differences in the odd ratios estimated using logistic regression for each information source were assessed using the proportional change in the odds ratio (OR). RESULTS Mothers of 1624 cases and 2524 controls were interviewed ∼6 years (range 0-18 years) after their child's birth. Most drugs and infections were underreported; in general practitioner records, antibiotic prescriptions were nearly three times higher and infections >40% higher. Decreasing with increasing time since pregnancy, sensitivity was ⩽40% for most infections and all drugs except 'anti-epileptics and barbiturates' (sensitivity 80% among controls). ORs associated with individual drug/disease categories that were based on self-reported data varied from 26% lower to 26% higher than those based on medical records; reporting differences between mothers of cases and controls were not systematically in the same direction. CONCLUSIONS The findings highlight the scale of under-reporting and poor validity of questionnaire-based studies conducted several years after pregnancy. Future research using prospectively collected data should be encouraged to minimize measurement errors.
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Affiliation(s)
- Audrey Bonaventure
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Paris, France
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Eleanor Kane
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Jill Simpson
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Eve Roman
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
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Mohamad Zainal NH, Mohd Nor NH, Saat A, Clifton VL. Childhood allergy susceptibility: The role of the immune system development in the in-utero period. Hum Immunol 2022; 83:437-446. [DOI: 10.1016/j.humimm.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
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Pesce G, Sesé L, Calciano L, Travert B, Dessimond B, Maesano CN, Ferrante G, Huel G, Prud'homme J, Guinot M, Soomro MH, Baloch RM, Lhote R, Annesi-Maesano I. Foetal exposure to heavy metals and risk of atopic diseases in early childhood. Pediatr Allergy Immunol 2021; 32:242-250. [PMID: 33091176 DOI: 10.1111/pai.13397] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accumulating evidence suggests that in utero exposures can influence the development of the immune system and thus contribute to disease development. Studies investigating the association between prenatal exposures to heavy metals and atopic diseases, however, are scarce. METHODS Children from the EDEN birth cohort were prospectively followed up using parental questionnaires with validated questions on asthma, allergic rhinitis, eczema, and food allergy symptoms. The questionnaires were administered every 4 months during the children's first year, and then every year until the age of 5, with a final survey at the age of 8. Serum concentrations of lead (Pb), cadmium (Cd), and manganese (Mn) were assessed in maternal blood samples collected during mid-pregnancy and in cord blood of 651 mother-children pairs. Hazard ratios (HR) for the incidence of each atopic disease in relation to the exposure to metals were calculated using Cox proportional hazard models. RESULTS Levels of Cd in cord blood were associated with greater risk of asthma (hazard ratio [95% confidence interval] for upper vs lower quartile: 1.81 [1.00-3.29]), eczema (1.60 [1.09-2.35]), and food allergy (3.17 [1.36-7.38]), while Mn levels in maternal serum were associated with eczema (1.55 [1.05-2.28]). These associations were similar in males and females and were confirmed using log concentrations of metals as exposures. CONCLUSIONS Our results support the hypothesis that fetal exposure to heavy metals may affect the development of asthma, eczema, and food allergy in childhood and suggest that timing of exposure in utero may have a role in these associations.
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Affiliation(s)
- Giancarlo Pesce
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Lucile Sesé
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Service des Explorations Fonctionnelles et Respiratoires, Hôpital Avicenne, Bobigny, France
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Benoit Travert
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Boris Dessimond
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Cara Nichole Maesano
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Guy Huel
- INSERM UMR-S 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Villejuif, France
| | - Julie Prud'homme
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Martine Guinot
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Munawar Hussain Soomro
- Department of Community Medicine, Faculty of Medicine, Isra University, Hyderabad, Pakistan
| | - Ramen Munir Baloch
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
| | - Raphael Lhote
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France.,Assistance Publique - Hôpitaux de Paris (AP-HP), Internal Medicine 2, Auto-immune and systemic diseases, University Hospital Pitié-Salpêtrière, Paris, France
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases (EPAR) Team, Faculté de Médecine Saint-Antoine, Institute Pierre Louis d'Epidemiologie et Sante Publique (IPLESP), Sorbonne Université and INSERM UMR-S 1136, Paris, France
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Conlan N, Maher GM, Al Khalaf SY, McCarthy FP, Khashan AS. Association between hypertensive disorders of pregnancy and the risk of asthma, eczema and allergies in offspring: A systematic review and meta-analysis. Clin Exp Allergy 2020; 51:29-38. [PMID: 33037716 DOI: 10.1111/cea.13754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Conduct a systematic review and meta-analysis examining the association between hypertensive disorders of pregnancy (HDP) and risk of asthma, eczema, food allergies and allergic rhinitis in the offspring. DESIGN A systematic review and random-effects meta-analyses were used to synthesize the published literature. PRISMA guidelines were followed throughout. Two independent reviewers carried out data extraction and quality assessment of included studies. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess certainty of findings. DATA SOURCES A systematic search of PubMed, Embase, Web of Science and CINAHL was performed from inception of databases-21 April 2020, supplemented by hand-searching reference lists of included articles. ELIGIBILITY CRITERIA Two reviewers independently reviewed titles, abstracts and full-text articles. English language, cohort, case-control and cross-sectional published studies examining the association between HDP (primary exposure: pre-eclampsia; secondary exposures: all other HDP) and asthma, eczema, food allergies and allergic rhinitis were included. RESULTS Of the 2833 studies retrieved, 14 studies met inclusion criteria. Of these, 11 studies reported evidence of association between HDP and atopic disorders. Thirteen studies reported estimates for asthma. Seven of these included adjusted estimates (including 3 645 773 participants) for a pre-eclampsia-asthma relationship resulting in a pooled odds ratio (OR) of 1.14 (95% CI: 1.04, 1.26) (I2 = 62%). However, this OR was reduced to 1.08 (95% CI: (0.78, 1.48) when the large registry-based cohort studies were excluded, and only studies using parent-reported measures to determine a diagnosis of asthma were included. Four studies included adjusted estimates (including 254 998 participants) for other HDP and asthma (pooled OR: 1.02, 95% CI: 0.96, 1.09) (I2 = 0%). Two studies provided adjusted estimates (including 1 699 663 participants) for a pre-eclampsia-eczema relationship (pooled OR: 1.06, 95% CI: 0.98, 1.14) (I2 = 0%). One study including pre-eclampsia-food allergies was identified (OR: 1.28, 95% CI: 1.11, 1.46). Three studies examined a HDP (including pre-eclampsia) and allergic rhinitis relationship, with effect estimates ranging from 1.14 to 2.10. Studies were classified as low or low-moderate risk of bias, while GRADE certainty of findings were low to very low. CONCLUSIONS While pre-eclampsia was associated with a possible increased risk of asthma in offspring, there was no evidence for a relationship between other HDP and asthma. There is a lack of published literature examining the association between HDP and eczema, food allergy and allergic rhinitis. Further primary research is warranted to gain a better understanding of the association between HDP and the risk of childhood atopic disease. SYSTEMATIC REVIEW REGISTRATION Review protocol in appendix.
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Affiliation(s)
- Nicola Conlan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland
| | - Gillian M Maher
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Sukainah Y Al Khalaf
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- INFANT Research Centre, University College Cork, Cork, Ireland.,Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- School of Public Health, Western Gateway Building, University College Cork, Cork, Ireland.,INFANT Research Centre, University College Cork, Cork, Ireland
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Santos KD, Traebert J, Piovezan AP, Silva JD. Relevance of the first thousand days of life to the development of wheezing in children aged 6-7 years. Allergol Immunopathol (Madr) 2020; 48:270-280. [PMID: 32284262 DOI: 10.1016/j.aller.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The first thousand days of life are a critical stage for the development of respiratory and immune systems. Many events in this period may be associated with wheezing in childhood. OBJECTIVE This study aimed to investigate the association between early life determinants and wheezing in children aged 6-7 years. MATERIALS AND METHODS Population-based case-control study using early-life related questions. We used the International Study of Asthma and Allergies in Childhood questionnaire to assess wheezing symptoms. Multiple logistic regressions were performed according to a hierarchical framework, considering the complex dynamic of wheezing/asthma and potential interaction between different levels of determination. RESULTS A total of 820 children were included, from which 162 reported wheezing symptoms (19.7%). Multivariable analysis identified socioeconomic conditions (OR 2.08, 95% CI 1.08-4.00), family history of asthma (OR 2.28, 95% CI 1.37-3.75), vaginal discharge that required treatment during pregnancy (OR 1.68, 95% CI 1.00-2.83), neonatal hyperbilirubinemia (OR 2.00, 95% CI 1.17-3.42), anemia and intestinal parasitosis in the first two years (OR 2.28, 95% CI 1.22-4.25; OR 1.72, 95% CI 1.02-2.92, respectively) independently associated to wheezing at 6-7 years. Intended pregnancy was associated with reduced wheezing (OR 0.47, 95% CI 0.28-0.77). CONCLUSIONS Several factors were associated with wheezing in childhood. Considering that intended pregnancy reduced wheezing and other associated exposures are considered modifiable, these findings may guide the planning of strategies to decrease the susceptibility to asthma symptoms in childhood.
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Affiliation(s)
- Karoliny Dos Santos
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina (UNISUL), Av. Pedra Branca, 25, Cidade Universitária Pedra Branca, 88137-270, Palhoça, Santa Catarina, SC, Brazil.
| | - Jefferson Traebert
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina (UNISUL), Av. Pedra Branca, 25, Cidade Universitária Pedra Branca, 88137-270, Palhoça, Santa Catarina, SC, Brazil.
| | - Anna Paula Piovezan
- Postgraduate Program in Health Sciences, University of Southern Santa Catarina (UNISUL), Av. Pedra Branca, 25, Cidade Universitária Pedra Branca, 88137-270, Palhoça, Santa Catarina, SC, Brazil.
| | - Jane da Silva
- Department of Internal Medicine and Allergy Clinic of Professor Polydoro Ernani de São Thiago University Hospital, Federal University of Santa Catarina (UFSC), Florianopolis, SC, Brazil.
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Bai L, Zhao D, Cheng Q, Zhang Y, Wang S, Zhang H, Xie M, He R, Su H. Trimester-specific association between antibiotics exposure during pregnancy and childhood asthma or wheeze: the role of confounding. Ann Epidemiol 2018; 30:1-8. [PMID: 30448356 DOI: 10.1016/j.annepidem.2018.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/19/2018] [Accepted: 10/06/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE We conducted the meta-analysis to respectively evaluate the risk of prenatal antibiotics use during specific trimesters (first, second, and third trimester) on childhood asthma or wheeze and to explore whether the association was biased by potential confounding. METHODS The quality of included articles was assessed according to Newcastle-Ottawa Quality Assessment Scale and the Strengthening the Reporting of Observational Studies in Epidemiology. A random effects model was used to calculate pooled risk ratios and corresponding 95% confidence interval (CI), and publication bias was tested by Egger statistical test. RESULTS Eight studies were included finally. We found a crude positive association of prenatal antibiotics use during each pregnancy trimester and risk of childhood asthma or wheeze with RRs of 1.28 (95% CI, 1.09-1.51) for the first trimester of pregnancy, 1.25 (95% CI, 1.02-1.52) for the second trimester, and 1.25 (95% CI, 1.05-1.49) for the third trimester. However, when considering potential factors of maternal infections and presence of siblings, the relationship for each trimester was insignificant. CONCLUSIONS This systemic review and meta-analysis proposed a crude positive association between prenatal antibiotic use in every specific trimester and risk of childhood asthma or wheeze. However, adjustment for confounders decreased the relative risk estimates, supporting the concept that these associations are, at least in part, because of confounding by indication.
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Affiliation(s)
- Lijun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Desheng Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Qiang Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Yanwu Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Shusi Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Heng Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Mingyu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China
| | - Ruixin He
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Hong Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Province Key Laboratory of Major Autoimmune Diseases, Hefei, Anhui, China.
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Jensen ET, Kuhl JT, Martin LJ, Rothenberg ME, Dellon ES. Prenatal, intrapartum, and postnatal factors are associated with pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2018; 141:214-222. [PMID: 28601683 PMCID: PMC6511884 DOI: 10.1016/j.jaci.2017.05.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/16/2017] [Accepted: 05/24/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multiple lines of evidence point to the potential importance of early-life environmental factors in the rapid increase in the incidence of eosinophilic esophagitis (EoE), but potential exposures have not been extensively studied. OBJECTIVE We sought to assess the association between prenatal, intrapartum, and postnatal factors and the development of pediatric EoE using a case-control study. METHODS Patients with EoE were recruited from an existing registry at Cincinnati Children's Hospital Medical Center (CCHMC). Population-based community control subjects were identified from a separate CCHMC registry. Mothers of study subjects were contacted and completed a Web-based questionnaire. Crude and adjusted models were used to estimate associations. RESULTS Mothers of 127 cases and 121 control subjects were included. We observed a positive association between several early-life factors and EoE, including prenatal (maternal fever: adjusted odds ratio [aOR], 3.18; 95% CI, 1.27-7.98; preterm labor: aOR, 2.18; 95% CI, 1.06-4.48), intrapartum (cesarean delivery: aOR, 1.77; 95% CI, 1.01, 3.09), and infancy (antibiotic use: aOR, 2.30; 95% CI, 1.21-4.38; use of an acid suppressant: aOR, 6.05; 95% CI, 2.55-14.40) factors. We observed an inverse association between having a furry pet in infancy and EoE (aOR, 0.58; 95% CI, 0.34-0.97). No associations were observed for breast-feeding or maternal multivitamin or folic acid supplement use. CONCLUSION Early-life factors, including maternal fever, preterm labor, cesarean delivery, and antibiotic or acid suppressant use in infancy, were associated with risk of pediatric EoE; having a pet in the home was protective. These results add to growing evidence that implicate early-life exposures in EoE pathogenesis.
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Affiliation(s)
- Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University Public Health Sciences, Winston-Salem, NC; Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Jonathan T Kuhl
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Lisa J Martin
- Division of Genetics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - Evan S Dellon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC
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Pesce G, Marchetti P, Calciano L, Pironi V, Ricci P, Marcon A. Fetal Exposure to Maternal Pregnancy Complications and Respiratory Health in Childhood. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2017; 30:218-226. [DOI: 10.1089/ped.2017.0786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Giancarlo Pesce
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Pierpaolo Marchetti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Vanda Pironi
- Unit of Epidemiology, Agenzia Tutela della Salute (ATS) della Val Padana, Mantua, Italy
| | - Paolo Ricci
- Unit of Epidemiology, Agenzia Tutela della Salute (ATS) della Val Padana, Mantua, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Breastfeeding and perinatal exposure, and the risk of asthma and allergies. Curr Opin Allergy Clin Immunol 2017; 16:231-6. [PMID: 27054317 DOI: 10.1097/aci.0000000000000266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Exposures during the perinatal period, a phase of rapid development, may have a profound and sustained effect on disease risk. In particular, perinatal exposures may influence the development and maturation of the infant immune system and the risk of allergic disease. We aimed to summarize the current literature on perinatal exposures and the risk of asthma and allergic disease RECENT FINDINGS Increased risk of offspring wheeze or asthma was found for: maternal obesity and hypertension during pregnancy; febrile illness, gynaecological, and viral respiratory infections in pregnancy; exposure to bisphenol A and phthalates in pregnancy and childhood; exposure to smoking in utero; low birth weight; caesarean section and neonatal hyperbilirubinaemia. Reduced risk of offspring atopic eczema was found for hookworm infection in pregnancy and reduced risk of offspring wheeze was associated with increased pregnancy dietary intake of vitamin E and zinc. Higher levels of selenium in pregnancy were associated with less risk of asthma in genetically susceptible offspring. Early life pet ownership was associated with a decrease in atopic asthma but an increase in nonatopic asthma risk. SUMMARY A diverse range of exposures were associated with allergic disease risk, highlighting the susceptibility of children during the perinatal period. Clinicians should reinforce public health messages concerning maternal obesity, smoking, and breastfeeding. The infant gut microbiome is emerging as an important hypothesis, which may mediate the relationship between many perinatal exposures and allergic disease.
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Abstract
BACKGROUND The influence of maternal infection during pregnancy on allergic disorders in offspring is not well understood. We performed a systematic review and meta-analysis to evaluate current evidence on the association between maternal infection during pregnancy and asthma or eczema in offspring. METHODS We searched databases (PubMed, EMBASE, Medline, and Web of Science) for all relevant studies published before March 2016. Any cohort studies, case-control studies, or cross-sectional studies published in English and focused on the association between maternal infection during pregnancy and the risk of asthma or eczema in offspring were included. Random-effects models were used for combined analyses. RESULTS A total of 10 studies with 299,830 participants were included. Maternal infection was associated with an increased risk for asthma (odds ratio [OR]: 1.55; 95% confidence interval [CI]: 1.24-1.92; P < 0.01) and eczema (OR: 1.36; 95% CI: 1.13-1.64; P < 0.01). Further analyses showed associations between asthma and several specific maternal infections: fever episode (OR: 1.73; 95% CI: 1.35-2.23), chorioamnionitis (OR: 1.42; 95% CI: 0.96-2.11), respiratory infection (OR: 1.49; 95% CI: 0.94-2.36), and urogenital infection (OR: 1.39; 95% CI: 1.18-1.64). CONCLUSION The results from this meta-analysis and systematic review provide evidence that maternal infection during pregnancy might be related to subsequent asthma and eczema in offspring. However, there was variation of included studies with regard to type of maternal infection, age of children, and methods of exposure ascertainment. Additional studies are needed to further confirm these associations.
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Affiliation(s)
- Tingting Zhu
- Department of Pediatrics, West China Second University Hospital Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, P.R. China Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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Doğruel D, Bingöl G, Altıntaş DU, Yılmaz M, Kendirli SG. Prevalence of and risk factors for atopic dermatitis: A birth cohort study of infants in southeast Turkey. Allergol Immunopathol (Madr) 2016; 44:214-20. [PMID: 26589340 DOI: 10.1016/j.aller.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/18/2015] [Accepted: 07/31/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is most common in the first year of life. The aim of this study was to determine the prevalence of and risk factors for AD in a birth cohort of infants from southeast Turkey. METHODS Adana Paediatric Allergy Research (ADAPAR) birth cohort study was derived from 1377 infants who were born in Cukurova University, Medical Hospital, Adana, Turkey between February 2010 and February 2011. At birth, a physical examination was performed, cord blood samples were taken, and the mother completed a baseline questionnaire that provided data on gestational conditions, family history of allergic diseases and environmental exposures. Follow-up visits scheduled at 3, 6, and 12 months included an infant physical examination and an extended questionnaire. Skin prick test was performed and food-specific IgE levels were measured at 6 and 12 months. Atopic dermatitis was diagnosed based on confirmatory examination by a physician. RESULTS Of the 1377 infants enrolled, 59 (4.3%) were diagnosed with AD as of 12 months. Maternal allergic disease (ORs 6.28, 95% CI 1.03-38.30; p=0.046), maternal infection during gestation (ORs 3.73, 95% CI 1.25-11.09; p=0.018), and presence of food allergy (ORs 13.7, 95% CI 3.07-61.0; p=0.001) were identified as risk factors for AD. Breastfeeding and cord blood IgE levels were not identified as risk factors. CONCLUSIONS In this cohort we found prevalence of AD as 4.3% during the first year of life. Positive family history of atopic diseases, prenatal infections and presence of food allergy are the risk factors for early presentation of AD.
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Affiliation(s)
- D Doğruel
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey.
| | - G Bingöl
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - D U Altıntaş
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - M Yılmaz
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - S G Kendirli
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
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Abstract
Complex multifactorial diseases such as allergic rhinitis and asthma are not only becoming an increasing burden to healthcare systems, but especially affect the life quality of children and families suffering from their allergic symptoms. Also physicians are challenged by the multifaceted diseases as their work involves not only the often difficult decisions on case-adapted diagnostics, treatment, and monitoring, but also possible preventive measures. This review gives an outline of the latest scientific developments related to the etiology, diagnosis, and management of allergic airway diseases in childhood, as well as prenatal and early life risk factors and strategies for prevention.
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Affiliation(s)
- Stephanie Hofmaier
- Department of Paediatric Pneumology & Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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