Published ahead of print on September 22, 2006, doi:10.1164/rccm.200512-1978OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200512-1978OC
Maternal Complications and Procedures in Pregnancy and at Birth and Wheezing Phenotypes in ChildrenUnit of Epidemiology and Pediatric Pulmunology Service, Anna Meyer Children's Hospital; Center of Study and Prevention of Cancer; and Department of Statistics, University of Florence, Florence; Unit of Cancer Epidemiology, San Giovanni Battista Hospital–Center of Cancer Prevention; and Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin; Department of Epidemiology, Rome E Local Health Authority; and Department of Respiratory Physiology, Catholic University of Rome, Rome; Department of Pediatrics I, University of Milan, Milan; Department of Pediatrics I, University of Bari, Bari; Pediatric Pulmunology and Allergology Service–ARNAS (Azienda di Rilievo Nazionale ad Alta Specializzazione), IBIM (Istituto di Biomedicina e Immunologia Molecolare) National Research Council, Palermo; Unit of Epidemiology, Provincial Health Authority, Trento; and Unit of Preventive Medicine, Local Health Authority, Mantova, Italy; and Center for Public Health Research, Massey University Wellington Campus, Wellington, New Zealand Correspondence and requests for reprints should be addressed to Franca Rusconi, M.D., Epidemiology Unit, Anna Meyer Children's Hospital, Via Luca Giordano 7/m, 50132 Florence, Italy. E-mail: f.rusconi{at}meyer.it Rationale: There is increasing interest in the potential influence of fetal and early life conditions on childhood wheezing. Objectives: To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children. Methods: We studied 15,609 children, aged 6–7 yr, enrolled in a population-based study. Standardized questionnaires were completed by the children's mothers. Results: Of the children, 9.5% (1,478) had transient early wheezing, 5.4% (884) had persistent wheezing, and 6.1% (948) had late-onset wheezing. Maternal hypertension or preeclampsia was associated with an increased risk of all three wheezing phenotypes (for transient early wheezing: odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.08–1.82; for persistent wheezing: OR, 1.59; 95% CI, 1.15–2.19; and for late-onset wheezing: OR, 1.47; 95% CI, 1.06–2.01). Use of antibiotics for urinary tract infections was associated with transient early wheezing (OR, 1.52; 95% CI, 1.16–2.00), whereas antibiotic administration at delivery was associated with both transient early wheezing (OR, 1.21; 95% CI, 1.01–1.46) and persistent wheezing (OR, 1.39; 95% CI, 1.10–1.75). Children who had a mother with diabetes were also more likely to have persistent wheezing (OR, 1.72; 95% CI, 0.99–3.00). Neither amniocentesis/chorionic villus sampling, nor weight gain in pregnancy, nor cesarean section was associated with the subsequent development of wheezing. Maternal asthma or atopy was not an effect modifier of the associations found. Conclusions: Some maternal complications during pregnancy and at delivery may increase the risk of developing different phenotypes of wheezing in childhood.
Key Words: asthma • perinatal • programming
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