Published ahead of print on September 22, 2006, doi:10.1164/rccm.200512-1978OC Am. J. Respir. Crit. Care Med., Volume 175, Number 1, January 2007, 16-21 A more recent version of this article appeared on January 1, 2007
Submitted on December 29, 2005 Maternal Complications and Procedures in Pregnancy and at Birth and Wheezing Phenotypes in ChildrenFranca Rusconi1*,1 Unit of Epidemiology, "Anna Meyer" Children's Hospital, Florence, Italy, 2 Unit of Cancer Epidemiology, San Giovanni Battista Hospital-Center of Cancer Prevention (CPO), Piedmont, Turin, Italy, 3 Department of Epidemiology, Rome E Local Health Authority, Rome, Italy, 4 Department of Pediatrics I, University of Milan, Milan, Italy, 5 Department of Pediatrics I, University of Bari, Bari, Italy, 6 Center of Study and Prevention of Cancer (CSPO), Florence, Italy, 7 Department of Respiratory Physiology, Catholic University of Rome, Rome, Italy, 8 Pediatric Pulmonology and Allergology Service, ARNAS, IBIM National Research Council, Palermo, Italy, 9 Pediatric Pulmonology Service, "Anna Meyer" Children's Hospital, Florence, Italy, 10 Unit of Epidemiology, Provincial Health Authority, Trento, Italy, 11 Unit of Preventive Medicine, Local Health Authority, Mantova, Italy, 12 Department of Statistics, University of Florence, Florence, Italy, 13 Wellington, New Zealand and, Unit of Cancer Epidemiology, Department of Biomedical Sciences and Human Oncology, University of Turin, Center for Public Health Research, Massey University Wellington Campus, Italy, 14 SIDRIA-2 Collaborative Group, Italy * To whom correspondence should be addressed. 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 years, enrolled in a population-based study. Standardized questionnaires were completed by the children's mothers. Results: 9.5% (1,478) of children had transient early wheezing, 5.4% (884) had persistent wheezing, and 6.1% (948) had late-onset wheezing. Maternal hypertension or preeclampsia were associated with an increased risk of all three wheezing phenotypes [Odds Ratio (OR): 1.40, 95% confidence interval (95% CI): 1.08-1.82 for transient early wheezing, OR: 1.59 (95% CI: 1.15-2.19) for persistent wheezing, and OR:1.47 (95%CI: 1.06-2.01) for late-onset wheezing]. Use of antibiotics for urinary tract infections was associated with transient early wheezing (OR: 1.52; 95% CI: 1.16-2.00), while 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 or cesarean section were 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,programming,perinatal
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