Perinatal exposures and Kawasaki disease in Washington State: a population-based, case-control study
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Kristen Hayward1, Carol A Wallace, Thomas Koepsell
1Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA. kristen.hayward@seattlechil-drens. org
Insights
Certain perinatal exposures, including maternal age and early infant hospitalization for bacterial illness, are linked to Kawasaki Disease (KD). Further research into early infectious exposures and KD is warranted.
Area of Science:
- Pediatric epidemiology
- Immunology
- Environmental health
Background:
- Kawasaki Disease (KD) is a significant childhood illness with unknown etiology.
- Investigating perinatal exposures may reveal insights into KD development.
- This study explores links between early life exposures and later KD diagnosis.
Purpose of the Study:
- To test the hypothesis that specific perinatal exposures are associated with Kawasaki Disease in later childhood.
- To identify potential risk factors for KD development.
- To explore the influence of gender on these associations.
Main Methods:
- Retrospective, population-based, case-control study.
- Utilized hospital discharge records, birth certificates, and birth hospitalization records (1987-2007) in Washington State.
- Employed unconditional logistic regression to analyze associations between perinatal exposures and KD, adjusting for covariates.
Main Results:
- Maternal age ≥35 years, foreign-born mothers, and early infancy hospitalization were significantly associated with KD.
- Early hospitalization for bacterial illness showed a 2.8-fold increased risk of KD.
- Maternal Group B streptococcal colonization was associated with a reduced risk of KD.
Conclusions:
- Preliminary evidence suggests associations between certain perinatal exposures and Kawasaki Disease.
- Highlights the possibility of late biological effects from immune exposures during infancy.
- Emphasizes the need for further investigation into the link between early infectious exposures and KD.
Background:
This study tested the hypothesis that selected perinatal exposures are associated with Kawasaki Disease (KD) in later childhood.
Methods:
A retrospective, population-based, case-control study was performed. Children hospitalized for KD in Washington State from 1987 to 2007 (n = 995) were identified through hospital discharge records and were linked to birth certificates and birth hospitalization discharge records. Controls were randomly selected from remaining birth records. Maternal and infant exposure information was obtained from hospital discharge records. Unconditional logistic regression was used to obtain adjusted relative risk estimates and to explore the effect of gender on observed associations.
Results:
After adjusting for race, gender and birth year, the following were significantly associated with KD: maternal age ≥35 years (odds ratio [OR] 1.65; [95% confidence interval: 1.20-2.27]); mother of foreign birth (OR 1.36; [1.06-1.75]); maternal Group B streptococcal colonization (OR 0.51; [0.26-0.97]); and early infancy hospitalization (OR 1.42; [1.04-1.93]). Early hospitalization for bacterial illness was associated with a 2.8-fold increased risk of KD (OR 2.84; [1.59-5.06]). There was weak evidence to suggest that the association between early hospitalization and KD varies by gender.
Conclusions:
This study provides preliminary evidence of association between certain perinatal exposures and KD and raises the possibility of late biological effects of immune exposures during infancy. The association between KD and early infectious exposures deserves further study.
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