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Published on: August 7, 2017
Perinatal risk factors for wheezing phenotypes in the first 8 years of life
D Caudri1, O E M Savenije, H A Smit
1Department of Pediatrics/Respiratory Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Identifying specific risk factors for childhood wheezing phenotypes is key for prevention. Modifiable factors like maternal health and infant care practices offer targets for early intervention programs.
Area of Science:
- Pediatric Allergy and Pulmonology
- Birth Cohort Studies
- Epidemiology
Background:
- Wheezing is common in preschoolers, with distinct phenotypes identified.
- The Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort study identified five wheezing phenotypes.
- Perinatal risk factors associated with these phenotypes remain largely unknown.
Purpose of the Study:
- To investigate associations between perinatal factors and distinct wheezing phenotypes in children.
- To identify potential targets for preventive strategies against childhood wheezing.
Main Methods:
- Utilized data from the PIAMA birth cohort (n=3963) with perinatal factors collected at 3 months.
- Wheezing was monitored annually until age 8.
- Weighted multinomial logistic regression models analyzed associations between perinatal risk factors and wheezing phenotypes, adjusting for confounders.
Main Results:
- Transient early wheeze linked to male gender, parental allergy, maternal factors (age, BMI, smoking), and early life exposures (siblings, daycare).
- Persistent wheeze associated with male gender, parental allergy, and shorter breastfeeding duration.
- Intermediate onset wheeze linked to lower birth weight; late onset wheeze linked to maternal allergy.
Conclusions:
- Different perinatal risk factors are associated with specific childhood wheezing phenotypes.
- Modifiable factors including maternal age, BMI, smoking cessation, breastfeeding, and daycare attendance represent potential targets for prevention programs.
Background:
A novel data-driven approach was used to identify wheezing phenotypes in pre-schoolchildren aged 0-8 years, in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort. Five phenotypes were identified: never/infrequent wheeze, transient early wheeze, intermediate onset wheeze, persistent wheeze and late onset wheeze. It is unknown which perinatal risk factors drive development of these phenotypes.
Objective:
The objective of the study was to assess associations of perinatal factors with wheezing phenotypes and to identify possible targets for prevention.
Methods:
In the PIAMA study (n = 3963), perinatal factors were collected at 3 months, and wheezing was assessed annually until the age of 8 years. Associations between perinatal risk factors and the five wheezing phenotypes were assessed using weighted multinomial logistic regression models. Odds ratios were adjusted for confounding variables and calculated with 'never/infrequent wheeze' as reference category.
Results:
Complete data were available for 2728 children. Risk factors for transient early wheeze (n = 455) were male gender, maternal and paternal allergy, low maternal age, high maternal body mass index, short pregnancy duration, smoking during pregnancy, presence of older siblings and day-care attendance. Risk factors for persistent wheeze (n = 83) were male gender, maternal and paternal allergy, and not receiving breastfeeding for at least 12 weeks. Intermediate onset wheeze (n = 98) was associated with a lower birth weight and late onset wheeze (n = 45) with maternal allergy.
Conclusion And Clinical Relevance:
We identified different risk factors for specific childhood wheezing phenotypes. Some of these are modifiable, such as maternal age and body mass index, smoking, day-care attendance and breastfeeding, and may be important targets for prevention programmes.
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