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Birth weight and childhood wheezing disorders: a systematic review and meta-analysis
Teumzghi F Mebrahtu1, Richard G Feltbower1, Darren C Greenwood1
1Division of Epidemiology and Biostatistics, School of Medicine, University of Leeds, Leeds, UK.
Insights
Low birth weight (<2.5kg) is an independent risk factor for childhood wheezing disorders, but high birth weight is not associated. This meta-analysis clarifies the link between birth weight and respiratory health in children.
Area of Science:
- Pediatric Respiratory Medicine
- Epidemiology
- Perinatal Health
Background:
- Previous studies on birth weight and childhood wheezing disorders yielded inconsistent results.
- Existing systematic reviews and meta-analyses have reported conflicting findings.
- A comprehensive systematic review and meta-analysis was needed to clarify these associations.
Purpose of the Study:
- To systematically review and meta-analyze existing studies investigating the relationship between birth weight and childhood wheezing disorders.
- To determine if low birth weight or high birth weight are independent risk factors for wheezing disorders.
- To assess the robustness of these risk associations and quantify heterogeneity.
Main Methods:
- Conducted an online literature search of EMBASE and Medline databases up to February 2014.
- Included 37 studies with a total of 1,717,737 participants.
- Estimated summary odds ratios (ORs) using random-effects models and performed subgroup meta-analyses.
Main Results:
- Low birth weight (<2.5kg) was associated with an increased risk of childhood wheezing disorders (OR=1.60 for <2.5kg vs ≥2.5kg; OR=1.37 for <2.5kg vs 2.5-4.0kg).
- High birth weight (>4kg) showed no significant association with wheezing disorders (OR=1.02 vs 2.5-4.0kg).
- Substantial heterogeneity was observed in low birth weight risk estimates, with some evidence of small study effects.
Conclusions:
- Low birth weight (<2.5kg) is identified as an independent risk factor for wheezing disorders in childhood and adolescence.
- No significant association was found between high birth weight and childhood wheezing disorders.
- Heterogeneity among low birth weight risk estimates warrants further investigation.
Background:
Previous observational studies have claimed that birth weight and childhood wheezing disorders are associated although the results remained inconsistent. One systematic review and two systematic reviews that included meta-analyses reported inconsistent results. We aimed to conduct a systematic review and meta-analysis to investigate this.
Methods:
An online search of published papers linking childhood asthma and wheezing disorders with birth weight up to February 2014 was carried out using EMBASE and Medline medical research databases. Summary ORs were estimated using random-effects models. Subgroup meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity.
Results:
A total of 37 studies comprising 1,71, 737 participants were included in our meta-analysis. The unadjusted summary ORs for risk of childhood wheezing disorders associated with low birth weight (<2.5 kg) were 1.60 (95% CI 1.39 to 1.85, p<0.001) and 1.37 (95% CI 1.05 to 1.79, p=0.02) when compared with ≥2.5 and 2.5-4.0 kg birthweight groups, respectively. The overall summary OR for high birth weight (>4 kg) as compared to the 2.5-4.0 kg birthweight group was 1.02 (95% CI 0.99 to 1.04, p=0.13). There was substantial heterogeneity in the unadjusted low birth weight risk estimates which was not accounted for by predefined study characteristics. There was no significant heterogeneity in the high birth weight risk estimates. There was some evidence of funnel plot asymmetry and small study effects in the low birth weight (2.5 vs ≥2.5 kg and <2.5 vs 2.5-4 kg) OR estimates.
Conclusions:
Our results suggest that low birth (<2.5 kg) is an independent risk factor for wheezing disorders during childhood and adolescence although there was substantial heterogeneity among the risk estimates. However, we found no significant association of high birth weight with wheezing disorders.
