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Published on: August 7, 2017
Modelling maternal and perinatal risk factors to predict poorly controlled childhood asthma
Samuel Schäfer1,2, Kevin Wang3, Felicia Sundling1
1Sydney Medical School-Nepean, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia.
Insights
Maternal and perinatal factors influence childhood asthma hospitalizations differently in boys and girls. Understanding these sex-specific risks can improve asthma control and future research.
Area of Science:
- Pulmonology and Environmental Health
- Pediatric Respiratory Medicine
- Reproductive Health and Perinatal Medicine
Background:
- Childhood asthma is a common non-communicable pulmonary condition, with higher prevalence in prepubertal boys.
- Existing research often overlooks sex-specific differences in asthma development and progression.
- Maternal and perinatal factors are potential contributors to childhood asthma, but their sex-dependent influence requires further investigation.
Purpose of the Study:
- To investigate the association between maternal and perinatal risk factors and poorly controlled childhood asthma.
- To explore sex-specific differences in these associations.
- To identify key predictors for multiple asthma-related hospital admissions in children.
Main Methods:
- Retrospective analysis of 1694 children's electronic obstetric and pediatric records from a single Australian metropolitan teaching hospital.
- Backward-eliminated Poisson regression modeling to identify risk factors for multiple asthma hospital admissions.
- Independent confirmation of parameter stability using approximated exhaustive search and Receiver Operating Characteristic (ROC) analysis.
Main Results:
- For girls, parity, birth length z-score, and birth weight z-score were significant risk factors for multiple asthma admissions.
- For boys, maternal Body Mass Index (BMI) and threatened preterm labor were prominent risk factors.
- Allergic status was a risk factor for both sexes, with predictive modeling showing higher accuracy for girls (AUC=0.84) than boys (AUC=0.75) for >3 admissions.
Conclusions:
- Maternal and perinatal risk factors are associated with multiple childhood asthma hospital admissions in a sex- and birth order-dependent manner.
- These findings highlight the need for sex-specific risk stratification strategies to improve childhood asthma management.
- Further research should explore the in utero environment's influence on sex differences in respiratory conditions.
Abstract:
Asthma is the most common non-communicable pulmonary condition, affecting prepubertal boys more often than girls. This study explored how maternal and perinatal risk factors are linked to poorly controlled childhood asthma in a sex dependent manner. This single centre study was performed at a metropolitan teaching hospital in Western Sydney, Australia, using electronical obstetric records from 2000 to 2017 and electronical pediatric records from 2007 to 2018. The data of 1694 children with complete entries were retrospectively analysed. Risk factors for multiple hospital admission for asthma were selected by backward-eliminated Poisson regression modelling. Selection stability of these parameters was independently confirmed using approximated exhaustive search. Sex-specific regression models indicated that most notably parity (RR[95%CI] for parity = 3; 1.85[1.22-2.81]), birth length z-score (1.45[1.23-1.70]) and birth weight z-score (0.77[0.65-0.90]) contributed to multiple asthma admissions in girls, while boys were affected most prominently by maternal BMI (e.g. BMI 35-39.9; 1.92[1.38-2.67]) and threatened preterm labor (1.68[1.10-2.58]). Allergic status was a risk factors for both boys and girls (1.47[1.18-1.83] and 1.46[1.13-1.89]). Applying ROC analysis, the predictive modelling of risk factors for hospital admissions showed an incremental increase with an AUC of 0.84 and 0.75 for girls and boys respectively for >3 hospital admissions. Multiple hospital admissions for asthma are associated with maternal and perinatal risk factors in a sex and birth order dependent manner. Hence, prospective risk stratification studies aiming to improve childhood asthma control are warranted to test the clinical utility of these parameters. Furthermore, the influence of the early in utero environment on male-female differences in other communicable and non-communicable respiratory conditions should be considered.
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