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Pre-eclampsia and risk of early-childhood asthma: a register study with sibling comparison and an exploration of
Kristine Kjer Byberg1,2, Cecilia Lundholm1, Bronwyn K Brew1,3
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
Insights
Severe pre-eclampsia in mothers is linked to a higher risk of childhood asthma, even after accounting for family history and other factors. This association was particularly strong for asthma developing before age two.
Area of Science:
- Obstetrics and Gynecology
- Pediatrics
- Respiratory Medicine
Background:
- Pre-eclampsia is a serious pregnancy complication.
- Childhood asthma is a significant public health concern.
- Understanding the link between maternal health and child respiratory outcomes is crucial.
Purpose of the Study:
- To investigate the association between maternal pre-eclampsia and childhood asthma.
- To differentiate between allergic and non-allergic asthma in relation to pre-eclampsia.
- To account for familial factors and intermediate variables in the analysis.
Main Methods:
- Utilized Swedish national health registers for a large cohort (779,711 children).
- Employed Cox regression for incident asthma and logistic regression for prevalent asthma.
- Controlled for familial factors using sibling comparisons and stratified analyses for intermediate variables.
Main Results:
- Severe pre-eclampsia showed a significant association with asthma, particularly in children under two years old (adjHR 1.78).
- This association persisted after sibling comparison (adjHR 1.45) and stratification for intermediate risks.
- Both mild/moderate and severe pre-eclampsia were linked to non-allergic asthma at age six, but not allergic asthma.
Conclusions:
- Severe pre-eclampsia is independently associated with an increased risk of childhood asthma.
- The link between severe pre-eclampsia and asthma is robust, independent of shared familial factors.
- Pre-eclampsia may influence the development of non-allergic asthma in offspring.
Background:
We aimed to study whether pre-eclampsia is associated with childhood asthma, allergic and non-allergic asthma, accounting for family factors and intermediate variables.
Methods:
The study population comprised 779 711 children born in 2005-2012, identified from Swedish national health registers (n = 14 823/7410 exposed to mild/moderate and severe pre-eclampsia, respectively). We used Cox regression to estimate the associations of mild/moderate and severe pre-eclampsia with incident asthma, before and after age 2 years. Cox regressions were controlled for familial factors using sibling comparisons, then stratified on high and low risk for intermediate variables: caesarean section, prematurity and small for gestational age. We used logistic regression for allergic and non-allergic prevalent asthma at 6 years as a measure of more established asthma.
Results:
The incidence of asthma in children was 7.7% (n = 60 239). The associations varied from adjusted hazard ratio (adjHR) 1.11, 95% confidence interval (CI): 1.00, 1.24 for mild/moderate pre-eclampsia and asthma at >2 years age, to adjHR 1.78, 95% CI: 1.64, 1.95 for severe pre-eclampsia and asthma at <2 years age. Sibling comparisons attenuated most estimates except for the association between severe pre-eclampsia and asthma at <2 years age (adjHR 1.45, 95% CI: 1.10, 1.90), which also remained when stratifying for the risk of intermediates. Mild/moderate and severe pre-eclampsia were associated with prevalent non-allergic (but not allergic) asthma at 6 years, with adjusted odds ratio (adjOR) 1.17, 95% CI: 1.00, 1.36 and adjOR 1.51, 95% CI: 1.23, 1.84, respectively.
Conclusions:
We found evidence that severe, but not mild/moderate, pre-eclampsia is associated with asthma regardless of familial factors and confounders.
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