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First trimester invasive procedures: effects on symptom status and lung volume in very young children
A Greenough1, B Yuksel, S Naik
1Department of Child Health, King's College Hospital, London, United Kingdom. a.greenough@kcl.ac.uk
Insights
First trimester invasive procedures like early amniocentesis and chorion villus sampling are linked to increased respiratory issues in young children. These interventions may negatively impact infant lung health and increase hospital admissions for respiratory problems.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- First trimester invasive procedures, including early amniocentesis (EA) and chorion villus sampling (CVS), are potential risk factors for perinatal lung function abnormalities.
- Understanding the long-term respiratory implications of these procedures is crucial for informed clinical practice and patient counseling.
Purpose of the Study:
- To evaluate the association between first trimester invasive procedures (EA and CVS) and respiratory morbidity in very young children.
- To identify specific respiratory symptoms and outcomes related to these prenatal interventions.
Main Methods:
- A cohort study involving 439 EA, 453 CVS, and 435 control infants, assessed at one year using questionnaires and diary cards.
- Prospective follow-up data and functional residual capacity (FRC) measurements at a median age of 5 months were collected.
- Logistic regression analysis was used to identify factors associated with respiratory symptoms.
Main Results:
- Infants exposed to EA showed a significantly higher incidence of respiratory symptoms (31%) compared to CVS (22%) and control groups (17%).
- EA was also associated with a higher rate of chest-related hospital admissions (3% vs. 0.4% in controls).
- Both EA and CVS were significant predictors of respiratory symptoms, alongside bottle feeding, parental smoking, family history of atopy, and immaturity.
Conclusions:
- First trimester invasive procedures, particularly early amniocentesis, are associated with increased respiratory morbidity in early childhood.
- These findings suggest a need for closer respiratory monitoring in infants whose mothers underwent invasive procedures during the first trimester.
- Further research may explore the mechanisms linking these procedures to altered lung development and function.
Abstract:
First trimester procedures have been associated with perinatal lung function abnormalities that may suggest subsequent respiratory problems. Our aim was, therefore, to assess the impact of first trimester invasive procedures [early amniocentesis (EA) and chorion villus sampling (CVS)] on respiratory morbidity in very young children. A questionnaire was issued to parents of 439 EA and 453 CVS (subjects), and 435 controls (their mothers had undergone no invasive procedures) when their children were one year old. Data were also obtained from diary cards issued to a subset of 278 of the EA, 262 of the CVS, and 264 of the control infants followed prospectively. Functional residual capacity (FRC) was measured at a median age of 5 months (range: 0.25-24) in 159 children whose mothers had undergone EA, 168 following CVS and in 165 controls. Analysis of the one-year questionnaire demonstrated an excess of symptomatic infants in the EA group (31%) compared to the CVS (22%; P < 0.01) and control groups (17%; P < 0.01). Findings from the prospective follow-up study confirmed those results and also demonstrated an increase in chest-related hospital admissions in the EA group (3%) compared to the controls (0.4%; P < 0.05). Logistic regression analysis revealed that positive symptom status related significantly to EA and CVS interventions (P < 0.0001), bottle feeding (P < 0.001), parental smoking (P < 0.01), a family history of atopy (P < 0.01), and immaturity (P < 0.01). In the control group, FRC correlated best with weight (r = 0.92). The mean FRC of the EA and CVS groups was higher than that of the controls (P < 0.01). A higher proportion of children had an FRC two standard deviations above the controls' mean in the EA group (n = 14) compared to the CVS group (n = 3; P < 0.01). The symptomatic infants tended to have higher FRCs than the asymptomatic children. We conclude that first trimester procedures are associated with increased respiratory morbidity in very young children.