Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children

Abstract

BackgroundPreterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results.ObjectivesWe performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years).MethodsFirst, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes.ResultsYounger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27).ConclusionYounger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth.

Wheezing, asthma, and atopy in premature infants at 2 years of age

“…A recent analysis by Rzehak et al observed an increased incidence of asthma until the age of 6 years with a high gain of body mass index in the first 2 years in 8 European cohort studies with 12,050 participants (26). Sonnenschein-van der Voort described increased risk for wheezing and asthma in children with an increased infant weight gain (27). Cesarean section has been associated with the development of asthma and recurrent wheezing (28).…”

Early-life origins of chronic respiratory diseases: understanding and promoting healthy ageing

“…A recent meta-analysis on 147 000 European infants showed that gestational age, even beyond 37 weeks, correlated inversely with the risk of asthma at school age [37]. This may be explained by higher concentrations in the amniotic fluid of signals such as proinflammatory mediators that would induce fetal lung maturation [37].…”

“…This may be explained by higher concentrations in the amniotic fluid of signals such as proinflammatory mediators that would induce fetal lung maturation [37]. Variations in amniotic fluid composition may also help to explain why preterm birth and caesarean section are risk factors for asthma.…”

Maternal antibiotic use and child asthma: is the association causal?

“…Maternal asthma, and exposure to cigarette smoke and air pollution in pregnancy are among the factors known to increase offspring risk for asthma [7,8]. Preterm birth and low birth weight have also been associated with asthma risk [9]. More recently, several lines of investigation have provided intriguing evidence that perturbations to the natural mother-to-newborn transfer of microbial life may also play an important role in asthma pathogenesis.…”