Background Maternal psychological distress during pregnancy might affect fetal lung development and subsequently predispose children to childhood asthma. Objective We sought to assess the ...associations of maternal psychological distress during pregnancy with early childhood wheezing. Methods We performed a population-based prospective cohort study among 4848 children. We assessed maternal and paternal psychological distress at the second trimester of gestation and 3 years after delivery and maternal psychological distress at 2 and 6 months after delivery by using the Brief Symptom Inventory questionnaire. Wheezing in the children was annually examined by using questionnaires from 1 to 4 years. Physician-diagnosed ever asthma was reported at 6 years. Results Mothers with psychological distress during pregnancy had increased odds of wheezing in their children from 1 to 4 years of life (overall distress: odds ratio OR, 1.60 95% CI, 1.32-1.93; depression: OR, 1.46 95% CI, 1.20-1.77; and anxiety: OR, 1.39 95% CI, 1.15-1.67). We observed similar positive associations with the number of wheezing episodes, wheezing patterns, and physician-diagnosed asthma at 6 years. Paternal distress during pregnancy and maternal and paternal distress after delivery did not affect these results and were not associated with childhood wheezing. Conclusion Maternal psychological distress during pregnancy is associated with increased odds of wheezing in their children during the first 6 years of life independent of paternal psychological distress during pregnancy and maternal and paternal psychological distress after delivery. These results suggest a possible intrauterine programming effect of maternal psychological distress leading to respiratory morbidity.
Background
Breastfeeding is associated with a lower risk of asthma symptoms in early childhood, but its effect at older ages remains unclear. We examined the associations of duration and ...exclusiveness of breastfeeding with asthma outcomes in children aged 6 years, and whether these associations were explained by atopic or infectious mechanisms.
Methods
We performed a population‐based prospective cohort study among 5675 children. Information about breastfeeding was collected by questionnaires. At age 6 years, we measured interrupter resistance (Rint) and fractional exhaled nitric oxide (FeNO). Information about wheezing patterns (early (≤3 years only), late (>3 years only), persistent (≤3 and >3 years)), and current asthma at 6 years was derived from repeated questionnaires.
Results
Compared to children who were ever breastfed, those who were never breastfed had lower FeNO levels (sympercent (95% CI): ‐16.0 (‐24.5, ‐7.5)) and increased risks of late and persistent wheezing (OR(95% CI): 1.69 (1.06, 2.69) and 1.44 (1.00, 2.07), respectively). Shorter duration of breastfeeding was associated with early wheezing and current asthma (1.40 (1.14, 1.73) and 2.19 (1.29, 3.71), respectively). Less exclusive breastfeeding was associated with early wheezing (1.28 (1.08, 1.53)). Breastfeeding duration and exclusiveness were not associated with FeNO or Rint. The associations were not explained by inhalant allergies, partly by lower respiratory tract infections in early life, and to a lesser extent by lower respiratory tract infections in later life.
Conclusions
Breastfeeding patterns may influence wheezing and asthma in childhood, which seems to be partly explained by infectious mechanisms.
Background Low birth weight and rapid infant growth in early infancy are associated with increased risk of childhood asthma, but little is known about the role of postinfancy growth in asthmatic ...children. Objectives We sought to examine the associations of children's growth patterns with asthma, bronchial responsiveness, and lung function until adolescence. Methods Individual growth trajectories from birth until 10 years of age were estimated by using linear spline multilevel models for 9723 children participating in a population-based prospective cohort study. Current asthma at 8, 14, and 17 years of age was based on questionnaires. Lung function and bronchial responsiveness or reversibility were measured during clinic visits at 8 and 15 years of age. Results Rapid weight growth between 0 and 3 months of age was most consistently associated with increased risks of current asthma at the ages of 8 and 17 years, bronchial responsiveness at age 8 years, and bronchial reversibility at age 15 years. Rapid weight growth was associated with lung function values, with the strongest associations for weight gain between 3 and 7 years of age and higher forced vital capacity (FVC) and FEV1 values at age 15 years (0.12 95% CI, 0.08 to 0.17 and 0.11 95% CI, 0.07 to 0.15, z score per SD, respectively) and weight growth between 0 and 3 months of age and lower FEV1 /FVC ratios at age 8 and 15 years (−0.13 95% CI, −0.16 to −0.10 and −0.04 95% CI, −0.07 to −0.01, z score per SD, respectively). Rapid length growth was associated with lower FVC and FVC1 values at age 15 years. Conclusion Faster weight growth in early childhood is associated with asthma and bronchial hyperresponsiveness, and faster weight growth across childhood is associated with higher FVC and FEV1 values.
Objectives
To assess the associations of folate, homocysteine and vitamin B12 levels of children at birth and their methylenetetrahydrofolate reductase (MTHFR) variants with asthma and eczema in ...childhood.
Methods
This study was embedded in a population‐based prospective cohort study (n = 2,001). Neonatal cord blood folate, homocysteine and vitamin B12 levels were measured, and MTHFR C677T and A1298C genotyped. Wheezing and physician‐diagnosed eczema were annually obtained by questionnaire until 4 years. At 6 years, we collected information on physician‐diagnosed asthma ever and self‐reported eczema ever, measured fractional exhaled nitric oxide (FeNO), and interrupter resistance (Rint). Data were analysed with generalized estimating equations or logistic regression: continuous outcomes with linear regression models.
Results
Folate, homocysteine and vitamin B12 levels of children at birth were not associated with wheezing or eczema until 4 years, asthma and eczema ever, or FeNO or Rint at 6 years. In children carrying C677T mutations in MTHFR, higher folate levels were associated with an increased risk of eczema (repeated eczema until 4 years: OR 1.40 (95% CI 1.09–1.80) (SD change) P‐interaction = 0.003, eczema ever at 6 years: OR 1.41 (0.97–2.03) P‐interaction = 0.011). No interactions between MTHFR and child folate and homocysteine levels were observed for wheezing and asthma.
Conclusions
Folate, homocysteine and vitamin B12 levels of children at birth did not affect asthma‐ and eczema‐related outcomes up to the age of 6 years. Further studies are warranted to establish the role of MTHFR variants in these associations.
Maternal fish consumption during pregnancy might influence the fetal immune system through anti-inflammatory effects of omega-3 fatty acids, and might affect the risks of childhood asthma and atopy. ...In Generation R, a prospective cohort study in the Netherlands, we examined the associations of first trimester fish consumption with childhood wheezing and eczema in the first 4 years of life.
In total, 2976 mothers completed a 293-item semiquantitative food frequency questionnaire covering dietary intake in the first trimester. The occurrence of wheezing and eczema was yearly assessed by questionnaires.
Median weekly fish consumption was 83 (95% range 0-316) grams per week. We observed no consistent associations of maternal total-, lean- or fatty-fish consumption during pregnancy with the risks of childhood wheezing. Maternal shellfish consumption of 1-13 g per week was associated with overall increased risks of childhood wheezing and eczema (OR 1.20 (1.04, 1.40) and OR 1.18 (1.01, 1.37), respectively). Maternal fatty fish consumption of 35-69 g per week was associated with increased overall risks of childhood eczema (OR 1.17 (1.00, 1.38)), but maternal total- or lean-fish consumption was not.
During pregnancy, shellfish consumption was associated with increased risks of wheezing and eczema, while fatty fish consumption was associated with a higher risk of eczema only. Maternal total fish or lean fish consumption were not associated with wheezing or eczema. Further studies are needed to replicate these findings and to explore underlying mechanisms.
Summary
Background
Helicobacter pylori prevalence in Western countries has been declining simultaneously with increases in childhood asthma and allergic diseases; prior studies have linked these ...phenomena.
Aims
To examine the association between H. pylori colonisation in children and risk of asthma and related conditions at school age. We secondly examined additional effects of maternal H. pylori status by pairing with children's status.
Methods
This study was embedded in a multi‐ethnic population‐based cohort in Rotterdam, The Netherlands. We measured anti‐H. pylori and anti‐CagA antibodies in serum of children obtained at age 6 years, and of their mothers obtained during midpregnancy. Asthma or related conditions were reported for children at age 6 years. We used multivariate logistic regression analyses among 3797 subjects.
Results
In children, the H. pylori positivity rate was 8.7%, and 29.2% of these were CagA‐positive. A child's colonisation with a CagA‐negative‐H. pylori strain was associated with an increased risk of asthma (Odds ratio 2.11; 95% CI 1.23–3.60), but this differed for European (3.64; 1.97–6.73) and non‐European (0.52; 0.14–1.89) children. When taking into account maternal H. pylori status, only H. pylori‐positive children with an H. pylori‐negative mother had increased risk of asthma (2.42; 1.11–5.27), accounting for 3.4% of the asthma risk.
Conclusions
Colonisation of a European child with a CagA‐negative‐H. pylori strain at age 6 was associated with an increased prevalence of asthma, but there was no association for non‐European children. The underlying mechanisms for the observed risk differences require further research.
We studied the associations of maternal pre-pregnancy body mass index and gestational weight gain with risks of preschool wheezing in offspring and explored the role of growth, infectious and atopic ...mechanisms. This substudy of 4656 children was embedded in a population-based birth cohort. Information about maternal pre-pregnancy weight, gestational weight gain and wheezing at the ages of 1-4 years was obtained by either physical measurements or questionnaires. Among mothers with a history of asthma or atopy, maternal pre-pregnancy obesity was associated with an overall increased risk of preschool wheezing (odds ratio 1.47, 95% confidence interval 1.12-1.95). Also, each standard deviation increase of gestational weight gain was associated with an increased overall risk of preschool wheezing (1.09, 1.04-1.14), was independent of pre-pregnancy body mass index and was not different between mothers with and without a history of asthma or atopy. Child's growth, respiratory tract infections or eczema did not alter the results. Mothers with pre-pregnancy obesity and a history of asthma or atopy, and mothers with higher gestational weight gain showed higher risks of wheezing in their offspring. These associations could not be explained by growth, infectious or atopic mechanisms. Further research is needed to identify underlying mechanisms and long-term consequences.
Purpose: Primary care COPD guidelines indicate that COPD patients with asthma characteristics should be treated as having asthma. This study aims to describe the prevalence of asthma characteristics ...in patients with a pulmonologist-confirmed working diagnosis of COPD or ACO. Patients and Methods: This retrospective cross-sectional study used real-life data (collected between 2007 and 2017) from a Dutch asthma/COPD-service, a structured web-based system in which pulmonologists support general practitioners in their diagnosis of patients with suspicion of obstructive lung disease. The prevalence of asthma characteristics (history of asthma, atopy, symptoms, and reversibility) and blood eosinophil (Eos) counts were assessed in patients with a working diagnosis of COPD or ACO. Results: Of the 14,141 patients, greater than or equal to40 years in the dataset, 4475 (31.6%) were diagnosed with asthma, 3532 (25.0%) with COPD, and 1276 (9.0%) with ACO. Asthma characteristics were present in 65.6% (n=1956) of the COPD and 90.9% (n=1059) of the ACO patients. Eos counts of greater than or equal to 300 cells per microL were found in 35.7% (n=924) of the COPD patients and 35.3% (n=341) of the ACO patients. Conclusion: In this group of COPD and ACO patients remotely diagnosed by pulmonologists, a substantial proportion would be considered to have asthma characteristics according to the guidelines. This may explain the high number of inhaled corticosteroid (ICS) prescriptions found in primary care COPD patients. Prospective studies are necessary to identify patients who may or may not benefit from ICS containing treatment. Hence, personalized care in primary care can be optimized. Keywords: chronic obstructive pulmonary disease, asthma COPD overlap, asthma characteristics, guidelines
Low birth weight is associated with an increased risk of wheezing in childhood.
We examined the associations of longitudinally measured fetal and infant growth patterns with the risks of asthma ...symptoms in preschool children.
This study was embedded in a population-based prospective cohort study among 5,125 children. Second- and third-trimester fetal growth characteristics (head circumference, femur length, abdominal circumference, and weight) were estimated by repeated ultrasounds. Infant growth (head circumference, length, and weight) was measured at birth and at the ages of 3, 6, and 12 months. Parental report of asthma symptoms until the age of 4 years was yearly obtained by questionnaires.
Both fetal restricted and accelerated growth, defined as a negative or positive change of more than 0.67 standard deviation score, were not associated with asthma symptoms until the age of 4 years. Accelerated weight gain from birth to 3 months following normal fetal growth was associated with increased risks of asthma symptoms (overall odds ratio for wheezing: 1.44 95% confidence interval: 1.22, 1.70; shortness of breath: 1.32 1.12, 1.56; dry cough: 1.16 1.01, 1.34; persistent phlegm: 1.30 1.07, 1.58), but not with eczema (0.95 0.80, 1.14). These associations were independent of other fetal growth patterns and tended to be stronger for children of atopic mothers than for children of nonatopic mothers.
Weight-gain acceleration in early infancy was associated with increased risks of asthma symptoms in preschool children, independent of fetal growth. Early infancy might be a critical period for the development of asthma.
The aim of our study was to examine the associations of breastfeeding duration and exclusiveness with the risks of asthma-related symptoms in preschool children, and to explore whether these ...associations are explained by atopic or infectious mechanisms. This study was embedded in a population-based prospective cohort study of 5,368 children. Information on breastfeeding duration, exclusiveness and asthma-related symptoms, including wheezing, shortness of breath, dry cough and persistent phlegm, was obtained by questionnaires. Compared with children who were breastfed for 6 months, those who were never breastfed had overall increased risks of wheezing, shortness of breath, dry cough and persistent phlegm during the first 4 yrs (OR 1.44 (95% CI 1.24-1.66), 1.26 (1.07-1.48), 1.25 (1.08-1.44) and 1.57 (1.29-1.91), respectively). Similar associations were observed for exclusive breastfeeding. The strongest associations per symptom per year were observed for wheezing at 1 and 2 yrs. Additionally adjusted analyses showed that the associations of breastfeeding with asthma-related symptoms were not explained by eczema but partly by lower respiratory tract infections. Shorter duration and nonexclusivity of breastfeeding were associated with increased risks of asthma-related symptoms in preschool children. These associations seemed, at least partly, to be explained by infectious, but not by atopic, mechanisms.
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