Maternal and neonatal risk factors of asthma in children: Nationwide population based study

Residential greenness and pollen exposure across gestational trimesters in relation to preschool wheezing: Results for the PIPO birth cohort

INTRODUCTION

Previous studies on prenatal green space exposure and early respiratory health show inconsistent results. This may reflect stage-specific in utero effects and pollen influence. We examine associations of surrounding greenness and pollen exposure during pregnancy (overall and by trimester) with preschool wheezing, and assess potential mediation by pollen.

METHODS

We used data from the PIPO birth cohort (n = 860). Wheezing was reported biannually between 18 and 48 months of age. Residential greenness was measured with Normalized Difference Vegetation Index (NDVI) in 100 and 250 m buffer. Cumulative grass and birch pollen was estimated using modelled airborne pollen counts and categorized per trimester into no, low and high. All exposures were assessed for the overall pregnancy and per trimester. We used Generalized Estimated Equations to obtain odds ratios (OR) and 95% confidence intervals (CI). To assess mediation by pollen we used a data duplication algorithm with a generalized estimation approach.

RESULTS

Approximately 10% of participants wheezed. During pregnancy, greenness (OR = 1.07, CI: 1.05-1.08) and grass pollen exposure (OR = 1.09, CI: 1.03-1.15) increased the odds of wheezing, while birch pollen decreased it (OR = 0.86, CI:0.87-1.00). Per trimester, more greenness during the 2nd trimester increased the odds (OR = 1.21, CI: 1.16-1.26), whereas third-trimester greenness decreased it (OR = 0.87, CI: 0.84-0.91). Grass pollen exposure in the 1st and 3rd trimesters increased the odds of wheezing (OR = 1.23, CI: 1.12-1.34 and OR = 1.13, CI: 1.00-1.27, respectively), while birch pollen exposure in the 1st and 2nd trimesters decreased the odds (OR = 0.88, CI: 0.77-1.00 and OR = 0.83, CI: 0.73-0.95, respectively). No significant associations were found for greenness in the 1st trimester, grass pollen in the 2nd trimester, and birch pollen in the 1st and 3rd trimester. Mediation analysis showed large uncertainty.

DISCUSSION

Surrounding greenness and pollen exposure during pregnancy may impact the likelihood of preschool wheezing differently depending on the timing of exposure and the pollen type.

Pollen exposures in pregnancy and early life are associated with childhood asthma incidence

Background

Pollen exposure is an environmental risk factor for asthma symptoms and allergic reactions in children. The extent to which pollen exposure in pregnancy and the first year of life influences the development of childhood asthma and rhinitis is not fully understood.

Objective

We aimed to investigate early life exposures to pollen with childhood asthma and rhinitis at age 6 in a longitudinal birth cohort of the United Kingdom.

Methods

In this retrospective cohort study, via logistic regressions, we analyzed the associations between pollen exposures in pregnancy and the first year of life with childhood asthma and rhinitis.

Results

Higher pollen exposure accumulated during pregnancy and during the first year of life both associated with an increased odds of asthma at age 6 (OR = 1.14, 95% CI 1.03-1.26, p = 0.01; OR = 1.15, 95% CI 1.03-1.29, p = 0.02, respectively). We did not observe statistically significant associations between early life pollen exposures and the odds of rhinitis at the same age.

Conclusion

High pollen exposure during early life (prenatal and postnatal) associated with an increased risk of asthma incidence at age 6. Further studies are desired to validate these findings and to elucidate the mechanisms of early life exposures to pollen on asthma etiology.

Early life exposures of childhood asthma and allergies-an epidemiologic perspective

Children around the world are continuing to develop and suffer from chronic lung diseases such as asthma. Childhood asthma commonly presents with recurrent episodes of cough, shortness of breath, and wheezing, all of which can lead to missed school days and hospitalization admissions. The role of environmental pollutants and aeroallergens has been increasingly recognized in relation to asthma etiology. We showcase the impacts of air pollution and pollen exposures in early life on childhood asthma and allergies through an epidemiologic perspective. We also examine the effects of indoor microbial exposures such as endotoxin and glucan on allergic diseases in schoolchildren as many spend most of their time in a household or classroom setting. Findings of this work can assist in the identification of key environmental factors in critical life periods and improve clinicians' diagnoses of asthma during early childhood.

Long-Term Pulmonary and Neurodevelopmental Outcomes of Meconium Aspiration Syndrome Affected Infants: A Retrospective National Population-Based Study in Taiwan

INTRODUCTION

Meconium aspiration syndrome (MAS) may cause severe pulmonary and neurologic injuries in affected infants after birth, leading to long-term adverse pulmonary or neurodevelopmental outcomes.

METHODS

This retrospective population-based cohort study enrolled 1,554,069 mother-child pairs between 2004 and 2014. A total of 8,049 infants were in the MAS-affected group, whereas 1,546,020 were in the healthy control group. Children were followed up for at least 3 years. According to respiratory support, MAS was classified as mild, moderate, and severe. With the healthy control group as the reference, the associations between MAS severity and adverse pulmonary outcomes (hospital admission, intensive care unit (ICU) admission, length of hospital stay, or invasive ventilator support during admission related to pulmonary problem) or adverse neurodevelopmental outcomes (cerebral palsy, needs for rehabilitation, visual impairment, or hearing impairment) were accessed.

RESULTS

MAS-affected infants had a higher risk of hospital and ICU admission and longer length of hospital stay, regardless of severity. Infants with severe MAS had a higher risk of invasive ventilator support during re-admission (odds ratio: 17.50, 95% confidence interval [CI]: 7.70-39.75, p < 0.001). Moderate (hazard ratio [HR]: 1.66, 95% CI: 1.30-2.13, p < 0.001) and severe (HR: 4.94, 95% CI: 4.94-7.11, p < 0.001) MAS groups had a higher risk of adverse neurodevelopmental outcome, and the statistical significance remained remarkable in severe MAS group after adjusting for covariates (adjusted HR: 2.28, 95% CI: 1.54-3.38, p < 0.001) Conclusions: Adverse pulmonary or neurodevelopmental outcomes could occur in MAS-affected infants at birth. Close monitoring and follow-up of MAS-affected infants are warranted.

Intranasal corticosteroids reduced acute rhinosinusitis in children with allergic rhinitis: A nested case-control study

BACKGROUND

Children with allergic rhinitis (AR) have substantially more acute rhinosinusitis than children without AR. We evaluated whether intranasal corticosteroids (INCS), second-generation antihistamines (SGH), and/or intranasal antihistamines (INH) for AR affect acute rhinosinusitis in children with AR aged 2-18 years.

METHODS

By using the National Health Research Institutes Database 2005 of Taiwan, a cohort of patients with AR aged 2-18 years treated with AR medications between 2002 and 2018 was made, within which a nested case-control study was performed. Risk settings for acute rhinosinusitis cases matched controls for age, sex, and comorbidities. Current users of INCS, INH, and/or SGH were compared with remote and recent users of any AR medications and current users of INCS with and without SGH were compared with current users of SGH.

RESULTS

Current users of SGH and/or INCS had a higher risk of acute rhinosinusitis than remote users of AR drugs, and current users of SGH had a higher risk of acute rhinosinusitis than recent users; however, no difference in the risk of acute rhinosinusitis was found between current users of INCS and recent users of AR drugs. Current users of INCS with and without SGH had a lower risk of acute rhinosinusitis than current users of SGH alone.

CONCLUSIONS

Treatment of INCS with and without SGH diminished the risk of acute rhinosinusitis compared with treatment using SGH alone. Adequate INCS treatment for patients with AR is important to reduce the incidence of acute rhinosinusitis.

Managing Asthma During Pregnancy and the Postpartum Period

Asthma is one of the most common chronic diseases in pregnancy and is associated with adverse perinatal outcomes. Asthma symptoms worsen in approximately 40% of women, and exacerbations requiring medical intervention occur in at least 20% of women. Factors associated with exacerbation and worsening asthma include multiparity, obesity, Black race, exacerbations before pregnancy, and poor asthma control. Exacerbations are associated with further increased risks for poor perinatal outcomes, including low birth weight, preterm birth, and small for gestational age (SGA) status, as well as an increase in the development of asthma in early childhood. Common medications used for asthma, including short-acting β-agonists and inhaled corticosteroids, are considered safe to use in pregnancy. Whereas guidelines generally suggest traditional step therapy for managing asthma in pregnancy, there are alternative models of care and management approaches that may be effective in pregnancy, but require more research. These include single-inhaler maintenance and reliever therapy, treatment adjustment with FeNO, treatable traits personalized medicine approaches, and telemedicine. Little is known about changes to asthma in the postpartum period. However, low adherence to medication and the potential effects of postpartum depression on asthma exacerbation risk warrant further research.

Association between early-life antibiotics use and the risk of attention-deficit/hyperactivity disorder: A real-world evidence study

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. Recently, children using antibiotics showed an increased incidence of neurodevelopmental disorders.

AIMS

The purpose of this study was to investigate the association between antibiotics use and the risk of ADHD in children.

STUDY DESIGN

Population-based retrospective cohort study.

SUBJECTS

The Taiwan National Health Insurance Research Database was used to collect data of children. Prevalence of antibiotics use was analyzed in the children (age, <2 years) included in this study. There were 1,601,689 children included in this study between 2004 and 2012.

OUTCOME MEASURES

The risk of developing ADHD was estimated using the Cox proportional hazards model.

RESULTS

71.25 % of children used at least one antibiotic, and the mean follow-up period was 7.07 years. After controlling for other related influencing factors, children who used antibiotics had a 1.12 times higher risk of ADHD than those who did not. The risk of ADHD increased through the use of penicillin and cephalosporin regardless of the duration of antibiotics use.

CONCLUSIONS

Antibiotics use in children-especially penicillin and cephalosporin-was associated with a higher risk of ADHD.

Association of cesarean section with asthma in children/adolescents: a systematic review and meta-analysis based on cohort studies

BACKGROUND

Whether cesarean section (CS) is a risk factor for asthma in offspring is controversial. The purpose of this study was to investigate the association between CS and asthma in children/adolescents.

METHODS

Pubmed, Embase, Web of Science, and Cochrane Library electronic databases were searched for cohort studies on the relationship between mode of delivery and asthma in children/adolescents up to February 2023. Birth via CS was considered an exposure factor. Asthma incidence was taken as a result.

RESULTS

Thirty-five cohort studies (thirteen prospective and twenty-two retrospective cohort studies) were included. The results showed that the incidence of asthma was higher in CS offspring (odds ratio (OR) = 1.18, P < 0.001) than in the vaginal delivery (VD) group. Partial subgroup analyses showed a higher incidence of asthma in female offspring born via CS (OR = 1.26, P < 0.001) compared with the VD group, while there was no difference in males (OR = 1.07, P = 0.325). Asthma incidence was higher in CS offspring than in the VD group in Europe (OR = 1.20, P < 0.001), North America (OR = 1.15, P < 0.001), and Oceania (OR = 1.06, P = 0.008). This trend was not found in the Asian population (OR = 1.17, P = 0.102). The incidence of atopic asthma was higher in offspring born via CS (OR = 1.14, P < 0.001) compared to the VD group. The CS group had a higher incidence of persistent asthma, but the difference did not reach statistical significance (OR = 1.15, P = 0.063).

CONCLUSION

In this meta-analysis, CS may be a risk factor for asthma in offspring children/adolescents compared with VD. The relationship between CS and asthma was influenced by sex and region.