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Whalen OM, Campbell LE, Lane AE, Karayanidis F, Mallise CA, Woolard AJ, Holliday EG, Mattes J, Collison A, Gibson PG, Murphy VE. Effect of fractional exhaled nitric oxide (F ENO)-based asthma management during pregnancy versus usual care on infant development, temperament, sensory function and autism signs. Eur J Pediatr 2024:10.1007/s00431-024-05578-4. [PMID: 38691129 DOI: 10.1007/s00431-024-05578-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 05/03/2024]
Abstract
Asthma during pregnancy is associated with a range of adverse perinatal outcomes. It is also linked to increased rates of neurodevelopmental conditions in the offspring. We aimed to assess whether fractional exhaled nitric oxide (FENO)-based asthma management during pregnancy improves child developmental and behavioural outcomes compared to usual care. The Breathing for Life Trial was a randomised controlled trial that compared FENO-based asthma management during pregnancy to usual care. Participants were invited to the developmental follow-up, the Breathing for Life Trial - Infant Development study, which followed up infants at 6 weeks, 6 months and 12 months. The primary outcomes were measured in infants at 12 months using the Bayley-III: Cognitive, Language and Motor composite scores. Secondary outcomes included Bayley-III social-emotional and adaptive behaviour scores, autism likelihood and sensory and temperament outcomes. The exposure of interest was the randomised intervention group. Two hundred and twenty-two infants and their 217 participating mothers were recruited to the follow-up; 107 mothers were in the intervention group and 113 were in the control group. There was no evidence of an intervention effect for the primary outcomes: Bayley-III cognitive (mean = 108.9 control, 108.5 intervention, p = 0.93), language (mean = 95.9 control, 95.6 intervention, p = 0.87) and motor composite scores (mean = 97.2 control, 97.9 intervention, p = 0.25). Mean scores for secondary outcomes were also similar among infants born to control and FENO group mothers, with few results reaching p < 0.05. CONCLUSION In this sample, FENO-guided asthma treatment during pregnancy did not improve infant developmental outcomes in the first year of life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: ACTRN12613000202763. WHAT IS KNOWN • Maternal asthma during pregnancy has been associated with increased rates of neurodevelopmental conditions in offspring, including intellectual disability and autism. WHAT IS NEW • This is the first study to examine how managing asthma during pregnancy via a FENO-guided algorithm or usual care affects infant developmental and behavioural outcomes. While the results of the study showed no impact of the intervention, and therefore do not support the integration of FENO-based management of asthma in antenatal settings for optimal infant development, they do send a positive message about the implications of active asthma management during pregnancy on infant developmental outcomes.
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Affiliation(s)
- Olivia M Whalen
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Linda E Campbell
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Alison E Lane
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Frini Karayanidis
- School of Psychological Sciences, University of Newcastle, Callaghan, Australia
- Healthy Minds Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Hunter Medical Research Institute, Newcastle, Australia
| | - Carly A Mallise
- Hunter Medical Research Institute, Newcastle, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Alix J Woolard
- Telethon Kids Institute, Australia & Medical School, University of Western Australia, Perth, Australia
| | - Elizabeth G Holliday
- Hunter Medical Research Institute, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Joerg Mattes
- Hunter Medical Research Institute, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Adam Collison
- Hunter Medical Research Institute, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Peter G Gibson
- Hunter Medical Research Institute, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
- Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, Australia
| | - Vanessa E Murphy
- Hunter Medical Research Institute, Newcastle, Australia.
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
- Asthma and Breathing Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia.
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Nagata A, Masumoto T, Nishigori H, Nakagawa T, Otani S, Kurozawa Y. Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero. JAMA Netw Open 2023; 6:e2339347. [PMID: 37874567 PMCID: PMC10599123 DOI: 10.1001/jamanetworkopen.2023.39347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Importance Corticosteroids and β2-adrenergic agonists are commonly used during pregnancy to treat asthma. However, offspring neurodevelopmental outcomes following in utero exposure to these medications remain unclear. Objective To investigate the association between timing of in utero exposure to corticosteroids and β2-adrenergic agonists and offspring neurodevelopmental milestones during the first 3 years of life. Design, Setting, and Participants This cohort study obtained data from the Japan Environment and Children's Study, an ongoing birth cohort study conducted in collaboration with 15 Regional Centers across Japan. Participants were mother-offspring pairs who were recruited between January 1, 2011, and March 31, 2014. Data were analyzed between January and February 2023. Exposure Corticosteroids and β2-adrenergic agonists were the exposure of interest. Timing of corticosteroid and β2-adrenergic agonist exposure included early pregnancy (weeks 0-12), mid- to late pregnancy (weeks >12), and both stages of pregnancy. Main Outcomes and Measures Offspring neurodevelopmental milestones (communication, gross motor, fine motor, problem-solving, and personal-social skills) were assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition, at 6, 12, 18, 24, 30, and 36 months. Results In total, 91 460 mother-offspring pairs were analyzed. Among mothers, the mean (SD) age at delivery was 31.20 (5.05) years. Among offspring, 46 596 (50.9%) were males and 44 864 (49.1%) were females, of whom 66.4% had a gestational age of 39 to 41 weeks. During early, mid- to late, and both stages of pregnancy, 401 (0.4%), 935 (1.0%), and 568 (0.6%) offspring, respectively, were exposed to corticosteroids, whereas 170 (0.2%), 394 (0.4%), and 184 (0.2%), respectively, were exposed to β2-adrenergic agonists. No association of corticosteroid exposure during early, mid- to late, and both stages of pregnancy with all 5 neurodevelopmental milestones was found. Similarly, no association between β2-adrenergic agonist use during early pregnancy and all 5 neurodevelopmental milestones was observed. An association was found between β2-adrenergic agonist exposure during mid- to late pregnancy and delayed personal-social skills (adjusted odds ratio, 1.48; 95% CI, 1.01-2.32; P = .045). Conclusions and Relevance Results of this study found no association between in utero corticosteroid and β2-adrenergic agonist exposure and offspring neurodevelopmental outcomes, regardless of the timing of exposure. Despite the limitations and low power of the study, the findings suggest that corticosteroids and β2-adrenergic agonists are safe for pregnant individuals with asthma and the neurodevelopment of their offspring.
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Affiliation(s)
- Abir Nagata
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan
- Graduate School of Public Health, St Luke’s International University, Tokyo, Japan
| | - Toshio Masumoto
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Hidekazu Nishigori
- Department of Development and Environmental Medicine, Fukushima Medical Center for Children and Women, Fukushima Medical University Graduate School of Medicine, Fukushima, Japan
| | - Takatoshi Nakagawa
- Department of Regenerative Dermatology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinji Otani
- International Platform for Dryland Research and Education, Tottori University, Tottori, Japan
| | - Youichi Kurozawa
- Division of Health Administration and Promotion, Faculty of Medicine, Tottori University, Tottori, Japan
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Meakin AS, Saif Z, Seedat N, Clifton VL. The impact of maternal asthma during pregnancy on fetal growth and development: a review. Expert Rev Respir Med 2020; 14:1207-1216. [PMID: 32825809 DOI: 10.1080/17476348.2020.1814148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Asthma is a highly prevalent co-morbidity during pregnancy that can worsen as gestation progresses and is associated with several adverse perinatal outcomes. These adverse outcomes often result from uncontrolled asthma during pregnancy and acute asthma exacerbations that are associated with alterations in placental function and fetal growth. AREAS COVERED This paper will discuss how maternal asthma in pregnancy affects fetal growth and development which may alter future offspring health. Changes in placental function occur in a sex-specific manner in pregnancies complicated by asthma and result in differences in fetal growth and development which may influence child health. The follow up of children from mothers with asthma suggests they are at greater risk of developing asthma, have alterations in microvascular structure that may contribute to a future risk of cardiovascular disease and epigenetic modifications in immune cell function. The current evidence suggests that appropriately managed asthma during pregnancy results in normal fetal growth and development. EXPERT OPINION Clinical management of asthma during pregnancy needs significant improvement to prevent adverse outcomes for the fetus. The key to improving maternal and fetal outcomes is through education of health professionals and parents about controlling asthma during pregnancy.
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Affiliation(s)
- Ashley S Meakin
- Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Zarqa Saif
- Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Nabila Seedat
- Mater Research Institute, The University of Queensland , Brisbane, Australia
| | - Vicki L Clifton
- Mater Research Institute, The University of Queensland , Brisbane, Australia
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Whalen OM, Karayanidis F, Murphy VE, Lane AE, Mallise CA, Campbell LE. The effects of maternal asthma during pregnancy on child cognitive and behavioral development: A systematic review. J Asthma 2018; 56:130-141. [PMID: 29482387 DOI: 10.1080/02770903.2018.1437174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Maternal asthma during pregnancy is associated with a higher risk of negative perinatal outcomes. However, little is known about the direct effects of maternal asthma on infant cognitive development. We examined the evidence for an impact of maternal asthma during pregnancy on cognitive and behavioral development of the child. DATA SOURCES We conducted a MEDLINE, PsychINFO, and manual search of the databases for all available studies until January 9th, 2018. STUDY SELECTIONS Studies were deemed relevant if they included child cognitive and behavioral development as the outcome, with maternal asthma as the determinant of interest. RESULTS Ten articles matched selection criteria. Some studies report that maternal asthma is associated with increased risk for autism and intellectual disability in children. However, these effects are small and are often eliminated when controlling for confounding variables. Other studies have found no association. The only prospective study found that well-managed asthma during pregnancy was not associated with negative developmental outcomes in children. CONCLUSIONS The evidence suggests that the relationship between maternal asthma during pregnancy and poor developmental and behavioral outcomes of children is weak. Children of mothers with well-managed asthma during pregnancy have similar developmental trajectories to those born to healthy mothers. Prospective, longitudinal studies are needed to confirm these conclusions. Optimal asthma management is important in pregnancy as it may have longer term benefits for the health of the offspring. As the rate of asthma increases in the population, the implications of maternal asthma on child development will be of greater importance.
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Affiliation(s)
- Olivia M Whalen
- a School of Psychology , University of Newcastle , Callaghan , NSW , Australia.,d Priority Research Centre GrowUp Well , University of Newcastle , Callaghan , NSW , Australia
| | - Frini Karayanidis
- a School of Psychology , University of Newcastle , Callaghan , NSW , Australia.,e Priority Research Centre for Stroke and Brain Injury , University of Newcastle , Callaghan , NSW , Australia
| | - Vanessa E Murphy
- c School of Medicine and Public Health , University of Newcastle , Callaghan , NSW , Australia.,d Priority Research Centre GrowUp Well , University of Newcastle , Callaghan , NSW , Australia
| | - Alison E Lane
- b School of Health Sciences , University of Newcastle , Callaghan , NSW , Australia.,d Priority Research Centre GrowUp Well , University of Newcastle , Callaghan , NSW , Australia
| | - Carly A Mallise
- a School of Psychology , University of Newcastle , Callaghan , NSW , Australia.,d Priority Research Centre GrowUp Well , University of Newcastle , Callaghan , NSW , Australia
| | - Linda E Campbell
- a School of Psychology , University of Newcastle , Callaghan , NSW , Australia.,d Priority Research Centre GrowUp Well , University of Newcastle , Callaghan , NSW , Australia
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Meakin AS, Saif Z, Jones AR, Aviles PFV, Clifton VL. Review: Placental adaptations to the presence of maternal asthma during pregnancy. Placenta 2017; 54:17-23. [PMID: 28131319 DOI: 10.1016/j.placenta.2017.01.123] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/10/2017] [Accepted: 01/20/2017] [Indexed: 12/19/2022]
Abstract
Asthma is a highly prevalent chronic medical condition affecting an estimated 12% of pregnant, women each year, with prevalence of asthma greatest (up to 16%) among the socially disadvantaged. Maternal asthma is associated with significant perinatal morbidity and mortality including preterm births, neonatal hospitalisations and low birthweight outcomes each year. We have identified that the placenta adapts to the presence of chronic, maternal asthma during pregnancy in a sex specific manner that may confer sex differences in fetal outcome. The male fetus was at greater risk of a poor outcome than a female fetus in the presence of maternal asthma and an acute inflammatory event such as an asthma exacerbation. This review will examine the role of sex specific differences in placental function on fetal growth and survival.
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Affiliation(s)
- A S Meakin
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Z Saif
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - A R Jones
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | | | - V L Clifton
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia.
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Developmental perturbation induced by maternal asthma during pregnancy: the short- and long-term impacts on offspring. J Pregnancy 2012; 2012:741613. [PMID: 22830026 PMCID: PMC3399337 DOI: 10.1155/2012/741613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/06/2012] [Indexed: 12/11/2022] Open
Abstract
Maternal asthma is a common disease to complicate human pregnancy. Epidemiological studies have identified that asthma during pregnancy increases the risk of a number of poor outcomes for the neonate including growth restriction, lower birthweight, preterm delivery, neonatal resuscitation, and stillbirth. Asthma therefore represents a significant health burden to society and could have an impact on the lifelong health of the children of women with asthma. Our research has identified that maternal asthma in pregnancy induces placental dysfunction and developmental perturbation in the fetus in a sex specific manner. These alterations in development could increase the risk of metabolic disease in adulthood of children of asthmatic mothers, especially females. In this paper, we will discuss the evidence currently available that supports the hypothesis that children of mothers with asthma may be at risk of lifelong health complications which include diabetes and hypertension.
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Abstract
Worldwide the prevalence of asthma among pregnant women is on the rise, and pregnancy leads to a worsening of asthma for many women. This article examines the changes in asthma that may occur during pregnancy, with particular reference to asthma exacerbations. Asthma affects not only the mother but the baby as well, with potential complications including low birth weight, preterm delivery, perinatal mortality, and preeclampsia. Barriers to effective asthma management and opportunities for optimized care and treatment are discussed, and a summary of the clinical guidelines for the management of asthma during pregnancy is presented.
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Affiliation(s)
- Vanessa E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Locked Bag 1, HRMC, Newcastle, New South Wales 2310, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, New South Wales 2310, Australia.
| | - Peter G Gibson
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Locked Bag 1, HRMC, Newcastle, New South Wales 2310, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, HRMC, Newcastle, New South Wales 2310, Australia; Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe (Sydney), New South Wales 2037, Australia
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Al-Ozairi E, Waugh JJS, Taylor R. Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone. Obstet Med 2009; 2:34-7. [PMID: 27582805 DOI: 10.1258/om.2008.080046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2008] [Indexed: 11/18/2022] Open
Abstract
Severe hyperemesis gravidarum causes profound maternal morbidity. Termination of pregnancy is still offered before the use of medical therapy. This report describes management of a woman who had undergone two previous terminations for hyperemesis, and additionally presents the dosage profile of prednisolone used to successfully manage a consecutive series of 33 women with severe hyperemesis gravidarum. The treatment protocol is described. The group had a median weight loss in pregnancy of 5.5 kg (range 2.0-12.5 kg), had been admitted on a median of 3.0 (range 0-9) occasions and had spent 7.5 (range 0-25) days on i.v. fluids. Continuing vomiting prevented oral steroid therapy in 14 women and i.v. hydrocortisone (50 mg t.i.d.; two women required 100 mg t.i.d.) was used initially for 24-48 h. Nineteen women commenced prednisolone 10 mg t.i.d. and this achieved suppression of vomiting within 48 h in all but two women who required 15 mg t.i.d. Two distinct subtypes of hyperemesis gravidarum were identified. Remitting hyperemesis spontaneously ceases between 14 and 22 weeks gestation and accounts for approximately 80% of cases. In contrast, full-term hyperemesis persists until minutes after delivery. These separate sub-types have not previously been described. Steroid treatment of hyperemesis should be considered in women who fulfil the criteria of severe disease.
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Affiliation(s)
| | - J J S Waugh
- Directorate of Obstetrics, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP , UK
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Leonard H, de Klerk N, Bourke J, Bower C. Maternal health in pregnancy and intellectual disability in the offspring: a population-based study. Ann Epidemiol 2005; 16:448-54. [PMID: 16182562 DOI: 10.1016/j.annepidem.2005.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 05/16/2005] [Accepted: 05/27/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of the study is to investigate the relationship between common maternal conditions and intellectual disability (ID) of unknown cause in the offspring. METHODS Information about the maternal health of children with and without ID was obtained by using record linkage. For mothers with specific medical conditions, proportions of children with mild to moderate ID, severe ID, and autism spectrum disorder (ASD) with ID were compared with those who did not have ID. RESULTS There was an increased risk for mild to moderate ID in children of mothers with asthma (odds ratio [OR], 1.52; confidence interval [CI], 1.26-1.83]), diabetes (OR, 1.69; CI, 1.26-2.27), a renal or urinary condition (OR, 2.09; CI, 1.39-3.14), and epilepsy (OR, 3.53; CI, 2.56-4.84). ASD risk was increased for children of women with diabetes (OR, 2.89; CI, 1.28-6.51) and epilepsy (OR, 4.57; CI, 1.69-12.31). For anemia (n = 1101), there was an increased risk for severe ID (OR, 5.26; CI, 2.16-12.80). CONCLUSIONS The increased risk for ID in offspring of mothers with such conditions as asthma and diabetes is particularly important for disadvantaged or ethnic populations, for whom these conditions are more prevalent and may be less well managed.
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Affiliation(s)
- Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, West Perth, Australia.
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