Relevance of the first thousand days of life to the development of wheezing in children aged 6-7 years

Main Article Content

Karoliny dos Santos
Jefferson Traebert
Anna Paula Piovezan
Jane da Silva

Keywords

Asthma, Child health, Child development, Epidemiologic factors, Odds ratio

Abstract

Introduction: The first thousand days of life are a critical stage for the development of respiratory and immune systems. Many events in this period may be associated with wheezing in childhood. Objective: This study aimed to investigate the association between early life determinants and wheezing in children aged 6-7 years.


Materials and Methods: Population-based case-control study using early-life related questions. We used the International Study of Asthma and Allergies in Childhood questionnaire to assess wheezing symptoms. Multiple logistic regressions were performed according to a hierarchical framework, considering the complex dynamic of wheezing/asthma and potential interaction between different levels of determination.


Results: A total of 820 children were included, from which 162 reported wheezing symptoms (19.7%). Multivariable analysis identified socioeconomic conditions (OR 2.08, 95% CI 1.08-4.00), family history of asthma (OR 2.28, 95% CI 1.37-3.75), vaginal discharge that required treatment during pregnancy (OR 1.68, 95% CI 1.00-2.83), neonatal hyperbilirubinemia (OR 2.00, 95% CI 1.17-3.42), anemia and intestinal parasitosis in the first two years (OR 2.28, 95% CI 1.22-4.25; OR 1.72, 95% CI 1.02-2.92, respectively) independently associated to wheezing at 6-7 years. Intended pregnancy was associated with reduced wheezing (OR 0.47, 95% CI 0.28-0.77).


Conclusions: Several factors were associated with wheezing in childhood. Considering that intended pregnancy reduced wheezing and other associated exposures are considered modifiable, these findings may guide the planning of strategies to decrease the susceptibility to asthma symptoms in childhood.

Abstract 47 | PDF Downloads 37

References

1. Schaub B, Prescott SL, Sampson HA. 1 - The maturation of immune function in pregnancy and early childhood A2 - Wahn, Ulrich. In: Allergy, immunity and tolerance in early childhood. Amsterdam: Academic Press; 2016. p. 1-17.

2. Zeltner TB, Burri PH. The postnatal development and growth of the human lung. II. Morphology. Respir Physiol. 1987;67(3):269-82.

3. Goenka A, Kollmann TR. Development of immunity in early life. J Infect. 2015;71 Suppl 1:S112-20.

4. Sly PD. The early origins of asthma: who is really at risk? Curr Opin Allergy Clin Immunol. 2011;11(1):24-8.

5. Wark PA, Murphy V, Mattes J. The interaction between mother and fetus and the development of allergic asthma. Expert Rev Respir Med. 2014;8(1):57-66.

6. Cano Garcinuno A, Mora Gandarillas I. Early patterns of wheezing in asthmatic and nonasthmatic children. Eur Respir J. 2013;42(4):1020-8.

7. Lai CK, Beasley R, Crane J, Foliaki S, Shah J, Weiland S. Global variation in the prevalence and severity of asthma symptoms: phase three of the International Study of Asthma and Allergies in Childhood (ISAAC). Thorax. 2009;64(6):476-83.

8. Bijanzadeh M, Mahesh PA, Ramachandra NB. An understanding of the genetic basis of asthma. Indian J Med Res. 2011;134:149-61.

9. Castro-Rodriguez JA, Forno E, Rodriguez-Martinez CE, Celedon JC. Risk and protective factors for childhood asthma: what is the evidence? J Allergy Clin Immunol Pract. 2016;4(6):1111-22.

10. Thomsen SF. Genetics of asthma: an introduction for the clinician. Eur Clin Respir J. 2015;2.

11. Uphoff E, Cabieses B, Pinart M, Valdes M, Anto JM, Wright J. A systematic review of socioeconomic position in relation to asthma and allergic diseases. Eur Respir J. 2015;46(2):364-74.

12. Leonardi-Bee J, Pritchard D, Britton J. Asthma and current intestinal parasite infection: systematic review and meta-analysis. Am J Respir Crit Care Med. 2006;174(5):514-23.

13. Drury KE, Schaeffer M, Silverberg JI. Association Between Atopic Disease and Anemia in US Children. JAMA Pediatr. 2016;170(1):29-34.

14. Shaheen SO, Newson RB, Henderson AJ, Emmett PM, Sherriff A, Cooke M. Umbilical cord trace elements and minerals and risk of early childhood wheezing and eczema. Eur Respir J. 2004;24(2):292-7.

15. Maazi H, Shirinbak S, Bloksma N, Nawijn MC, van Oosterhout AJ. Iron administration reduces airway hyperreactivity and eosinophilia in a mouse model of allergic asthma. Clin Exp Immunol. 2011;166(1):80-6.

16. Hale LP, Kant EP, Greer PK, Foster WM. Iron supplementation decreases severity of allergic inflammation in murine lung. PLoS One. 2012;7(9):e45667.

17. Collier CH, Risnes K, Norwitz ER, Bracken MB, Illuzzi JL. Maternal infection in pregnancy and risk of asthma in offspring. Matern Child Health J. 2013;17(10):1940-50.

18. Pesce G, Marcon A, Marchetti P, Girardi P, de Marco R. Febrile and gynecological infections during pregnancy are associated with a greater risk of childhood eczema. Pediatr Allergy Immunol. 2014;25(2):159-65.

19. Keski-Nisula L, Katila ML, Remes S, Heinonen S, Pekkanen J. Intrauterine bacterial growth at birth and risk of asthma and allergic sensitization among offspring at the age of 15 to 17 years. J Allergy Clin Immunol. 2009;123(6):1305-11.

20. Das RR, Naik SS. Neonatal hyperbilirubinemia and childhood allergic diseases: a systematic review. Pediatr Allergy Immunol. 2015;26(1):2-11.

21. Dani C, Martelli E, Tronchin M, Buonocore G, Longini M, Di Filippo A, et al. Bilirubin influence on oxidative lung damage and surfactant surface tension properties. Pediatr Pulmonol. 2004;38(3):179-85.

22. Sedgh G, Singh S, Hussain R. Intended and unintended pregnancies worldwide in 2012 and recent trends. Stud Fam Plann. 2014;45(3):301-14.

23. Than LC, Honein MA, Watkins ML, Yoon PW, Daniel KL, Correa A. Intent to become pregnant as a predictor of exposures during pregnancy: is there a relation? J Reprod Med. 2005;50(6):389-96.

24. Shah PS, Balkhair T, Ohlsson A, Beyene J, Scott F, Frick C. Intention to become pregnant and low birth weight and preterm birth: a systematic review. Matern Child Health J. 2011;15(2):205-16.

25. Hall JA, Benton L, Copas A, Stephenson J. Pregnancy intention and pregnancy outcome: systematic review and meta-analysis. Matern Child Health J. 2017;21(3):670-704.

26. Gipson JD, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: a review of the literature. Stud Fam Plann. 2008;39(1):18-38.

27. Wright RJ. Perinatal stress and early life programming of lung structure and function. Biol Psychol. 2010;84(1):46-56.