Infectious and uterus related complications during pregnancy and development of atopic and nonatopic asthma in children
Infectious and uterus related complications during pregnancy and development of atopic and nonatopic asthma in children
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DOI：
10.1046/j.1398-9995.2003.00338.x
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发表时间：
2004-01-01
期刊：
影响因子：
12.4
通讯作者：
Volterrani, A
中科院分区：
文献类型：
--
作者：
Calvani, M;Alessandri, C;Volterrani, A
背景：有研究表明，生命早期的环境因素，特别是与卫生和感染有关的因素，似乎与最近在发达国家观察到的哮喘和过敏性疾病的增加有关。这些因素在子宫内的可能影响还没有完全弄清楚。本研究的目的是探讨孕期感染和子宫相关并发症以及相关药物因素与儿童特应性和非特应性哮喘的关系。方法：这是一项病例对照研究，纳入338名哮喘儿童和467名从未患过喘息或哮喘的对照组。父母报告通过标准化问卷对发热、流感、先兆流产和相关药物因素进行回顾性评估。结果：孕期流感发作与儿童哮喘的发生显著相关[调整后优势比(AOR)1.91；95%可信区间(95%CI)1.1~3.2]，主要为非特应性哮喘。发热发作有相似的结果(AOR 2.16；95%可信区间1.2-3.9)，但与特应性和非特应性哮喘有关。这种影响似乎主要是由于怀孕后期感染的流感和发烧所致。暴露于Isoxsuprine与哮喘显著相关(AOR 1.54；95%CI 1.08-2.19)，而哮喘组先兆流产的发生率高于对照组，尽管这种差异只有在妊娠中期发生时才有统计学意义(AOR 2.06；95%CI 1.07-3.94)。结论：产前感染性并发症可能与儿童哮喘的发生有关，并提示了一个新的哮喘危险因素--接触异索舒普林可能起到一定的作用。因此，能够区分特应性和非特应性哮喘的更大规模的前瞻性研究将有助于证实这些结果，并解释这些因素可能通过的作用机制。
Background: It has been suggested that environmental factors early in life, particularly related to hygiene and infections, seem to be involved in the increase of asthma and allergic disease observed recently in developed countries. The possible effect of these factors also in utero have yet to be completely clarified. The aim of this study was to investigate the association between infective and uterus related complications during pregnancy, as well as related drug factors, with atopic and nonatopic asthma in children.Methods: This was a case-controlled study enrolling 338 children with asthma and 467 controls, who had never suffered from wheeze or asthma. Fever episodes, flu episodes, threatened abortions and related drug factors were retrospectively assessed by parental report via a standardized questionnaire. Atopy was determined by skin-prick tests to 10 prevalent allergens at the time of examination.Results: Flu episodes during pregnancy were significantly associated with development of asthma in children [adjusted odds ratio (aOR) 1.91; 95% confidence interval (95% CI) 1.1-3.2], mainly with nonatopic asthma. Fever episodes showed similar results (aOR 2.16; 95% CI 1.2-3.9), but were associated with both atopic and nonatopic asthma. The effect seems mainly due to flu and fever episodes contracted in the third trimester. Exposure to isoxsuprine was significantly associated with asthma (aOR 1.54; 95% CI 1.08-2.19) while threatened abortions were more frequent in the asthma group than in controls, although the difference was statistically significant only when such events occurred in the second trimester (aOR 2.06; 95% CI 1.07-3.94). Both threatened abortions and exposure to isoxsuprine were associated only with nonatopic asthma.Conclusions: This study confirms that prenatal infective complications may contribute to the development of asthma in children and show a possible role for a new risk factor for asthma, that is exposure to isoxsuprine. Therefore, larger prospective studies, capable of separating atopic and nonatopic asthma, would serve to confirm these results and to explain the possible mechanism through which these factors may act.