Jaakkola Jouni J K, Ahmed Parvez, Ieromnimon Antonia, Goepfert Petra, Laiou Elpiniki, Quansah Reginald, Jaakkola Maritta S
Institute of Occupational and Environmental Medicine, University of Birmingham, UK.
J Allergy Clin Immunol. 2006 Oct;118(4):823-30. doi: 10.1016/j.jaci.2006.06.043. Epub 2006 Sep 8.
Accumulating evidence suggests that reduced duration of pregnancy predicts increased risk of asthma, but the studies published have been inconsistent.
We sought to synthesize the evidence on the relation between preterm delivery and the risk of asthma later in life and to assess differences between the studies as potential sources for heterogeneity of the results.
We conducted a MEDLINE search (until the end of May 2005). The outcome was asthma. The determinant of interest was preterm delivery defined as a gestational age of less than 37 weeks.
We identified 19 articles that provided estimates for the meta-analysis. The summary effect estimates for asthma (fixed-effects odds ratio, 1.074 [95% CI, 1.072-1.075]; heterogeneity P = .000; random-effects odds ratio, 1.366 [95% CI, 1.303-1.432]) showed an increased risk in relation to preterm delivery, with substantial heterogeneity between study-specific estimates. The effect of preterm delivery on asthma was stronger in cross-sectional studies; studies with broad outcome criteria, a small sample size, and a younger study population; and studies conducted in English-speaking populations, outside Europe, and published more recently. In metaregression, adjusting for other determinants, the effect estimate was significantly associated only with the mean age of the study population.
The weight of evidence shows that preterm babies have an increased risk of asthma compared with term babies.
Recognition of prematurity as a determinant of asthma emphasizes the importance of active treatment of physiologic airflow obstruction and a need for special preventive measures against known environmental determinants of asthma in preterm babies.
越来越多的证据表明，孕期缩短预示着哮喘风险增加，但已发表的研究结果并不一致。
我们试图综合早产与日后患哮喘风险之间关系的证据，并评估研究间的差异，将其作为结果异质性的潜在来源。
我们进行了MEDLINE检索（截至2005年5月底）。结局为哮喘。感兴趣的决定因素是定义为胎龄小于37周的早产。
我们确定了19篇文章，为荟萃分析提供了估计值。哮喘的汇总效应估计值（固定效应比值比，1.074 [95% CI，1.072 - 1.075]；异质性P = 0.000；随机效应比值比，1.366 [95% CI，1.303 - 1.432]）显示，与早产相关的风险增加，各研究特异性估计值之间存在显著异质性。早产对哮喘的影响在横断面研究中更强；结局标准宽泛、样本量小且研究人群较年轻的研究；以及在欧洲以外的英语人群中进行且发表时间较近的研究。在元回归分析中，调整其他决定因素后，效应估计值仅与研究人群的平均年龄显著相关。
证据表明，与足月儿相比，早产儿患哮喘的风险增加。
认识到早产是哮喘的一个决定因素，强调了积极治疗生理性气流阻塞的重要性，以及对早产儿采取针对已知哮喘环境决定因素的特殊预防措施的必要性。
