Department of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA.
Am J Respir Crit Care Med. 2013 Jun 1;187(11):1186-93. doi: 10.1164/rccm.201208-1530OC.
Exploring prenatal factors influencing childhood wheeze may inform programming mechanisms.
We examined associations among prenatal maternal cortisol profiles, maternal obesity, and repeated wheeze up to age 2 years (n = 261).
Salivary cortisol was collected five times per day over 3 days at 29.0 ± 4.9 weeks gestation. Mothers were categorized as obese (body mass index ≥ 30 kg/m(2)) versus nonobese (body mass index < 30 kg/m(2)). Using logistic regression, we examined the influence of log-transformed cortisol metrics (level at each time point, morning rise, diurnal and afternoon slopes) and obesity on wheeze adjusting for covariates. Linear mixed models were implemented to examine associations between cortisol trajectories and wheezing. Interactions between maternal cortisol and obesity were considered.
Mothers were primarily minority (56.5% Hispanic, 24.1% African American), 61% had less than or equal to 12 years of education, 34% were obese, and 8.4% of children had repeated wheeze. An interquartile range increase in mean log cortisol at bedtime (odds ratio, 2.2; 95% confidence interval, 1.09-4.09) and maternal obesity (odds ratio, 3.43; 95% confidence interval, 1.26-9.35) were independently associated with wheeze. Linear mixed models revealed an association between a flatter afternoon slope (slower decline in log cortisol per hour) and repeated wheeze in children of obese mothers (children with [-0.017 change] and without [-0.061 change] wheeze [P = 0.009 for time × wheeze interaction]), but not in children of nonobese mothers (with [-0.050 change] and without [-0.061 change] wheeze [P = 0.51]).
Maternal prenatal cortisol disruption and obesity were independently associated with children's wheeze. Obese women with adverse cortisol profiles were most likely to have children with repeated wheeze.
探究影响儿童喘息的产前因素可能有助于揭示发育编程机制。
我们研究了 261 例孕妇产前皮质醇水平、母体肥胖和 2 岁前反复喘息之间的相关性。
在妊娠 29.0±4.9 周时，每天采集 5 次唾液样本，共 3 天。母亲被分为肥胖（BMI≥30kg/m²）和非肥胖（BMI<30kg/m²）。使用逻辑回归分析，我们调整了协变量，分析了对数转换皮质醇指标（每个时间点的水平、清晨上升、日间和下午斜率）和肥胖对喘息的影响。采用线性混合模型检验皮质醇轨迹与喘息的关系。考虑了母体皮质醇与肥胖之间的相互作用。
母亲主要是少数族裔（56.5%西班牙裔，24.1%非裔美国人），61%受教育程度低于或等于 12 年，34%肥胖，8.4%的儿童反复喘息。平均对数皮质醇在睡前的中位数增加一个四分位间距（比值比，2.2；95%置信区间，1.09-4.09）和母体肥胖（比值比，3.43；95%置信区间，1.26-9.35）与喘息独立相关。线性混合模型显示，肥胖母亲的儿童中下午斜率较平坦（每小时皮质醇对数下降速度较慢）与反复喘息相关（有喘息的儿童 [-0.017 变化]，无喘息的儿童 [-0.061 变化]，P=0.009 时的时间×喘息交互作用），但在非肥胖母亲的儿童中则不然（有喘息的儿童 [-0.050 变化]，无喘息的儿童 [-0.061 变化]，P=0.51）。
母亲产前皮质醇紊乱和肥胖与儿童喘息独立相关。皮质醇水平异常的肥胖妇女最有可能其孩子反复喘息。
