早产、婴儿体重增加与儿童哮喘风险：对14.7万名欧洲儿童的荟萃分析
Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children.
作者信息
Sonnenschein-van der Voort Agnes M M, Arends Lidia R, de Jongste Johan C, Annesi-Maesano Isabella, Arshad S Hasan, Barros Henrique, Basterrechea Mikel, Bisgaard Hans, Chatzi Leda, Corpeleijn Eva, Correia Sofia, Craig Leone C, Devereux Graham, Dogaru Cristian, Dostal Miroslav, Duchen Karel, Eggesbø Merete, van der Ent C Kors, Fantini Maria P, Forastiere Francesco, Frey Urs, Gehring Ulrike, Gori Davide, van der Gugten Anne C, Hanke Wojciech, Henderson A John, Heude Barbara, Iñiguez Carmen, Inskip Hazel M, Keil Thomas, Kelleher Cecily C, Kogevinas Manolis, Kreiner-Møller Eskil, Kuehni Claudia E, Küpers Leanne K, Lancz Kinga, Larsen Pernille S, Lau Susanne, Ludvigsson Johnny, Mommers Monique, Nybo Andersen Anne-Marie, Palkovicova Lubica, Pike Katharine C, Pizzi Costanza, Polanska Kinga, Porta Daniela, Richiardi Lorenzo, Roberts Graham, Schmidt Anne, Sram Radim J, Sunyer Jordi, Thijs Carel, Torrent Maties, Viljoen Karien, Wijga Alet H, Vrijheid Martine, Jaddoe Vincent W V, Duijts Liesbeth
机构信息
Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Paediatrics, Division of Respiratory Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands; Institute of Pedagogical Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, Rotterdam, The Netherlands.
出版信息
J Allergy Clin Immunol. 2014 May;133(5):1317-29. doi: 10.1016/j.jaci.2013.12.1082. Epub 2014 Feb 12.
BACKGROUND
Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results.
OBJECTIVES
We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years).
METHODS
First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes.
RESULTS
Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27).
CONCLUSION
Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth.
背景
早产、低出生体重和婴儿追赶生长似乎与日后患呼吸道疾病的风险增加有关，但个别研究结果相互矛盾。
目的
我们对31项出生队列研究中的147,252名儿童进行了个体参与者数据荟萃分析，以确定出生和婴儿生长特征与学龄前喘息（1 - 4岁）和学龄期哮喘（5 - 10岁）风险之间的关联。
方法
首先，我们进行了一项调整后的单阶段随机效应荟萃分析，以评估胎龄、出生体重和婴儿体重增加与儿童哮喘的综合关联。其次，我们进行了一项调整后的两阶段随机效应荟萃分析，以评估早产（胎龄<37周）和低出生体重（<2500 g）与儿童哮喘结局之间的关联。
结果
出生时胎龄较小和婴儿体重增加较高与学龄前喘息和学龄期哮喘的风险较高独立相关（P <.05）。出生体重与儿童哮喘的负相关关系可由出生时的胎龄来解释。与足月出生且婴儿体重正常增加的儿童相比，我们观察到早产且婴儿体重增加高的儿童患学龄期哮喘的风险最高（比值比[OR]，4.47；95%可信区间，2.58 - 7.76）。早产与学龄前喘息风险增加呈正相关（合并比值比[pOR]，1.34；95%可信区间，1.25 - 1.43）和学龄期哮喘（pOR，1.40；95%可信区间，1.18 - 1.67），且独立于出生体重。对于根据出生时胎龄调整后的低出生体重与学龄前喘息（pOR，1.10；95%可信区间，1.00 - 1.21）和学龄期哮喘（pOR，1.13；95%可信区间，1.01 - 1.27）之间的关联，观察到的效应估计值较弱。
结论
出生时胎龄较小和婴儿体重增加较高与儿童哮喘结局相关。低出生体重与儿童哮喘之间的关联在很大程度上可由出生时的胎龄来解释。
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