Rosas-Salazar Christian, Hartert Tina V
aDivision of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics bDivision of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine cCenter for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Curr Opin Allergy Clin Immunol. 2017 Apr;17(2):110-115. doi: 10.1097/ACI.0000000000000342.
To critically evaluate and summarize studies published between July 2015 and June 2016 linking prenatal exposures and the onset of childhood wheezing illnesses and to discuss future research directions in this field.
The aggregated evidence indicates a consistent detrimental effect of prenatal exposure to parental smoking, outdoor air pollution, and maternal stress on childhood wheezing illnesses. Less consistent evidence suggests an adverse impact of maternal obesity during pregnancy and prenatal exposure to antibiotics on these outcomes. There is insufficient evidence to support an association between in-utero exposure to acetaminophen or prenatal levels of specific nutrients (such as vitamin D, folic acid, or polyunsaturated fatty acids) and childhood wheezing illnesses.
Several common potentially modifiable prenatal exposures appear to be consistently associated with childhood wheezing illnesses (e.g. parental smoking, outdoor air pollution, and maternal stress). However, the effect of many other prenatal exposures on the onset of childhood wheezing illnesses remains unclear. The existing scientific evidence from the past year does not allow us to make any new recommendations on primary prevention measures. Intervention studies will best demonstrate whether changing the prenatal environment can prevent childhood wheezing illnesses and asthma.
批判性评估和总结2015年7月至2016年6月期间发表的有关产前暴露与儿童喘息性疾病发病之间关系的研究，并讨论该领域未来的研究方向。
综合证据表明，产前暴露于父母吸烟、室外空气污染和母亲压力对儿童喘息性疾病具有持续的有害影响。不太一致的证据表明，孕期母亲肥胖和产前接触抗生素对这些结果有不利影响。没有足够的证据支持宫内接触对乙酰氨基酚或特定营养素（如维生素D、叶酸或多不饱和脂肪酸）的产前水平与儿童喘息性疾病之间存在关联。
几种常见的、可能可改变的产前暴露似乎与儿童喘息性疾病持续相关（如父母吸烟、室外空气污染和母亲压力）。然而，许多其他产前暴露对儿童喘息性疾病发病的影响仍不清楚。过去一年的现有科学证据不允许我们就一级预防措施提出任何新建议。干预研究将最能证明改变产前环境是否可以预防儿童喘息性疾病和哮喘。
