Child Health, University of Aberdeen, Aberdeen, UK
Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
Eur Respir J. 2018 Jan 31;51(2). doi: 10.1183/13993003.01509-2017. Print 2018 Feb.
There is increasing evidence that antenatal factors predispose to childhood asthma. We tested the hypothesis that reduced first trimester fetal size is associated with increased risk for asthma at 15 years of age.Fetal size in the first and second trimester was ascertained by ultrasound scan. The primary outcome of being dispensed one or more asthma medications by the family doctor in the year before the 15th birthday was determined from routinely acquired dispensing data.Dispensing data were available for 1699 (88% of the original cohort) participants at 15 years of age and questionnaire data for 750 (39%). Each reduction in z-score for first trimester size was associated with increased odds for dispensed asthma medication at 15 years of age (OR 1.26, 95% CI 1.03-1.54) and self-reported use of asthma medications (OR 1.55, 95% CI 1.16-2.08). Overall, first and second trimester size and forced expiratory volume in 1 s at ages 5, 10 and 15 years were reduced for those dispensed asthma medications compared with those not dispensed asthma medications (p=0.003).Antenatal factors that are active by the first trimester may contribute to respiratory well-being throughout childhood. Dropout from a birth cohort study can overestimate of the magnitude of any true association.
越来越多的证据表明产前因素使儿童易患哮喘。我们检验了这样一个假设，即妊娠早期胎儿生长受限与 15 岁时哮喘风险增加有关。通过超声扫描确定妊娠早期和中期胎儿大小。根据常规获得的配药数据，确定了在 15 岁生日前一年，家庭医生开出一种或多种哮喘药物的主要结局。在 15 岁时，1699 名（原始队列的 88%）参与者有配药数据，750 名（39%）有问卷调查数据。妊娠早期大小的 z 评分每降低一个单位，与 15 岁时开具哮喘药物的几率增加相关（OR 1.26，95% CI 1.03-1.54）和自我报告使用哮喘药物（OR 1.55，95% CI 1.16-2.08）。总体而言，与未开具哮喘药物的参与者相比，开具哮喘药物的参与者在年龄为 5、10 和 15 岁时的第一和第二孕期大小以及 1 秒用力呼气量均降低（p=0.003）。妊娠早期活跃的产前因素可能会影响整个儿童期的呼吸健康。从出生队列研究中辍学可能会高估任何真实关联的程度。
