Lin Ching-Heng, Wang Jiun-Long, Chen Hsin-Hua, Hsu Jeng-Yuan, Chao Wen-Cheng
1Department of Medical Research, Taichung Veterans General Hospital, 1650 Taiwan Boulevard, Sect. 4, Taichung, 40705 Taiwan.
2Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Allergy Asthma Clin Immunol. 2019 Sep 3;15:52. doi: 10.1186/s13223-019-0365-y. eCollection 2019.
Increasing prevalence of childhood allergic diseases including asthma is a global health concern, and we aimed to investigate prenatal risk factors for childhood asthma and to address the potential shared prenatal impacts among childhood asthma, allergic rhinitis (AR) and atopic dermatitis (AD).
We used two claim databases, including Taiwan Birth Cohort Study (TBCS) and National Health Insurance Research Database (NHIRD), to identify independent paired mother-child data (mother-child dyads) between 2006 and 2009. The association between prenatal factors and asthma was determined by calculating adjusted odds ratio (aOR) with 95% confidence interval (CI) using conditional logistic regression analysis.
A total of 628,878 mother-child dyads were included, and 43,915 (6.98%) of children developed asthma prior to age 6. We found that male gender (aOR 1.50, 95% CI 1.47-1.53), maternal asthma (aOR 1.80, 95% CI 1.71-1.89), maternal AR (aOR 1.33, 95% CI 1.30-1.37), preterm birth (aOR 1.32, 95% CI 1.27-1.37), low birth weight (aOR 1.14, 95% CI 1.10-1.19) and cesarean section (aOR 1.10, 95% CI 1.08-1.13) were independent predictors for childhood asthma. A high urbanization level and a low number of older siblings were associated with asthma in a dose-response manner. Notably, we identified that the association between maternal asthma and childhood asthma (aOR 1.80, 95% CI 1.71-1.89) was stronger compared with those between maternal asthma and childhood AR (aOR 1.67, 95% CI 1.50-1.87) as well as childhood AD (aOR 1.31, 95% CI 1.22-1.40). Similarly, the association between maternal AR and childhood AR (aOR 1.62, 95% CI 1.53-1.72) was higher than those between maternal AR and childhood asthma (aOR 1.33, 95% CI 1.30-1.37) as well as childhood AD (aOR 1.35, 95% CI 1.31-1.40). Furthermore, the number of maternal allergic diseases was associated with the three childhood allergic diseases in a dose-response manner.
In conclusion, this population-based study provided evidence of prenatal impacts on childhood asthma and demonstrated the shared maternal impacts among childhood asthma, AR, and AD. These findings highlight the shared prenatal impacts among allergic diseases, and studies are warranted to address the pivotal pathway in allergic diseases.
包括哮喘在内的儿童过敏性疾病患病率不断上升是一个全球健康问题，我们旨在调查儿童哮喘的产前危险因素，并探讨儿童哮喘、过敏性鼻炎（AR）和特应性皮炎（AD）之间潜在的共同产前影响因素。
我们使用了两个索赔数据库，包括台湾出生队列研究（TBCS）和国民健康保险研究数据库（NHIRD），以识别2006年至2009年间独立配对的母婴数据（母婴二元组）。产前因素与哮喘之间的关联通过使用条件逻辑回归分析计算调整后的优势比（aOR）及95%置信区间（CI）来确定。
共纳入628,878对母婴二元组，其中43,915名（6.98%）儿童在6岁前患哮喘。我们发现，男性（aOR 1.50，95% CI 1.47 - 1.53）、母亲哮喘（aOR 1.80，95% CI 1.71 - 1.89）、母亲AR（aOR 1.33，95% CI 1.30 - 1.37）、早产（aOR 1.32，95% CI 1.27 - 1.37）、低出生体重（aOR 1.14，95% CI 1.10 - 1.19）和剖宫产（aOR 1.10，95% CI 1.08 - 1.13）是儿童哮喘的独立预测因素。高城市化水平和年长兄弟姐妹数量少与哮喘呈剂量反应关系。值得注意的是，我们发现母亲哮喘与儿童哮喘之间的关联（aOR 1.80，95% CI 1.71 - 1.89）比母亲哮喘与儿童AR（aOR 1.67，95% CI 1.50 - 1.87）以及儿童AD（aOR 1.31，95% CI 1.22 - 1.40）之间的关联更强。同样，母亲AR与儿童AR之间的关联（aOR 1.62，95% CI 1.53 - 1.72）高于母亲AR与儿童哮喘（aOR 1.33，95% CI 1.30 - 1.37）以及儿童AD（aOR 1.35，95% CI 1.31 - 1.40）之间的关联。此外，母亲过敏性疾病的数量与三种儿童过敏性疾病呈剂量反应关系。
总之，这项基于人群的研究提供了产前对儿童哮喘影响的证据，并证明了儿童哮喘、AR和AD之间存在共同的母亲影响因素。这些发现突出了过敏性疾病之间共同的产前影响，有必要开展研究以阐明过敏性疾病的关键发病途径。
