Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
J Pediatr. 2020 Apr;219:173-179.e1. doi: 10.1016/j.jpeds.2019.12.053. Epub 2020 Jan 24.
To examine maternal preexisting type 2 diabetes (T2D) and gestational diabetes mellitus (GDM) on risk of childhood asthma.
This retrospective birth cohort study included 97 554 singletons born in 2007-2011 within hospitals from a single integrated healthcare system. Children were prospectively followed from age 5 until December 31, 2017, using electronic medical records. Relative risks of childhood asthma associated with maternal diabetes in utero were estimated by hazard ratios using Cox regression adjusting for potential confounders.
There were 3119 children (3.2%) who were exposed to preexisting T2D and 9836 (10.1%) to GDM. Among mothers with GDM, 3380 (34.4%) were dispensed antidiabetic medication during pregnancy. During a median of 7.6 years (IQR, 6.3-9.0 years) after birth, 15 125 children (15.5%) were diagnosed with asthma after age 5. Maternal diabetes interacted with maternal asthma history to affect child's asthma risk (P = .05). Among children without maternal asthma (n = 89 487), the adjusted hazard ratios for childhood asthma were 1.21 (95% CI, 1.08-1.36; P < .001) for exposure to T2D, 1.12 (95% CI, 1.01-1.25; P = .04) for GDM requiring antidiabetic medications, and 1.01 (95% CI, 0.93-1.10; P = .82) for GDM not requiring medications compared with no diabetes during pregnancy. The corresponding hazard ratios were 1.53 (95% CI, 1.19-1.96; P < .001), 1.11 (95% CI, 0.65-1.46; P = .44), and 0.84 (95% CI, 0.66-1.08; P = .17) among children without maternal asthma (n = 8067). Gestational age at GDM diagnosis was not associated with childhood asthma (P = .27).
The risk of childhood asthma was predominately observed for exposure to preexisting T2D, small for GDM requiring medication, and not increased for GDM not requiring medication during pregnancy, compared with no diabetes during pregnancy.
研究母亲孕前 2 型糖尿病（T2D）和妊娠期糖尿病（GDM）与儿童哮喘的风险关系。
本回顾性出生队列研究纳入了 2007 年至 2011 年期间在单一综合医疗系统内医院出生的 97554 名单胎。使用电子病历对儿童从 5 岁开始进行前瞻性随访，直至 2017 年 12 月 31 日。使用 Cox 回归调整潜在混杂因素，估计与母体糖尿病相关的儿童哮喘的相对风险。
3119 名儿童（3.2%）暴露于孕前 T2D，9836 名儿童（10.1%）暴露于 GDM。在妊娠期间，GDM 母亲中有 3380 名（34.4%）接受了抗糖尿病药物治疗。在出生后中位数 7.6 年（IQR，6.3-9.0 年）后，15125 名（15.5%）儿童在 5 岁后被诊断为哮喘。糖尿病与母亲哮喘史相互作用，影响儿童哮喘的风险（P=0.05）。在没有母亲哮喘的儿童（n=89487）中，暴露于 T2D 的儿童哮喘调整后风险比为 1.21（95%CI，1.08-1.36；P<0.001），需要抗糖尿病药物治疗的 GDM 的风险比为 1.12（95%CI，1.01-1.25；P=0.04），GDM 不接受药物治疗的风险比为 1.01（95%CI，0.93-1.10；P=0.82）与妊娠期间无糖尿病相比。在没有母亲哮喘的儿童（n=8067）中，相应的风险比为 1.53（95%CI，1.19-1.96；P<0.001）、1.11（95%CI，0.65-1.46；P=0.44）和 0.84（95%CI，0.66-1.08；P=0.17）。GDM 诊断时的胎龄与儿童哮喘无关（P=0.27）。
与妊娠期间无糖尿病相比，儿童哮喘的风险主要与孕前 T2D 暴露有关，需要药物治疗的 GDM 较小，而 GDM 不接受药物治疗与儿童哮喘无关。
