Sydney Medical School-Nepean, Discipline of Paediatrics and Child Health, The University of Sydney, Sydney, NSW, Australia.
Centre for Personalized Medicine, Linköping University, Linköping, Sweden.
PLoS One. 2021 May 27;16(5):e0252215. doi: 10.1371/journal.pone.0252215. eCollection 2021.
Asthma is the most common non-communicable pulmonary condition, affecting prepubertal boys more often than girls. This study explored how maternal and perinatal risk factors are linked to poorly controlled childhood asthma in a sex dependent manner. This single centre study was performed at a metropolitan teaching hospital in Western Sydney, Australia, using electronical obstetric records from 2000 to 2017 and electronical pediatric records from 2007 to 2018. The data of 1694 children with complete entries were retrospectively analysed. Risk factors for multiple hospital admission for asthma were selected by backward-eliminated Poisson regression modelling. Selection stability of these parameters was independently confirmed using approximated exhaustive search. Sex-specific regression models indicated that most notably parity (RR[95%CI] for parity = 3; 1.85[1.22-2.81]), birth length z-score (1.45[1.23-1.70]) and birth weight z-score (0.77[0.65-0.90]) contributed to multiple asthma admissions in girls, while boys were affected most prominently by maternal BMI (e.g. BMI 35-39.9; 1.92[1.38-2.67]) and threatened preterm labor (1.68[1.10-2.58]). Allergic status was a risk factors for both boys and girls (1.47[1.18-1.83] and 1.46[1.13-1.89]). Applying ROC analysis, the predictive modelling of risk factors for hospital admissions showed an incremental increase with an AUC of 0.84 and 0.75 for girls and boys respectively for >3 hospital admissions. Multiple hospital admissions for asthma are associated with maternal and perinatal risk factors in a sex and birth order dependent manner. Hence, prospective risk stratification studies aiming to improve childhood asthma control are warranted to test the clinical utility of these parameters. Furthermore, the influence of the early in utero environment on male-female differences in other communicable and non-communicable respiratory conditions should be considered.
哮喘是最常见的非传染性肺部疾病，在青春期前男孩中比女孩更为常见。本研究旨在探索母体和围产期危险因素如何以性别依赖的方式与儿童哮喘控制不良相关。这项单中心研究在澳大利亚西部悉尼的一家大都市教学医院进行，使用了 2000 年至 2017 年的电子产科记录和 2007 年至 2018 年的电子儿科记录。对 1694 名完整记录的儿童进行了回顾性分析。通过后向消除泊松回归模型选择哮喘多次住院的危险因素。使用近似穷尽搜索独立确认这些参数的选择稳定性。性别特异性回归模型表明，尤其是产次（RR[95%CI]产次= 3；1.85[1.22-2.81]）、出生长度 z 评分（1.45[1.23-1.70]）和出生体重 z 评分（0.77[0.65-0.90]）对女孩多次哮喘发作有贡献，而男孩则受母亲 BMI（例如 BMI 35-39.9；1.92[1.38-2.67]）和早产威胁（1.68[1.10-2.58]）的影响最大。过敏状态是男孩和女孩的危险因素（1.47[1.18-1.83]和 1.46[1.13-1.89]）。应用 ROC 分析，对住院危险因素的预测模型显示，对于>3 次住院，女孩和男孩的 AUC 分别为 0.84 和 0.75，呈递增趋势。哮喘多次住院与母体和围产期危险因素有关，与性别和出生顺序有关。因此，需要进行前瞻性风险分层研究，以测试这些参数的临床实用性。此外，应考虑早期宫内环境对男性和女性在其他传染性和非传染性呼吸道疾病中的性别差异的影响。
