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. 2016 Sep;71(9):1295-304.
doi: 10.1111/all.12876. Epub 2016 Apr 13.

Longitudinal Study of Maternal Body Mass Index, Gestational Weight Gain, and Offspring Asthma

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Free PMC article

Longitudinal Study of Maternal Body Mass Index, Gestational Weight Gain, and Offspring Asthma

O Dumas et al. Allergy. .
Free PMC article

Abstract

Background: Sparse data are available on the relationship between prenatal exposures and asthma during later childhood. In a longitudinal study of adolescents and their mothers, we examined the association of (i) maternal prepregnancy body mass index (BMI) and (ii) gestational weight gain (GWG), with incidence of allergic and nonallergic asthma in offspring.

Methods: Analyses were conducted using data from 12 963 children aged 9-14 years at enrolment in the Growing Up Today Study, and their mothers, who are participants in the Nurses' Health Study II. Physician-diagnosed asthma and allergies were assessed by questionnaires sent regularly to participants and their mothers. Logistic regression was used to evaluate associations of maternal BMI and GWG with offspring asthma, overall and by subtype.

Results: Physician-diagnosed asthma during childhood or adolescence was reported by 2694 children (21%). Maternal prepregnancy overweight (OR: 1.19, 95% CI: 1.03-1.38) and obesity (1.34, 1.08-1.68) were associated with offspring asthma. In asthma subtype analyses, the association was seen only for asthma onset before age 12 years. Moreover, the association of maternal obesity with nonallergic asthma was observed in boys (2.39, 1.40-4.09) and not in girls (0.96, 0.50-1.85; Pinteraction = 0.03); the opposite pattern was suggested for allergic asthma. With regard to GWG, an association was suggested between gains of <15 lb and higher risk of offspring asthma (1.28, 0.98-1.66), without clear allergy- or sex-related patterns.

Conclusion: The relation of several prenatal factors to risk of childhood asthma supports the early origins hypothesis for asthma. The observed allergy- and sex-specific patterns suggest multiple etiologic pathways.

Keywords: allergy; childhood asthma; developmental origins of health and disease; gestational weight gain; maternal obesity.

Figures

Figure 1
Figure 1
Directed Acyclic Graph (DAG) presenting the relationships between the main exposures of interests, covariates and asthma outcomes. Maternal smoking and US region were evaluated early in the child’s life (age 2-7). In main analyses, we hypothesized that mode of delivery (C-section), breastfeeding duration, and child’s birth order may confound the relationship of prenatal and perinatal exposures with asthma through unmeasured common causes (U); we thus adjusted for these 3 factors when studying the associations with offspring asthma. However, mode of delivery is also a possible mediator in this relationship (alternative hypothesis not represented in the DAG); models not adjusted for C-section were thus also tested in sensitivity analyses. For simplicity, gestational diabetes was omitted from the DAG; the hypotheses posited for the relationship with the other variables were similar for gestational diabetes than for GWG.
Figure 2
Figure 2
Associations (adjusted odds ratio and 95% confidence intervals) between maternal pre-pregnancy obesity (body mass index ≥30 kg/m2) and incidence of allergic and non-allergic asthma in childhood, according to the child’s sex. Reference category for body mass index: 20.0-22.4 kg/m2. P for interaction are displayed only if statistically significant (<0.05). BMI – Body Mass Index; OR – Odds Ratio; CI – Confidence Interval

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