Maternal asthma severity and control during pregnancy and risk of offspring asthma

J Allergy Clin Immunol. 2018 Mar;141(3):886-892.e3. doi: 10.1016/j.jaci.2017.05.016. Epub 2017 Jul 13.

Abstract

Background: Severe and uncontrolled asthma during pregnancy has been linked to several unfavorable perinatal outcomes. However, current knowledge on the association between the severity and control of maternal asthma and offspring asthma is sparse.

Objective: We sought to investigate the extent to which offspring asthma is influenced by maternal asthma severity and control during pregnancy.

Methods: We performed a prospective population-based cohort study. Using linkage of Danish national registers, we constructed a cohort of 675,379 singletons, of which 15,014 children were born to asthmatic mothers. Among them, 7,188 children were born to mothers with active asthma during pregnancy. We categorized mothers with active asthma into 4 groups based on dispensed antiasthma prescriptions and on use of medical services: mild controlled, mild uncontrolled, moderate-to-severe controlled, and moderate-to-severe uncontrolled asthma. The outcomes were offspring early-onset transient, early-onset persistent, and late-onset asthma. We estimated prevalence ratios (PRs) of each phenotype of asthma using a log-binomial model with 95% CIs.

Results: Higher prevalence of early-onset persistent asthma was observed among children of asthmatic mothers with mild uncontrolled (PR, 1.19; 95% CI, 1.05-1.35), moderate-to-severe controlled (PR, 1.33; 95% CI, 1.09-1.63), and moderate-to-severe uncontrolled asthma (PR, 1.37; 95% CI, 1.17-1.61) compared with those of mothers with mild controlled asthma. A borderline increased prevalence of early-onset transient asthma was observed among children of mothers with uncontrolled asthma.

Conclusion: Maternal uncontrolled asthma increases the risk of early-onset persistent and transient asthma. If replicated, this could suggest that maintaining asthma control in pregnancy is an area for possible prevention of specific phenotypes of offspring asthma.

Keywords: Asthma; cohort study; control; early onset; late onset; phenotype; pregnancy; severity.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma / epidemiology*
  • Child
  • Child, Preschool
  • Denmark / epidemiology
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Prevalence
  • Prospective Studies