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									Maternal Infections In Pregnancy
And The Development Of Asthma
       Among Offspring
International Journal of Epidemiology 1999

Baizhuang Xu, Juha Pekkanen, Marjo-Riitta
   Järvelin, Päivi Olsen and Anna-Liisa
               Hartikainen-

              LICE VANIQI-
 INTRODUCTION
 It has been increasingly apparent that asthma phenotype
  could be programmed before birth.

 This was supported by findings that :
 children whose mothers smoked during pregnancy had a
  higher risk of developing asthma later in life than children of
  non-smoking mothers.
 LBW associated with the risk of childhood asthma.
 The effect of maternal line on childhood asthma was greater
  than that of paternal line.
 Newborns with disproportionate fetal growth had
 higher immunoglobulin E(IgE) concentration later
 in life.

 This suggested that fetal development as
 determined by certain intrauterine environment is
 an important stage that may predispose a baby to
 develop asthma later in life.

 The process of sensitization starts during
MATERIALS AND METHODS
 The study population was derived from a birth cohort
    designed to include all pregnancies in Northern Finland.
   The study period was from July 1 1985 -30 June 1986.
   The women were enrolled at their 24th week of gestation at
    the maternity health center.
   The cohort consisted of 9479 births (47(stillbirths)75(died
    before aged 7) and 31(could not be traced at age 7)leaving
    9326 children available in 1993.
   The current analysis was further limited to 8088-indication
    children with complete information on pregnancy and
    whose mother returned the questionnaire in 1993.
 The study was approved by the ethical committee of the
 University of Oulu,Finland.

 Data on development of asthma among children aged 7 was
 collected using a structured self-administered questionnaire
 filled in by mothers in 1993.

 The information of asthma was supplemented by linking
 cohort with the National Hospital Discharge Records.

 In the Q-3.1% of children reported having asthma while the
 NHDR reported-1.4% hospitalised due to asthma.
 The information on maternal infections during pregnancy
  was obtained using a structured SAQ.

 It was distributed to the mum at their last antenatal visit.


 For those who failed to fill it in,information was collected at
  the midwife’s first home visit after delivery.

 The demographic data was collected from delivery records.
 Some of the variables were further classified eg
  the number of cigarettes smoked per day,marital
  status,BMI,diagnosis of asthma or other allergens.
 Information on febrile infections were further
  classified as to what type of infection and at which
  gestation.
 For maternal vaginitis they were asked if they were
  treated to any gynae infection and choices were
  provided but the timing was unavailable.
 The difference in the prevalence of asthma was
  examined with Pearson’s x2 test
                          A     NA     PREV    P-VALUE

OVERALL                   283   7805     3.5
AGE
≤ 19 YEARS                12    301      3.8     0.476
20-34                     241   6487     3.6
>35                       30    1017     2.9
SEASON OF BIRTH
MAR-MAY                   72    2012     3.5    0.296
JUNE-AUGUST               71    2015     3.4
SEP-NOVEMBER              60    1923     3.0
DEC-FEBRUARY              80    1855     4.1
MATERNAL SMOKING DURING
PREGNANCY
YES                       66    1592     4.0     0.243
NO                        217   6186     3.4
MALE                      193   3952     4.7    0.000
FEMALE                    90    3853     2.3
                               A          NA    PREV     P-VALUE
VAGINITIS DURING PREGNANCY
YES                                80    1692     4.5      0.008
NO                             203       6113     3.2
FEBRILE INFXNS IN PREGNANCY
YES                                71    1321     5.1      0.000
NO                                 212   6484     3.2
BIRTHWEIGHT(grams)
<2500                              17    239      6.6      0.005
≥ 2500                         266       7566     3.4
GESTATIONAL WEEKS
≤36                                19    335      5.4       0.05
≥ 37                           264       7470     3.4
MATERNAL ALLERGENIC DISEASES
YES                                18    102      15.0     0.000
NO                             265       7703     3.3
Factors                               Adjusted OR   95% CI
Maternal Hx of allergic diseases
No                                        1.00
Yes                                       4.92      2.91 – 8.33
Febrile infections during pregnancy
No                                        1.00
Yes                                       1.65      1.25 – 2.18
Vaginitis during pregnancy
No                                        1.00
Yes                                       1.41      1.08 – 1.84
Sex of children
Girl                                      1.00
Boy                                       2.13      1.64 – 2.75
Birthweight (grams)
≥2500                                     1.00
<2500                                     2.06      1.08 – 3.94
Gestational weeks
≥37                                       1.00
≤36                                       1.30      0.74 – 2.28
Timing of febrile   A     NA     Prevalence   OR
   infections

      No            211   6481      3.2       1.00


  1st trimester     12    169       6.6       2.17


  2nd trimester     21    367       5.4       1.75


  3rd trimester     29    624       4.4       1.42


   Ant 2 or 3       10    164       5.7       1.86
   trimesters
  RESULTS
The prevalence of asthma by 7years was 3.5% among 8088
  children.
 Asthma was more common among children of mothers who
  had a history of asthma or allergic diseases or vaginitis during
  pregnancy
 Also among boys,children with low birth weight and those
  born prematurely.
 Even after adjusting for maternal age,maternal BMI,social
  class,season of birth as well as mutual adjustment these
  factors still showed substantially independent effects on
  childhood asthma.
  Of 1772 mothers with vaginitis:
 Candida(87.4%)Chlamydia(2.1%)Herpes(1.1%)
  Trichomonas(1.9%) and others (8.8%)
 There was a case report done in 1994 stating the association
  of Candida Albicans with atopic asthma.
 We observed a clear trend of risk of childhood asthma
  corresponding to the timing of maternal febrile infections
  during pregnancy.
 It appeared that the earlier mothers got febrile infections
  during pregnancy the higher the risk would be.
 OR for the 1st,2nd and 3rd trimester respectively were
  2.08,1.73,1.44
 The results were virtually unchanged after allowing for
    potential confounders.
   Overall the data implies the most critical time period for fetal
    sensitization might start at a very early stage in pregnancy.
   This can be true as lymphocytes are observed in the thymus
    at 8-9wks gestation and synthesis of immunoglobulin
    including IgE starts before 12 weeks in the fetus.
   Plenty of clinical and immunological studies have shown that
    the proliferation response of immune system to specific
    allergens starts in the utero
   Even if later in pregnancy avoidance maternal food allergen
    is ineffective in prevention of infant allergy.
LIMITATIONS
 Lost to follow up reporting.
 Incompletely filled questionnaires.
 Incomplete history of maternal allergic diseases.
 In Finland the prevalence of doctor-diagnosed asthma
  is low as compared to other European countries.
 But again this was not a major problem as the variables
  were adjusted and it still showed significant positive
  findings.
CONCLUSIONS
 Fiji has a high incidence of asthma
 I believe that we would wholeheartedly embrace
  any sort of evidence to decrease this trend.
 Not to mention Fiji as a Pacific Island where the
  incidence of diabetes is high also importantly
  gestational diabetes.
 In gestational diabetes they have increased risk
  vaginal infections,urinary infections.
 By taking into account what this study has
  gathered we can basically be aggressive and
 Some of these women presenting with vaginitis
 may be missed in clinic and some appears in
 unbooked mothers.

 What I have noticed is that in ANC most of the
 attention is focused on the uterus and because
 during pregnancy the vagina has a lot of secretions
 and sometimes whitish and would lead them to
 think that it was physiological when it is
 otherwise.

								
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