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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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