Asthma and lower airway disease
Preterm birth, infant weight gain, and childhood asthma risk: A meta-analysis of 147,000 European children

https://doi.org/10.1016/j.jaci.2013.12.1082Get rights and content
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Background

Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results.

Objectives

We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years).

Methods

First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes.

Results

Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27).

Conclusion

Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth.

Key words

Gestational age
low birth weight
infant growth
wheezing
asthma
children
cohort studies
epidemiology

Abbreviations used

BMI
Body mass index
ISAAC
International Study on Asthma and Allergy in Childhood
OR
Odds ratio
pOR
Pooled odds ratio
SDS
Standard deviation scores

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Supported by the European Community's Seventh Framework Programme FP7/2007-2013, project CHICOS. The research leading to these results has received funding from the European Respiratory Society and the European Community's Seventh Framework Programme FP7/2007-2013–Marie Curie Actions under grant agreement RESPIRE, PCOFUND-GA-2008-229571.

Disclosure of potential conflict of interest: I. Annesi-Maesano has received one or more grants from or has one or more grants pending with UE. S. H. Arshad has been supported by one or more grants from the National Institute of Health and Asthma UK and has received one or more payments for lecturing from or is on the speakers' bureau for Thermo Fisher and GlaxoSmithKline. H. Bisgaard has been supported by one or more grants from the Danish State Budget and the Lundbeck Foundation, has consultancy arrangements with Chiesi Pharmaceuticals, and has received one or more grants from or has one or more grants pending with the Danish Strategic Research Council, the Capital Region of Denmark, the Oticon Foundation, the European Research Council, and the Danish Council for Independent Research, Medical Sciences. C. Dogaru and C. E. Kuehni are employed by the University of Bern. M. Eggesbø has been supported by one or more grants from and has received support for travel from Chicos. A. J. Henderson has been supported by one or more grants from the Wellcome Trust and the Medical Research Council. H. M. Inskip has been supported by one or more grants from the UK Medical Research Council and many funding bodies and is a Board member for the UK Medical Research Council. T. Keil has received one or more grants from or has one or more grants pending with the European Commission. K. Lancz and L. Palkovicova have been supported by one or more grants from the NIH (NCI and Fogarty), the European Union, and the Slovak Ministry of Health. S. Lau has been supported by one or more grants from the German Research Foundation DFG, is a member of the Merck Drug monitoring committee, has consultancy arrangements with Allergopharma (Reinbek, Germany), has received one or more grants from or has one or more grants pending with Symbiopharm (Herborn, Germany), and has received one or more payments for lecturing from or is on the speakers' bureau for Symbiopharm, GlaxoSmithKline, CSL Behring. M. Mommers has been supported by one or more grants from the Netherlands Asthma Foundation and has received support for travel from the European Community Seventh Framework Programme. K. C. Pike has been supported by one or more grants from FSA BLF and has received various travel grants and bursaries, most recently from the European Respiratory Society. G. Roberts has been supported by one or more grants from the NIH and BMA. A. Schmidt has been supported by one or more grants from the Swiss National Science Foundation. C. Thijs has been supported by one or more grants from the Netherlands Asthma Foundation and has received support for travel from European Community's Seventh Framework Programme. M. Vrijheid has been supported by one or more grants from and has received support for travel from the European Community's Seventh Framework Programme FP7/2007-2013 (Project CHICOS). L. Duijts has received research support from the European Community's Seventh Framework Programme FP7/2007-2013 (Project CHICOS) and is the recipient of a European Respiratory Society/Marie Curie Joint Research Fellowship (no. MC 1226-2009). The rest of the authors declare that they have no relevant conflicts of interest.