Late Preterm Birth and Risk of Developing Asthma

doi:10.1016/j.jpeds.2010.01.008

The Journal of Pediatrics

Volume 157, Issue 1, July 2010, Pages 74-78

https://doi.org/10.1016/j.jpeds.2010.01.008 Get rights and content

Objective

To evaluate the association between gestational age at birth (late preterm vs term) and risk for physician-diagnosed asthma.

Study design

We conducted a retrospective cohort study using the Third National Health and Nutrition Examination Survey (1988-1994) linked natality files. The study included children age 2-83 months from singleton births, born late preterm (n = 537) or term (n = 5650). Using survival analysis, we modeled time to diagnosis of asthma; children with no asthma diagnosis were censored at the age of their survey interview. We used Cox proportional hazard regression to estimate hazard ratios and 95% confidence intervals for gestational age and asthma risk, adjusting for maternal age, maternal education, parental history of asthma/hay fever, maternal smoking history during pregnancy, race/ethnicity, and sex of the child.

Results

Adjusted analysis showed that physician-diagnosed asthma was modestly associated with late preterm birth (hazard ratio, 1.3; 95% confidence interval, 0.8-2.0), but this association was not statistically significant (P = .30).

Conclusions

Our study found that late preterm birth was not associated with a diagnosis of asthma in early childhood.

Section snippets

Methods

We conducted a retrospective cohort study using data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) linked to US birth certificate data. This linked data set was compiled by the National Center for Health Statistics (NCHS)/Centers for Disease Control and Prevention. NHANES III is a nationally representative cross-sectional survey designed to assess the health and nutritional status of US adults and children. It uses a multistage probability sampling

Results

Table I shows the distribution of sociodemographic characteristics of the study population by duration of gestation (late preterm vs term). Of the 6187 children in the study, 537 (7.6%) were born late preterm and 370 (6.3%) had physician-diagnosed asthma (data not shown). Compared with infants born at term, those born late preterm were more likely to be non-Hispanic black and to have a mother age <20 years, a mother who smoked during pregnancy, and a family reference person with less than a

Discussion

Compared with infants born at term, infants born late preterm are more susceptible to respiratory morbidities during their birth hospitalization and neonatal period.4, 12, 13, 14 Our data indicate that late preterm birth was weakly associated with asthma risk in early childhood, but this association was not statistically significant. Other covariates, including male sex, black race, a parental history of asthma/hay fever, less education (head of household), young maternal age, and maternal

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Cited by (51)

Early childhood health and morbidity, including respiratory function in late preterm and early term births
2019, Seminars in Fetal and Neonatal Medicine
Citation Excerpt :
Children born preterm have been noted to secrete more cytokines, chemokines, growth factors and immunomodulatory mediators in nasopharyngeal aspirates done at 1 year when compared with children born at term, suggesting that they were more responsive to pro-inflammatory stimuli, as seen in asthma [57]. Although a study published in 2010 by Abe showed no association between LP birth and asthma [58], several studies have since indicated otherwise, finding increased risk of wheezing illness and asthma in the LP population. Boyle et al. demonstrated increased parent-reported wheezing and use of asthma medication at three and five years of age in LP and ET children participating in the UK Millennium Cohort Study, although the highest risk was seen in very preterm infants (Fig. 1).
Late preterm (LP) and early term (ET) infants have generally been considered in the same way as their healthy full term (FT) counterparts. It is only in the last decade that an increased risk of later poor health in children born LP has been recognised; evidence for health outcomes following ET birth is still emerging. However, reports are largely consistent in highlighting an increased risk, which lessens approaching FT but is measurable and persists into adolescence and beyond. The most thoroughly explored area to date is respiratory morbidity. This article reviews the body of available evidence for effects of LP birth on pulmonary function and ongoing morbidity, and other areas where an increased risk of health problems has been identified in this population. Implications for delivery of health care are considered and areas for further research are highlighted.
Long-Term Pulmonary Outcome of Preterm Infants
2018, The Newborn Lung: Neonatology Questions and Controversies, Third Edition
Risk of Asthma in Late Preterm Infants: A Propensity Score Approach
2015, Journal of Allergy and Clinical Immunology: In Practice
Citation Excerpt :
We believe that the finding of no association between LPT and risk of asthma in our study is not due to lack of statistical power. For example, the literature showed that the effect size for the association between LPT and risk of asthma was 0.94-4.7.6,10,12-14,33 Given the sample size (n = 300 for each group), we had 80% power to detect an HR of 2.06.
The risk of asthma, specifically in former late preterm infants, has not been well defined. Covariate imbalance and lack of controlling for this has led to inconsistent results in prior studies.
The objective of this study was to determine the risk of asthma in former late preterm infants using a propensity score approach.
The study was a population-based birth cohort study. Study subjects were all children born in Rochester, Minn, between 1976 and 1982. Asthma status during the first 7 years of life was assessed by applying predetermined criteria. The propensity score was formulated using 15 covariates by fitting a logistic regression model for late preterm birth versus term birth. We applied the propensity score method to match late preterm infants (34 0/7 to 36 6/7 weeks of gestation) to term infants (37 0/7 to 40 6/7 weeks of gestation) within a caliper of 0.2 standard deviation of logit of propensity score.
Of the eligible 7040 infants, 5915 children had complete data. Before propensity score matching, late preterm infants had a higher risk of asthma (20 of 262, 7.6%) compared with full-term infants (272 of 5653, 4.8%) (P = .039). There was significant covariate imbalance between comparison groups. After matching with propensity scores, we found that former late preterm infants had a similar risk of asthma to the matched full-term infants (6.6% vs 7.7%, respectively, P = .61), and the result was consistent with covariate-adjustment Cox regression models controlling for significant covariates (P = .57).
A late preterm birth history is not independently associated with childhood asthma, as the reported risk of asthma among former late preterm infants appears to be due to covariate imbalance.
Genetic, familial and environmental correlates of asthma among early adolescents in Sri Lanka: A case control study
2015, World Allergy Organization Journal
Citation Excerpt :
The univariate analysis revealed that born as the first child, only child, bed room overcrowding, exposure to cockroaches, presence of allergic rhinitis and other allergies, family history of asthma, allergic rhinitis and eczema were significantly associated with current asthma status of these early adolescents (Table 3). However, there was no significant association of male sex [24], low birth weight [25], pre term birth [26], exclusive breast feeding for 4 months [14], presence of overweight [27] exposure to traffic smoke or bed room overcrowding [14,28,29] or exposure to mould in the bed room with current asthma in the present univariate analysis. Past or present exposure to pets [30], family history of other allergies; present or past exposure to tobacco smoke [31] also failed to show significant relationships with current asthma status as per the univariate analysis.
Background Despite advances in management, the mortality and morbidity due to asthma are increasing globally. Identification of specific correlates in the local context is useful in disease management. The objective of this study was to estimate the prevalence and to describe selected correlates of asthma among12-14 year old school children in a district in Sri Lanka.
Method A school based cross-sectional study was conducted using a self administered questionnaire. Multi-staged stratified cluster sampling was used to select 42 classes in grades 7, 8 and 9. “Current asthma” (CA)(case) was defined as ‘having Physician Diagnosed Asthma (PDA) and having had wheezing during the previous 12 months’. For each case, two healthy controls were selected from the same class to assess correlates. Information on correlates was collected by trained field midwives during home visits. Backward stepwise logistic regression model was used for analysis of correlates. Skin Prick Testing was carried out among asthmatics together with their healthy siblings using standard extracts of House Dust Mite (HDM), cockroach and Blomia. Ethical clearance was obtained from Ethical Review Committee, Faculty of Medicine, Colombo.
Results Out of 1483 subjects participated, 753 were females (50.8%). The prevalence rates for current wheezing (CW), ever wheezing (EW), current asthma (CA), and physician diagnosed asthma (PDA) were 16.7%, 19.4%, 10.7% and 14.5% respectively. A total of 158 CA cases were identified. Information on correlates of asthma was collected for 145 CA cases (97.9%) and for 285 controls (96.6%). The unconfounded predictors of having CA among adolescents in the present sample were; only child in the family (OR = 4.2, 95% CI: 1.7-9.9); first born of the family (OR = 2.6 95% CI: 1.3-5.2); presence of allergic rhinitis (OR = 2.7, 95% CI: 1.6-4.6); family history of asthma (OR = 1.8, 95% CI: 1.1-3.2); family history of allergic rhinitis (OR = 1.9, 95% CI: 1.1-3.2); family history of eczema (OR = 1.8, 95% CI: 1.0-3.2). Higher risk of sensitization to cockroach, HDM and Blomia was seen among asthmatics compared to healthy siblings.
Conclusion A significant proportion of students reported to have asthma. Atopy and other genetic and environmental correlates should be considered as important correlates in asthma management among early adolescents in Sri Lanka.
Respiratory consequences of late preterm birth
2015, Paediatric Respiratory Reviews
Citation Excerpt :
Not all studies have been in agreement, however, particularly at older ages. Data from 537 late preterm and 5650 term-born children in the Third National Health and Nutrition Examination Survey, for example, failed to demonstrate a significant increase in doctor-diagnosed asthma in children aged 2-83 months [45]. There are few studies and no prospective data describing long-term outcomes.
In developed countries most preterm births occur between 34 and 37 weeks’ gestation. Deliveries during this ‘late preterm’ period are increasing and, since even mild prematurity is now recognised to be associated with adverse health outcomes, this presents healthcare challenges. Respiratory problems associated with late preterm birth include neonatal respiratory distress, severe RSV infection and childhood wheezing. Late preterm birth prematurely interrupts in utero lung development and is associated with maternal and early life factors which adversely affect the developing respiratory system. This review considers 1) mechanisms underlying the association between late preterm birth and impaired respiratory development, 2) respiratory morbidity associated with late preterm birth, particularly long-term outcomes, and 3) interventions which might protect respiratory development by addressing risk factors affecting the late preterm population, including maternal smoking, early life growth restriction and vulnerability to viral infection.
The immune consequences of preterm birth
2023, Gynakologische Endokrinologie

View all citing articles on Scopus

: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The authors declare no conflicts of interest.

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Original ArticleLate Preterm Birth and Risk of Developing Asthma

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Semin Perinatol

J Pediatr

Semin Perinatol

J Allergy Clin Immunol

Chest

Births: final data for 2003

Natl Vital Stat Rep

Williams Obstetrics

“Late-preterm” infants: a population at risk

Pediatrics

Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk

Pediatrics

Infant mortality statistics from the 2005 period linked birth/infant death data set

Natl Vital Stat Rep

Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development

Pediatrics

Educational and behavioural problems in babies of 32-35 weeks gestation

Arch Dis Child Fetal Neonatal Ed

Early school-age outcomes of late preterm infants

Pediatrics

Increased risk of adverse neurological development for late preterm infants

J Pediatr

Acute neonatal respiratory distress in Italy: a one-year prospective study. Italian Group of Neonatal Pneumology

Acta Paediatr

Clinical outcomes of near-term infants

Pediatrics

The state of childhood asthma, United States, 1980–2005

Adv Data

Original Article
Late Preterm Birth and Risk of Developing Asthma