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Clinical & Experimental Allergy

Perinatal risk factors for wheezing phenotypes in the first 8 years of life

Authors

  • D. Caudri,

    1. Department of Pediatrics/Respiratory Medicine, Erasmus University Medical Center – Sophia Children's Hospital, Rotterdam, The Netherlands
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  • O. E. M. Savenije,

    1. Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    2. Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
    3. GRIAC Research Institute, Groningen, The Netherlands
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  • H. A. Smit,

    1. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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  • D. S. Postma,

    1. GRIAC Research Institute, Groningen, The Netherlands
    2. Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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  • G. H. Koppelman,

    1. Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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  • A. H. Wijga,

    1. Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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  • M. Kerkhof,

    1. Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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  • U. Gehring,

    1. Institute for Risk Assessment Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • M. O. Hoekstra,

    1. Department of General Pediatrics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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  • B. Brunekreef,

    1. Institute for Risk Assessment Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands
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  • J. C. de Jongste

    Corresponding author
    1. Department of Pediatrics/Respiratory Medicine, Erasmus University Medical Center – Sophia Children's Hospital, Rotterdam, The Netherlands
    • Correspondence: Johan C. de Jongste, Erasmus MC/Sophia Children's Hospital, Department of Pediatric Respiratory Medicine, PO Box 2060, 3000 CB Rotterdam, The Netherlands.

      E-mail: j.c.dejongste@erasmusmc.nl

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Summary

Background

A novel data-driven approach was used to identify wheezing phenotypes in pre-schoolchildren aged 0–8 years, in the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort. Five phenotypes were identified: never/infrequent wheeze, transient early wheeze, intermediate onset wheeze, persistent wheeze and late onset wheeze. It is unknown which perinatal risk factors drive development of these phenotypes.

Objective

The objective of the study was to assess associations of perinatal factors with wheezing phenotypes and to identify possible targets for prevention.

Methods

In the PIAMA study (n = 3963), perinatal factors were collected at 3 months, and wheezing was assessed annually until the age of 8 years. Associations between perinatal risk factors and the five wheezing phenotypes were assessed using weighted multinomial logistic regression models. Odds ratios were adjusted for confounding variables and calculated with ‘never/infrequent wheeze’ as reference category.

Results

Complete data were available for 2728 children. Risk factors for transient early wheeze (n = 455) were male gender, maternal and paternal allergy, low maternal age, high maternal body mass index, short pregnancy duration, smoking during pregnancy, presence of older siblings and day-care attendance. Risk factors for persistent wheeze (n = 83) were male gender, maternal and paternal allergy, and not receiving breastfeeding for at least 12 weeks. Intermediate onset wheeze (n = 98) was associated with a lower birth weight and late onset wheeze (n = 45) with maternal allergy.

Conclusion and Clinical Relevance

We identified different risk factors for specific childhood wheezing phenotypes. Some of these are modifiable, such as maternal age and body mass index, smoking, day-care attendance and breastfeeding, and may be important targets for prevention programmes.

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