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妊娠期间母亲哮喘的严重程度和控制以及后代哮喘的风险

2018/04/08

   摘要
   背景:妊娠期间重度和未控制的哮喘与几种不利的围产期结局有关。 然而,目前关于母亲哮喘严重程度与控制和后代哮喘之间关系的知识很少。
   目的:本文旨在观察后代哮喘受母亲孕期哮喘严重程度和控制影响的程度。
   方法:我们进行了一项前瞻性的基于人群的队列研究。利用丹麦国家登记册的联系,我们构建了675,379个单身人群队列,其中15014名儿童是由哮喘母亲所生的。 这些儿童中有7,188名儿童的母亲在孕期患有活动性哮喘。 我们根据抗哮喘处方和医疗服务使用将具有活动性哮喘的母亲分为4组:轻度控制,轻度未控制,中至重度控制,以及中至重度未控制哮喘。 结局是后代早发暂时性,早发持续性和迟发性哮喘。我们使用具有95%可信区间的对数二项式模型评估每种哮喘表型的患病率(PRs)。
   结果:与轻度控制哮喘母亲相比,轻度未控制(PR,1.19; 95%CI,1.05-1.35),中至重度控制(PR,1.33; 95%CI,1.09-1.63) )和中至重度未控制哮喘(PR,1.37; 95%CI,1.17-1.61)母亲的后代有更高的早发持续性哮喘患病率。未控制哮喘母亲的后代中观察到早发暂时性哮喘的患病率增加。
   结论:未控制哮喘孕妇增加了后代早发持续性和早发短暂性哮喘的风险。如果可重复,这表明在孕期维持哮喘控制可能是预防子代哮喘特定表型的一个方面。


(中日友好医院呼吸与危重症医学科 王瑞茵 摘译 林江涛 审校)
(J Allergy Clin Immunol. 2018 Mar;141(3):886-892.e3. doi: 10.1016/j.jaci.2017.05.016. Epub 2017 Jul 13.)


 
Maternal asthma severity and control during pregnancy and risk of offspring asthma.
 
Liu X, Agerbo E, Schlünssen V, Wright RJ, Li J, Munk-Olsen T.

Abstract
BACKGROUND:Severe and uncontrolled asthma during pregnancy has been linked to several unfavorable perinatal outcomes. However, current knowledge on the association between the severity and control of maternal asthma and offspring asthma is sparse.
OBJECTIVE:We sought to investigate the extent to which offspring asthma is influenced by maternal asthma severity and control during pregnancy.
METHODS:We performed a prospective population-based cohort study. Using linkage of Danish national registers, we constructed a cohort of 675,379 singletons, of which 15,014 children were born to asthmatic mothers. Among them, 7,188 children were born to mothers with active asthma during pregnancy. We categorized mothers with active asthma into 4 groups based on dispensed antiasthma prescriptions and on use of medical services: mild controlled, mild uncontrolled, moderate-to-severe controlled, and moderate-to-severe uncontrolled asthma. The outcomes were offspring early-onset transient, early-onset persistent, and late-onset asthma. We estimated prevalence ratios (PRs) of each phenotype of asthma using a log-binomial model with 95% CIs.
RESULTS:Higher prevalence of early-onset persistent asthma was observed among children of asthmatic mothers with mild uncontrolled (PR, 1.19; 95% CI, 1.05-1.35), moderate-to-severe controlled (PR, 1.33; 95% CI, 1.09-1.63), and moderate-to-severe uncontrolled asthma (PR, 1.37; 95% CI, 1.17-1.61) compared with those of mothers with mild controlled asthma. A borderline increased prevalence of early-onset transient asthma was observed among children of mothers with uncontrolled asthma.
CONCLUSIONS:Maternal uncontrolled asthma increases the risk of early-onset persistent and transient asthma. If replicated, this could suggest that maintaining asthma control in pregnancy is an area for possible prevention of specific phenotypes of offspring asthma.


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