3 years ago

Pregnancy Complications and Wheezing and Asthma in Childhood.

Franca Rusconi, Luigi Gagliardi
This review focuses on recent advances in the field of several frequent maternal complications in pregnancy and asthma and wheezing in childhood, for which large birth cohort studies have recently provided clues. Within the framework of epidemiologic studies, we discuss potential mechanisms, mediators and confounders involved in associations, in an attempt to discern causal pathways. Preeclampsia, a pregnancy-specific multiorgan disease that affects 2-4% of women in developed countries, is characterized by placental dysfunction and is associated with preterm delivery, fetal growth restriction and vascular and lung effects in the fetus. Recent cohort studies have found an association with asthma and wheezing in offspring, probably partly mediated by being preterm or small for gestational age. Obesity, diabetes, maternal depression, anxiety and psychological stress are increasingly complicating the course of pregnancy. With the exception of diabetes, for the other conditions, several studies have found associations especially with wheezing in early childhood. Biologically plausible mechanisms acting on the developing lung and on the modulation of immune function have been suggested. The importance of prenatal and postnatal confounders and mediators still needs to be fully ascertained. Cesarean deliveries are increasing in many countries, and available epidemiological evidence indicates that children born by cesarean delivery suffer from an increased risk of asthma. Recent studies suggest that the association between planned cesarean delivery - often an avoidable condition- and asthma development in childhood is stronger than that of emergency caesarean delivery, however consensus has still not been reached.

Publisher URL: http://doi.org/10.1164/rccm.201704-0744PP

DOI: 10.1164/rccm.201704-0744PP

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