Associations between maternal complications during pregnancy and childhood asthma: a retrospective cohort study

Ying Ma; Yu Wu; Yi Zhang; Ting Jiao; Shuangshuang Guo; Dongying Zhang; Jiewen Yang; Nali Deng; Zhijiang Liang; Harry H X Wang; Wei Bao; Ruoling Chen; Jie Tang; Xiaoqin Liu

doi:10.1183/23120541.00548-2022

Associations between maternal complications during pregnancy and childhood asthma: a retrospective cohort study

ERJ Open Res. 2023 Apr 11;9(2):00548-2022. doi: 10.1183/23120541.00548-2022. eCollection 2023 Mar.

Authors

Ying Ma^{1

2}, Yu Wu^{3

2}, Yi Zhang^{4

2}, Ting Jiao⁴, Shuangshuang Guo⁴, Dongying Zhang⁵, Jiewen Yang⁶, Nali Deng⁷, Zhijiang Liang⁸, Harry H X Wang⁹, Wei Bao¹⁰, Ruoling Chen¹¹, Jie Tang⁴, Xiaoqin Liu¹²

Affiliations

¹ Department of Child Healthcare, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
² These authors contributed equally to this work.
³ Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
⁴ Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Guangzhou, China.
⁵ National Clinical Research Center for Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
⁶ Institute of Guangzhou Social Welfare, Guangzhou, China.
⁷ Health Promotion Centre for Primary and Secondary Schools, Education Bureau of Guangzhou, Guangzhou, China.
⁸ Department of Public Health, Guangdong Women and Children Hospital, Guangzhou, China.
⁹ School of Public Health, Sun Yat-Sen University, Guangzhou, China.
¹⁰ Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
¹¹ Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.
¹² National Centre for Register-based Research (NCRR), Aarhus University, Aarhus, Denmark.

Abstract

Background: Studies on the associations between maternal complications during pregnancy and childhood asthma are exclusively conducted in Western countries. The findings are mixed and may not be translated to other populations. We aimed to investigate the associations among the Chinese population and to determine whether the associations were mediated through pre-term birth, caesarean delivery, low birthweight and not breastfeeding in the first 6 months.

Methods: We conducted a retrospective cohort study of 166 772 children in Guangzhou, China. Information on maternal gestational hypertension, gestational diabetes and gestational anaemia during pregnancy was extracted from medical records. Ever-diagnosis of asthma in children aged 6-12 years was obtained by questionnaire. Logistic regression models and mediation analyses were used to estimate the adjusted odds ratios (aORs) and 95% confidence intervals for childhood asthma.

Results: Gestational hypertension, gestational diabetes and gestational anaemia during pregnancy were associated with an increased risk of ever-diagnosed childhood asthma: aOR 1.48 (95% CI 1.37-1.60), 1.71 (95% CI 1.65-1.78) and 1.34 (95% CI 1.26-1.45), respectively. A stronger association was observed for two or three gestational complications (aOR 2.02 (95% CI 1.93-2.16)) than one gestational complication (aOR 1.64 (95% CI 1.52-1.77)). The aOR for the three gestational complications was 1.35 (95% CI 1.26-1.45), 1.63 (95% CI 1.58-1.70) and 1.32 (95% CI 1.24-1.43), respectively, after controlling for the mediators, including pre-term birth, caesarean delivery, low birthweight and not breastfeeding in the first 6 months.

Conclusions: Gestational hypertension, gestational diabetes and gestational anaemia were associated with childhood asthma, and the associations were partially explained by the mediation effects.