The impact of maternal asthma on the fetal lung: Outcomes, mechanisms and interventions

Joshua L Robinson; Kathryn L Gatford; Vicki L Clifton; Janna L Morrison; Michael J Stark

doi:10.1016/j.prrv.2023.12.004

The impact of maternal asthma on the fetal lung: Outcomes, mechanisms and interventions

Paediatr Respir Rev. 2023 Dec 23:S1526-0542(23)00086-6. doi: 10.1016/j.prrv.2023.12.004. Online ahead of print.

Authors

Joshua L Robinson¹, Kathryn L Gatford², Vicki L Clifton³, Janna L Morrison⁴, Michael J Stark⁵

Affiliations

¹ Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia. Electronic address: joshua.robinson@adelaide.edu.au.
² Robinson Research Institute, University of Adelaide, Adelaide, Australia; School of Biomedicine, University of Adelaide, Adelaide, Australia.
³ Mater Research Institute, University of Queensland, Brisbane, Australia.
⁴ Early Origins of Adult Health Research Group, Health and Biomedical Innovation, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, Australia.
⁵ Robinson Research Institute, University of Adelaide, Adelaide, Australia; Adelaide Medical School, University of Adelaide, Adelaide, Australia; Department of Neonatal Medicine, Women's & Children's Hospital, Adelaide, Australia. Electronic address: michael.stark@adelaide.edu.au.

PMID: 38195368
DOI: 10.1016/j.prrv.2023.12.004

Abstract

Maternal asthma affects up to 17% of pregnancies and is associated with adverse infant, childhood, and adult respiratory outcomes, including increased risks of neonatal respiratory distress syndrome, childhood wheeze and asthma. In addition to genetics, these poor outcomes are likely due to the mediating influence of maternal asthma on the in-utero environment, altering fetal lung and immune development and predisposing the offspring to later lung disease. Maternal asthma may impair glucocorticoid signalling in the fetus, a process critical for lung maturation, and increase fetal exposure to proinflammatory cytokines. Therefore, interventions to control maternal asthma, increase glucocorticoid signalling in the fetal lung, or Vitamin A, C, and D supplementation to improve alveologenesis and surfactant production may be beneficial for later lung function. This review highlights potential mechanisms underlying maternal asthma and offspring respiratory morbidities and describes how pregnancy interventions can promote optimal fetal lung development in babies of asthmatic mothers.

Keywords: Fetus; Lung development; Maternal asthma; Pregnancy.

Publication types

Review