与儿童期哮喘相关的母亲孕产史
2018/12/17
摘要
背景：目前尚不清楚通过辅助生殖技术（ART）降生的儿童高哮喘风险的基础。
目的：我们的目的是明确父母的低生育能力在试管婴儿与儿童哮喘的关联中的作用，并研究父母低生育能力及流产影响儿童哮喘发病的共同机制可能性。
方法：我们使用挪威国家健康登记处（n = 474402）和挪威母婴研究（MoBa）（n = 75797）的数据。我们使用对数线性回归来估计整体关联性，并使用固定效应逻辑回归来估计兄弟姐妹之间的关联性。
结果：ART后代的哮喘风险较高，基于登记表数据的调整后的相对风险（aRR）为1.20（95％CI 1.09-1.32），母婴研究的为1.42（95％CI 1.14-1.76）。虽然CI包含空值，但兄弟姐妹间的分析具有相似相关性。当与受孕时间> 12个月的自发受孕后代对比时，ART后代的哮喘风险升高减弱，aRR 1.22（95％CI为0.95-1.57）。母亲早期流产史（≤12周）的哮喘风险也增加，其中流1胎aRR为1.07（95％CI 1.03-1.11），流2胎aRR 1.18（95％CI 1.10~1.26）为2，流3胎及3胎以上aRR为1.24（95％ CI 1.12至1.37）。
结论：我们的研究结果表明，父母的生育能力和与ART程序本身相关的特征可能会增加后代哮喘风险，尽管这需要在未来的研究中得到证实，并进一步表明父母低生育能力及多次流产的共同机制可能影响后代哮喘发病。
Maternal history of miscarriages and measures of fertility in relation to childhood asthma.
Magnus, Maria Christine
Abstract
BACKGROUND:It remains unclear what underlies the greater risk of asthma reported among children conceived by assisted reproductive technologies (ART).
OBJECTIVE: Our aim was to clarify the role of parental subfertility and unmeasured confounding on the association between ART and childhood asthma, and to examine the possibility for common mechanisms underlying parental subfertility and miscarriages influencing asthma pathogenesis.
METHODS:We used data from national Norwegian health registries (n=474402) and the Norwegian Mother and Child Cohort Study (MoBa) (n=75797). We used log-linear regression to estimate overall associations, and fixed-effects logistic regression to estimate associations within siblings.
RESULTS:ART offspring had greater asthma risk, the adjusted relative risk (aRR) was 1.20 (95% CI 1.09 to 1.32) in the registry-based cohort, and 1.42 (95% CI 1.14 to 1.76) in MoBa. The sibling analysis yielded similar associations, although the CI included the null value. The elevated asthma risk among ART offspring was attenuated when they were compared with spontaneously conceived offspring with time to conception >12 months, aRR 1.22 (95% CI 0.95 to 1.57). Asthma risk also increased with maternal history of early miscarriages (≤12 weeks), with an aRR of 1.07 (95% CI 1.03 to 1.11) for one, aRR 1.18 (95% CI 1.10 to 1.26) for two and aRR 1.24 (95% CI 1.12 to 1.37) for three or more.
CONCLUSION:Our findings indicate that both parental subfertility and characteristics related to the ART procedure itself might increase offspring asthma risk, although this needs to be confirmed in future studies, and further suggest that common mechanisms underlying parental subfertility and recurrent miscarriages might influence offspring asthma pathogenesis.
背景：目前尚不清楚通过辅助生殖技术（ART）降生的儿童高哮喘风险的基础。
目的：我们的目的是明确父母的低生育能力在试管婴儿与儿童哮喘的关联中的作用，并研究父母低生育能力及流产影响儿童哮喘发病的共同机制可能性。
方法：我们使用挪威国家健康登记处（n = 474402）和挪威母婴研究（MoBa）（n = 75797）的数据。我们使用对数线性回归来估计整体关联性，并使用固定效应逻辑回归来估计兄弟姐妹之间的关联性。
结果：ART后代的哮喘风险较高，基于登记表数据的调整后的相对风险（aRR）为1.20（95％CI 1.09-1.32），母婴研究的为1.42（95％CI 1.14-1.76）。虽然CI包含空值，但兄弟姐妹间的分析具有相似相关性。当与受孕时间> 12个月的自发受孕后代对比时，ART后代的哮喘风险升高减弱，aRR 1.22（95％CI为0.95-1.57）。母亲早期流产史（≤12周）的哮喘风险也增加，其中流1胎aRR为1.07（95％CI 1.03-1.11），流2胎aRR 1.18（95％CI 1.10~1.26）为2，流3胎及3胎以上aRR为1.24（95％ CI 1.12至1.37）。
结论：我们的研究结果表明，父母的生育能力和与ART程序本身相关的特征可能会增加后代哮喘风险，尽管这需要在未来的研究中得到证实，并进一步表明父母低生育能力及多次流产的共同机制可能影响后代哮喘发病。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Thorax，2018-Dec-04）
（Thorax，2018-Dec-04）
Maternal history of miscarriages and measures of fertility in relation to childhood asthma.
Magnus, Maria Christine
Abstract
BACKGROUND:It remains unclear what underlies the greater risk of asthma reported among children conceived by assisted reproductive technologies (ART).
OBJECTIVE: Our aim was to clarify the role of parental subfertility and unmeasured confounding on the association between ART and childhood asthma, and to examine the possibility for common mechanisms underlying parental subfertility and miscarriages influencing asthma pathogenesis.
METHODS:We used data from national Norwegian health registries (n=474402) and the Norwegian Mother and Child Cohort Study (MoBa) (n=75797). We used log-linear regression to estimate overall associations, and fixed-effects logistic regression to estimate associations within siblings.
RESULTS:ART offspring had greater asthma risk, the adjusted relative risk (aRR) was 1.20 (95% CI 1.09 to 1.32) in the registry-based cohort, and 1.42 (95% CI 1.14 to 1.76) in MoBa. The sibling analysis yielded similar associations, although the CI included the null value. The elevated asthma risk among ART offspring was attenuated when they were compared with spontaneously conceived offspring with time to conception >12 months, aRR 1.22 (95% CI 0.95 to 1.57). Asthma risk also increased with maternal history of early miscarriages (≤12 weeks), with an aRR of 1.07 (95% CI 1.03 to 1.11) for one, aRR 1.18 (95% CI 1.10 to 1.26) for two and aRR 1.24 (95% CI 1.12 to 1.37) for three or more.
CONCLUSION:Our findings indicate that both parental subfertility and characteristics related to the ART procedure itself might increase offspring asthma risk, although this needs to be confirmed in future studies, and further suggest that common mechanisms underlying parental subfertility and recurrent miscarriages might influence offspring asthma pathogenesis.
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