哮喘联盟

    孕期及出生早期的一些因素对儿童喘鸣的影响越来越受到关注。在该研究中Rusconi F等对孕期并发症、怀孕和出生过程中的一些操作处理方式与儿童不同类型的喘鸣的关系进行了调查。
    作者采用标准化问卷对15,609名年龄在6～7岁儿童的母亲进行调查。结果发现9.5% (1,478)的儿童有早期一过性喘鸣，5.4% (884)儿童有持续性喘鸣， 6.1% (948) 儿童有迟发性喘鸣。妊高症和先兆子痫可增加上述三种类型喘鸣的风险。因尿路感染使用抗生素与儿童早期一过性喘鸣有关（优势比为1.52，95%可信区间为1.16～2.00）。分娩过程中使用抗生素也与一过性喘鸣(优势比为1.21，95%可信区间为1.01～1.46)和持续性喘鸣(优势比为1.39，95%可信区间为1.10～1.75)有关。母亲有糖尿病的儿童更容易患持续性喘鸣(优势比为1.72，95%可信区间为0.99～3.00)。而羊膜腔穿刺/绒毛膜取样、孕期体重增加及剖腹产均未发现与儿童喘鸣有关。母亲哮喘和过敏体质也未发现与上述三种喘鸣有明显相关性。

（王苹莉 浙江大学医学院附属二院呼吸内科 310008 摘译）
（Am J Respir Crit Care Med. 2007；175:16-21）

Rusconi F, Galassi C, Forastiere F，et al. Maternal complications and procedures in pregnancy and at birth and wheezing phenotypes in children. Am J Respir Crit Care Med. 2007 Jan 1;175(1):16-21.

RATIONALE: There is increasing interest in the potential influence of fetal and early life conditions on childhood wheezing. 

OBJECTIVES: To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children.

METHODS: We studied 15,609 children, aged 6-7 yr, enrolled in a population-based study. Standardized questionnaires were completed by the children’s mothers. RESULTS: Of the children, 9.5% (1,478) had transient early wheezing, 5.4% (884) had persistent wheezing, and 6.1% (948) had late-onset wheezing. Maternal hypertension or preeclampsia was associated with an increased risk of all three wheezing phenotypes (for transient early wheezing: odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.08-1.82; for persistent wheezing: OR, 1.59; 95% CI, 1.15-2.19; and for late-onset wheezing: OR, 1.47; 95% CI, 1.06-2.01). Use of antibiotics for urinary tract infections was associated with transient early wheezing (OR, 1.52; 95% CI, 1.16-2.00), whereas antibiotic administration at delivery was associated with both transient early wheezing (OR, 1.21; 95% CI, 1.01-1.46) and persistent wheezing (OR, 1.39; 95% CI, 1.10-1.75). Children who had a mother with diabetes were also more likely to have persistent wheezing (OR, 1.72; 95% CI, 0.99-3.00). Neither amniocentesis/chorionic villus sampling, nor weight gain in pregnancy, nor cesarean section was associated with the subsequent development of wheezing. Maternal asthma or atopy was not an effect modifier of the associations found. CONCLUSIONS: Some maternal complications during pregnancy and at delivery may increase the risk of developing different phenotypes of wheezing in childhood.