孕妇哮喘的控制状况和严重度对后代哮喘发病率的影响：两阶段对照研究
2010/01/07
关键词：官方健康数据库；儿童期哮喘；控制；母源性哮喘；信函问卷；怀孕
为了了解孕妇哮喘控制状况和严重度对其子女哮喘发病率的影响，Martel等进行了一项2阶段病例对照研究。该研究使用3个内在关联的数据库（加拿大魁北克省）和信函问卷的方式招募了8226位儿童( 其母亲均患有哮喘)以调查这些儿童十岁内哮喘的发病情况与母亲孕期哮喘控制和严重度的关联。
研究第一阶段选择2681例哮喘儿童和30,318例年龄匹配的对照儿童进行研究，第二阶段选择3254例母亲进行信函问卷调查获得更多的信息。采用验证指数衡量哮喘控制和严重度，哮喘的定义为2年内至少1次哮喘相关诊断并接受治疗用药，并以此计算儿童哮喘的发病率。
研究发现，怀孕期有未控制的中到重度哮喘患者，其子女患哮喘的危险性明显高于病情控制的轻度哮喘母亲的子女(校正后OR 1.27, 95% CI 1.06–1.52)。但病情未控制的轻度哮喘母亲与病情控制的中到重度哮喘母亲相比，其子女的哮喘患病率相当。
根据研究结果，作者认为孕妇哮喘的控制情况和严重度与子女哮喘的发病率明显相关，是儿童哮喘发病的重要危险因素。这一结果提示医生应积极治疗哮喘孕妇并鼓励患者坚持用药，这对于防控儿童哮喘具有重要意义。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 34:579-587）
Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case–control study
M-J. Martel1, É. Rey2, M-F. Beauchesne1,3, J-L. Malo4, S. Perreault1, A. Forget4 and L. Blais1,4 Canada.
Keywords: Administrative health databases, childhood asthma, control, maternal asthma, postal questionnaire, pregnancy
The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child’s first 10 yrs of life.
A two-stage, case–control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires.
A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (20 controls·case–1; stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered.
Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06–1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers.
Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.
Eur Respir J 2009; 34:579-587
为了了解孕妇哮喘控制状况和严重度对其子女哮喘发病率的影响，Martel等进行了一项2阶段病例对照研究。该研究使用3个内在关联的数据库（加拿大魁北克省）和信函问卷的方式招募了8226位儿童( 其母亲均患有哮喘)以调查这些儿童十岁内哮喘的发病情况与母亲孕期哮喘控制和严重度的关联。
研究第一阶段选择2681例哮喘儿童和30,318例年龄匹配的对照儿童进行研究，第二阶段选择3254例母亲进行信函问卷调查获得更多的信息。采用验证指数衡量哮喘控制和严重度，哮喘的定义为2年内至少1次哮喘相关诊断并接受治疗用药，并以此计算儿童哮喘的发病率。
研究发现，怀孕期有未控制的中到重度哮喘患者，其子女患哮喘的危险性明显高于病情控制的轻度哮喘母亲的子女(校正后OR 1.27, 95% CI 1.06–1.52)。但病情未控制的轻度哮喘母亲与病情控制的中到重度哮喘母亲相比，其子女的哮喘患病率相当。
根据研究结果，作者认为孕妇哮喘的控制情况和严重度与子女哮喘的发病率明显相关，是儿童哮喘发病的重要危险因素。这一结果提示医生应积极治疗哮喘孕妇并鼓励患者坚持用药，这对于防控儿童哮喘具有重要意义。
（韩伟 青岛市市立医院东院呼吸科 266071 摘译）
（Eur Respir J 2009; 34:579-587）
Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case–control study
M-J. Martel1, É. Rey2, M-F. Beauchesne1,3, J-L. Malo4, S. Perreault1, A. Forget4 and L. Blais1,4 Canada.
Keywords: Administrative health databases, childhood asthma, control, maternal asthma, postal questionnaire, pregnancy
The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child’s first 10 yrs of life.
A two-stage, case–control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires.
A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (20 controls·case–1; stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered.
Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06–1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers.
Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.
Eur Respir J 2009; 34:579-587
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