哮喘联盟

   摘要
   研究背景与研究目的：子宫内环境及生活中的暴露因素可能会对儿童哮喘的发展产生影响。本荟萃分析旨在评估妊娠期母体肥胖（MOP）或体重增加（GWG）是否会增加后代罹患哮喘的风险。
   研究方法：本研究包含PubMed, Embase, CINAHL, Scopus, The Cochrane Database及Ovid上至2013年10月发表的所有观察型研究。采用包含逆方差权重的随机效应模型计算汇集风险值。
   研究结果：共纳入14项研究（共计108321对母子/母女），其中12项研究涉及母体肥胖，5项研究涉及GWG。研究中儿童年龄为14个月至16周岁。MOP与哮喘/喘息曾发几率（OR值为1.31。95%CI 1.16-1.49）或现发几率（OR值为1.21。95%CI 1.07-1.37）增高有关；母体BMI每增加1 kg/m2，儿童哮喘几率增加2%-3%。高GWG与哮喘/喘息曾发几率上升有关。母体低体重和低GWG则与儿童哮喘或喘息无关。荟萃回归分析显示母亲哮喘史与儿童哮喘几率呈现负相关（边界临界意义）。本研究还发现现有研究存在显著异质性，提示之后的该领域研究需要标准化的研究方法。
   结论：MOP及高GWG与儿童哮喘风险增高有关；这一发现或对无哮喘病史的母亲特别有意义。因此，进行母体体重控制的回顾性随机临床试验是很有必要的。
 

（刘国梁 审校）
Pediatrics. 2014 Aug;134(2):e535-e546. Epub 2014 Jul 21.

 

Maternal Obesity in Pregnancy, Gestational Weight Gain, and Risk of Childhood Asthma.
 

Forno E1, Young OM2, Kumar R3, Simhan H2, Celedón JC4.
 

Abstract
BACKGROUND AND OBJECTIVE: Environmental or lifestyle exposures in utero may influence the development of childhood asthma. In this meta-analysis, we aimed to assess whether maternal obesity in pregnancy (MOP) or increased maternal gestational weight gain (GWG) increased the risk of asthma in offspring.
METHODS: We included all observational studies published until October 2013 in PubMed, Embase, CINAHL, Scopus, The Cochrane Database, and Ovid. Random effects models with inverse variance weights were used to calculate pooled risk estimates.
RESULTS: Fourteen studies were included (N = 108 321 mother-child pairs). Twelve studies reported maternal obesity, and 5 reported GWG. Age of children was 14 months to 16 years. MOP was associated with higher odds of asthma or wheeze ever (OR = 1.31; 95% confidence interval [CI], 1.16-1.49) or current (OR = 1.21; 95% CI, 1.07-1.37); each 1-kg/m2 increase in maternal BMI was associated with a 2% to 3% increase in the odds of childhood asthma. High GWG was associated with higher odds of asthma or wheeze ever (OR = 1.16; 95% CI, 1.001-1.34). Maternal underweight and low GWG were not associated with childhood asthma or wheeze. Meta-regression showed a negative association of borderline significance for maternal asthma history (P = .07). The significant heterogeneity among existing studies indicates a need for standardized approaches to future studies on the topic.
CONCLUSIONS: MOP and high GWG are associated with an elevated risk of childhood asthma; this finding may be particularly significant for mothers without asthma history. Prospective randomized trials of maternal weight management are needed.

Pediatrics. 2014 Aug;134(2):e535-e546. Epub 2014 Jul 21.