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Davidson et al. BMC Pulmonary Medicine 2010, 10:14 http://www.biomedcentral.com/1471-2466/10/14

RESEARCH ARTICLE

Open Access

Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study
Rebekah Davidson1†, Stephen E Roberts2†, Clare J Wotton1†, Michael J Goldacre1*†
Abstract
Background: There is muchinterest in the possibility that perinatal factors may influence the risk of disease in later life. We investigated the influence of maternal and perinatal factors on subsequent hospital admission for asthma in children. Methods: Analysis of data from the Oxford record linkage study (ORLS) to generate a retrospective cohort of 248 612 records of births between 1970 and 1989, with follow-up torecords of subsequent hospital admission for 4 017 children with asthma up to 1999. Results: Univariate analysis showed significant associations between an increased risk of admission for asthma and later years of birth (reflecting the increase in asthma in the 1970s and 1980s), low social class, asthma in the mother, unmarried mothers, maternal smoking in pregnancy, subsequent births comparedwith first-born, male sex, low birth weight, short gestational age, caesarean delivery, forceps delivery and not being breastfed. Multivariate analysis, identifying each risk factor that had a significant effect independently of other risk factors, confirmed associations with maternal asthma (odds ratio (OR) 3.1, 95% confidence interval 2.7-3.6), male sex (versus female, 1.8, 1.7-2.0), low birthweight (1000-2999 g versus 3000-3999 g, 1.2, 1.1-1.3), maternal smoking (1.1, 1.0-1.3) and delivery by caesarean section (1.2; 1.0-1.3). In those first admitted with asthma under two years old, there were associations with having siblings (e.g. second child compared with first-born, OR 1.3, 1.0-1.7) and short gestational age (24-37 weeks versus 38-41 weeks, 1.6, 1.2-2.2). Multivariate analysisconfined to those admitted with asthma aged six years or more, showed associations with maternal asthma (OR 3.8, 3.1-4.7), age of mother (under 25 versus 25-34 at birth, OR 1.16, 1.03-1.31; over 35 versus 25-34, OR 1.4, 1.1-1.7); high social class was protective (1 and 2, compared with 3, 0.72; 0.63-0.82). Hospital admission for asthma in people aged over six was more common in males than females(1.4; 1.2-1.5); but, by the teenage years, the sex ratio reversed and admission was more common in females than males. Conclusion: Several maternal characteristics and perinatal factors are associated with an elevated risk of hospital admission for asthma in the child in later life.

Background Asthma is characterised by widespread reversible narrowing of the bronchioles leading to dyspnoea,cough and wheezing. In some cases it may be brought on by exposure to a particular, identified allergen but in many cases there is no single identified causal factor. Much is still unknown about its aetiology or about factors
* Correspondence: michael.goldacre@dphpc.ox.ac.uk † Contributed equally 1 Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old RoadCampus, Old Road, Oxford OX3 7LF, UK

associated with susceptibility to it. With high prevalence of asthma across the developed world [1], there is a continued need for research into potential risk factors. Previously documented risk factors for asthma include maternal asthma [2,3], maternal smoking, [2,4] low birth weight and short gestational age [2,5-7]. It has also been suggested that caesareandelivery may increase the risk [8], and that breastfeeding may reduce the risk, of asthma in the child [9]. Studies into the risk of asthma associated with some other perinatal factors and maternal characteristics have been inconclusive.

© 2010 Davidson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License...
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