Birth mode of delivery in the modern delivery ward : indication improves understanding of childhood asthma

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Asthma, anxiety and depression in pregnancy : the impact on pregnancy, delivery and perinatal outcomes

Asthma and mood disorders such as anxiety or depression are associated with adverse pregnancy, delivery, and perinatal outcomes. There is an association between mood disorders and asthma and there may be common mechanisms on how the conditions affect pregnancy outcomes. For example, some of the associations may be explained by genetic or environmental factors, familial confounding. In this thesis we have investigated how asthma and anxiety or depression complicates pregnancy and delivery outcomes in a combination of large population-based registers and smaller clinical cohorts, using family design methods to adjust for possible shared genetic and environmental factors. In Study I and II we studied the associations between maternal asthma and adverse pregnancy outcomes, such as preeclampsia, placental abruption, mode of delivery, birth weight, and gestational age, using Swedish population-based cohorts. For Study II we identified cousins and siblings who were pregnant and gave birth during the same study period. We found that maternal asthma was associated with many of the adverse outcomes, such as preeclampsia (Study I, II), and that the associations were not confounded by factors shared within families (Study II). There were also increased risks for some adverse outcomes based on asthma severity and control (Study I). For Study III we investigated the impact of maternal asthma on early foetal growth, assessed by routine ultrasound scan in second trimester. The study population originated from the MAESTRO study of 1693 women prospectively followed during pregnancy. We did not find any significant effect of maternal asthma on early foetal growth. There was also no difference between women with and without asthma for birth weight and gestational age In Study IV, we estimated the association between maternal anxiety or depression and pregnancy outcomes using a population-based cohort. We found that maternal anxiety or depression was associated with several adverse pregnancy outcomes and that the associations were not confounded by familial factors shared by cousins and siblings. There was no interaction between asthma and anxiety or depression for any of the outcomes except for elective caesarean section. There were also higher odds for elective caesarean section in women with anxiety or depression diagnosis without medication compared to those with medication. In conclusion, maternal asthma as well as maternal anxiety or depression were associated with several serious pregnancy complications and adverse perinatal outcomes. Familial confounding did not explain the observed associations. Apart from elective caesarean section, we did not see any interaction between maternal asthma and anxiety or depression on the studied adverse pregnancy outcomes. This means that targeting the asthma disease as well as anxiety/depression in the pregnant woman will continue to be important in reducing risks for adverse outcomes in pregnancy. Greater awareness and proper management would most likely improve outcome

Maternal asthma and early fetal growth : the MAESTRO study

Background: Several maternal conditions can affect fetal growth, and asthma during pregnancy is known to be associated with lower birth weight and shorter gestational age. Objective: In a new Swedish cohort study on maternal asthma exposure and stress during pregnancy (MAESTRO), we have assessed if there is evidence of early fetal growth restriction in asthmatic women or if a growth restriction might come later during pregnancy. Methods: We recruited women from eight antenatal clinics in Stockholm, Sweden. Questionnaires on background factors, asthma status and stress were assessed dur- ing pregnancy. The participants were asked to consent to collection of medical re- cords including ultrasound measures during pregnancy, and linkage to national health registers. In women with and without asthma, we studied reduced or increased growth by comparing the second-trimester ultrasound with first-trimester estima- tion. We defined reduced growth as estimated days below the 10th percentile and increased growth as days above the 90th percentile. At birth, the weight and length of the newborn and the gestational age was compared between women with and without asthma. Results: We enrolled 1693 participants in early pregnancy and collected data on de- liveries and ultrasound scans in 1580 pregnancies, of which 18% of the mothers had asthma. No statistically significant reduced or increased growth between different measurement points were found when women with and without asthma were com- pared; adjusted odds ratios for reduced growth between first and second trimester 1.11 95% CI (0.63–1.95) and increased growth 1.09 95% CI (0.68–1.77). Conclusion and clinical relevance: In conclusion, we could not find evidence sup- porting an influence of maternal asthma on early fetal growth in the present cohort: Although the relatively small sample size, which may enhance the risk of a type II error, it is concluded that a potential difference is likely to be very small.Swedish Research Council, Grant Number: 2018-02640The Strategic Research Program in Epidemiology at Karolinska InstitutetHjärt-LungfondenStockholms County Council (ALF-projects)Swedish Initiative for research on Microdata in the Social And Medical Sciences (SIMSAM), Grant Number: 340-2013-5867Publishe

Parental socioeconomic status, childhood asthma and medication use : a population-based study

BACKGROUND: Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children. METHODS: This register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression. RESULTS: Compared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09-1.31 for diagnosis and HR 1.17, 95% CI 1.08-1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77-0.92 for diagnosis, and HR 0.80, 95% CI 0.74-0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61-2.65) and outpatient (HR 1.32, 95% CI 1.18-1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates. CONCLUSIONS: Our findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied.NonePublishe

Asthma during pregnancy in a population-based study : pregnancy complications and adverse perinatal outcomes

BACKGROUND: Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes. METHODS: We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression. RESULTS: In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4%) pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06-1.24) and premature contractions (adj OR 1.52; 95% CI 1.29-1.80). There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23-1.34), low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13-1.33). The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes. CONCLUSION: Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.NonePublishe

Parental socioeconomic status, childhood asthma and medication use--a population-based study.

BACKGROUND: Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children. METHODS: This register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression. RESULTS: Compared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09-1.31 for diagnosis and HR 1.17, 95% CI 1.08-1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77-0.92 for diagnosis, and HR 0.80, 95% CI 0.74-0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61-2.65) and outpatient (HR 1.32, 95% CI 1.18-1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates. CONCLUSIONS: Our findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied

Associations between moderate/severe asthma according to the Firoozi index the year before pregnancy and perinatal outcomes in a cohort of 284 214 pregnancies, mild asthma as reference.

<p>Unadjusted and adjusted model (n = 249 006) estimated by multinomial logistic regression with OR and 95% CI. In unadjusted analyses n = 8962 were included in the mild asthma group and n = 4072 in the moderate/severe group. In the adjusted analyses n = 7996 were included in the mild and n = 3646 in the moderate/severe group.</p><p>*Adjusted for age, BMI, parity, smoking at antenatal care admission, country of birth, cohabitation/marital status and level of education.</p

Background characteristics of study population of 284 214 pregnancies by asthma status.

<p>*Asthma recorded in the Swedish Medical Birth Register, asthma diagnosis in the Swedish National Patient Register and/or asthma medication suspended at least twice according to the Swedish Prescribed Drug Register.</p

Hazard ratios of inpatient and outpatient asthma diagnosis by parental SES.

<p>Hazard ratios and 95% confidence intervals for the association between parental SES (income and education) and inpatient or outpatient asthma diagnoses. The estimates have been adjusted for gender, parity, maternal age, marital status at delivery, healthcare regions, and metropolitan areas.</p

Frequency of medications consumptions among diagnosed children from different SES groups (parental income and education at diagnosis) from date of first diagnosis of asthma in a Swedish cohort of 211,520 children age 0–4.5.

<p>Definition of abbreviations: SES = socioeconomic status; ICS = inhaled corticosteroids; LTRA = leukotriene receptor antagonist.</p><p>Frequency of medications consumptions among diagnosed children from different SES groups (parental income and education at diagnosis) from date of first diagnosis of asthma in a Swedish cohort of 211,520 children age 0–4.5.</p