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Preterm Birth and Inhaled Corticosteroid Use in 6- to 19-Year-Olds: A Swedish National Cohort Study
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
Karolinska Institute.
Sundsvall Hospital.
Stockholm University.
2011 (English)In: PEDIATRICS, ISSN 0031-4005, Vol. 127, no 6, 1052-1059 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Preterm birth is associated with respiratory morbidity later in life, including asthma. Previous studies have mainly focused on asthma in early childhood in children born extremely preterm. In this study, we examined the risk of asthma in a national cohort of schoolchildren grouped according to degree of immaturity expressed as completed gestational weeks at birth.

METHODS: This was a register study in a Swedish national cohort of 1 100 826 children 6 to 19 years old. Retrieval of at least 1 prescription of inhaled corticosteroids (ICS) during 2006 was used as the main indicator for asthma. Logistic regression was used to test hypotheses, with adjustment for multiple socioeconomic and perinatal indicators.

RESULTS: Degree of immaturity, expressed as completed gestational weeks at birth, had an inverse dose-response relationship with ICS use. Compared with children born between 39 and 41 weeks gestation, the odds ratio for ICS use increased with the degree of prematurity, from 1.10 (95% confidence interval: 1.08-1.13) for children born in weeks 37 to 38, to 2.28 (95% confidence interval: 1.96-2.64) for children born in weeks 23 to 28, after adjustment for confounders. The increase in ICS use with decreasing gestational age at delivery was similar in boys and girls, and declined with older age.

CONCLUSION: Preterm birth increased the risk of ICS use in these 6- to 19-year-olds by degree of immaturity, from extremely preterm to early term birth.

Place, publisher, year, edition, pages
American Academy of Pediatrics; 1999 , 2011. Vol. 127, no 6, 1052-1059 p.
Keyword [en]
premature birth, asthma, inhaled corticosteroids, adolescents
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-69167DOI: 10.1542/peds.2010-3083ISI: 000291146100045OAI: diva2:424342
Available from: 2011-06-17 Created: 2011-06-17 Last updated: 2012-11-19Bibliographically approved
In thesis
1. Early life factors and the long-term development of asthma
Open this publication in new window or tab >>Early life factors and the long-term development of asthma
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Asthma, a huge burden on millions of individuals worldwide, is one of the most important public health issues in many countries. As genetic and   environmental factors interact, asthma may be programmed very early in life, perhaps even in utero.

The aim of this thesis was to assess the impact of gestational age, cord blood immunoglobulin E (IgE), a family history of asthma, migration, and pertussis immunization in early life on the development of asthma in child and adult populations.

As a proxy for asthma disease, dispensed asthma medication was used as the main outcome variable based on data from the Swedish Prescribed Drug  Register. Data from other national registers were used to control for  confounders. Three of our studies were based on national cohorts, and one on a local birth cohort that was initiated in 1974–75.

Gestational age had an inverse dose-response relationship with dispensed asthma medication in 6– to 19-year-olds. Odds ratios for dispensed asthma medication increased with degree of prematurity compared with children born in term. Furthermore, asthma medication was more likely to be dispensed among children and adolescents born early term after 37–38 weeks’ gestation than among those at the same age who were born in term.

Elevated cord blood IgE and a family history of asthma in infancy were associated with a two- to threefold increased likelihood of dispensed asthma medication and self-reported allergen-induced respiratory symptoms at the age of 32–34 years, but the predictive power was poor.

Age at migration had an inverse dose-response relationship with dispensed asthma medication at the age of 6–25 years in adoptees and foreign-born children with foreign-born parents. International adoptees and children born in Sweden to foreign-born parents had three- to fourfold higher rates of asthma medication compared with foreign-born children who were raised by their foreign-born birth parents.

No association was found between pertussis immunization in early infancy and dispensed asthma medication in 15-year-olds. The type of vaccine or vaccine schedule did not affect the outcome.

Fetal life is a vulnerable period. This thesis strengthens the evidence that every week of gestation is important for lung maturation. Cord blood IgE, however, did not predict the risk of asthma in adults. Furthermore, the study of migrating populations demonstrated that environmental changes at any age during childhood may affect the risk of asthma. Another, important public health message from this thesis is that vaccination against pertussis in early childhood can be considered safe with respect to the long-term development of asthma.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. 92 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1329
asthma, birth cohort, national register
National Category
urn:nbn:se:liu:diva-85159 (URN)978-91-7519-794-4 (ISBN)
Public defence
2012-12-06, Berzeliussalen, Hälsouniversitet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Available from: 2012-11-19 Created: 2012-11-08 Last updated: 2013-05-13Bibliographically approved

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Vogt, Hartmut
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PediatricsFaculty of Health SciencesDepartment of Paediatrics in Linköping
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