Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study WHAT’S KNOWN ON THIS SUBJECT: Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes. WHAT THIS STUDY ADDS: This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. abstract BACKGROUND AND OBJECTIVE: Maternal asthma is a common preg- nancy complication, with adverse short-term effects for the offspring. The objective was to determine whether asthma during pregnancy is a risk factor of offspring diseases. METHODS: We studied pregnant women from the Danish National Birth Cohort (births: 1996–2002; prospective data) giving birth to live sin- gletons (n = 66 712 mother-child pairs), with 4145 (6.2%) women suffering from asthma during pregnancy. We estimated the associations between asthma during pregnancy and offspring diseases ( International Classi fication of Diseases, 10th Revision diagnoses from national registries), controlling for potential confounders and validating findings by secondary analyses. RESULTS: Offspring median age at end of follow-up was 6.2 (3.6–8.9) years. Asthma was associated with an increased offspring risk of infectious and parasitic diseases (hazard ratio [HR] 1.34; 95% confidence interval [CI] 1.23–1.46), diseases of the nervous system (HR 1.43; CI 1.18–1.73), ear (HR 1.33; CI 1.19–1.48), respiratory system (HR 1.43; CI 1.34–1.52), and skin (HR 1.39; CI 1.20–1.60), and potentially (not confirmed in secondary analyses) of endocrine and metabolic disorders (HR 1.26; CI 1.02–1.55), diseases of the digestive system (HR 1.17; CI 1.04–1.32), and malformations (odds ratio 1.13; CI 1.01–1.26), but not of neoplasms, mental disorders, or diseases of the blood and immune system, circulatory system, musculoskeletal system, and genitourinary system. CONCLUSIONS: To the best of our knowledge, this is the first compre- hensive study of the associations between asthma during pregnancy and a wide spectrum of offspring diseases. In line with previous data on selected outcomes, asthma during pregnancy may be a risk factor for numerous offspring diseases, suggesting that careful monitoring of women with asthma during pregnancy and their offspring is impor- tant. Pediatrics 2013;132:1–9 AUTHORS: Marion Tegethoff, PhD, a Jørn Olsen, MD, PhD, b,c Emmanuel Schaffner, MSc, d,e and Gunther Meinlschmidt, PhD f,g,h Divisions of a Clinical Psychology and Psychiatry, d Applied Statistics in Life Sciences, and f Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland; b Department of Epidemiology, School of Public Health, University of California at Los Angeles, Los Angeles, California; c The Danish Epidemiology Science Centre, Department of Epidemiology, Institute of Public Health, University of Aarhus, Aarhus, Denmark; e Biostatistics and Computational Sciences, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; g Research Department of Psychobiology, Psychosomatics, and Psychotherapy, Clinic of Psychosomatic Medicine and Psychotherapy, LWL University Hospital and School of Medicine, Ruhr-University Bochum, Bochum, Germany; and h National Centre of Competence in Research “Swiss Etiological Study of Adjustment and Mental Health,” Basel, Switzerland KEY WORDS antenatal, child, prenatal exposure delayed effects, prenatal, programming ABBREVIATIONS CI—confidence interval DNBC—Danish National Birth Cohort HPA—hypothalamic-pituitary-adrenal HR—hazard ratio ICD-10—International Classification of Diseases, 10th Revision Dr Tegethoff conceptualized and designed the study, carried out the statistical analyses, interpreted data, drafted the initial manuscript, critically reviewed the manuscript, and obtained funding; Dr Olsen acquired data, interpreted data, critically reviewed the manuscript, and obtained funding; Mr Schaffner carried out the statistical analyses, interpreted data, and critically reviewed the manuscript; Dr Meinlschmidt conceptualized and designed the study, carried out the statistical analyses, interpreted data, critically reviewed the manuscript, and obtained funding; and all authors approved the final manuscript as submitted. (Continued on last page) PEDIATRICS Volume 132, Number 3, September 2013 1 ARTICLE by guest on April 9, 2017 Downloaded from