Maternal overweight and obesity before pregnancy as predictors of childhood asthma in children under five years: a retrospective cohort in Peru

Oviedo-Carquín, Víctor; Híjar-Zevallos, Cristhian; Urrunaga-Pastor, Diego; Herrera-Añazco, Percy

doi:10.1590/1806-9304202400000159-en

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Revista Brasileira de Saúde Materno Infantil

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 24 • 2024 • https://doi.org/10.1590/1806-9304202400000159-en copy

Maternal overweight and obesity before pregnancy as predictors of childhood asthma in children under five years: a retrospective cohort in Peru

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives:

to estimate the role of maternal overweight and obesity before pregnancy as predictors of childhood asthma in a population of Peruvian children under five years.

Methods:

we carried out a retrospective cohort study of children aged five years or less and their mothers from the Regional Hospital of Ayacucho and the María Auxiliadora Hospital in Lima, Peru. We included children who were born between 2013 and 2014 and follow them up until 2018 and 2019, respectively. The diagnosis of overweight and obesity of the mother before pregnancy and asthma in the child were registered in their clinical histories. Crude (cRR) and adjusted relative risks (aRR) and 95% confidence intervals (CI95%) were obtained using a generalized lineal model of the Poisson family with link log and robust variances.

Results:

we evaluated 431 medical records and found that 20.9% of the children had asthma, 26.7% of the mothers were overweight, and 20.2% were obese before pregnancy. In the adjusted regression model, overweight (aRR=2.94; CI95%= 1.54-5.60) and maternal obesity (aRR=5.10; CI95%= 2.73-9.51) were predictors of an increased risk of childhood asthma.

Conclusions:

maternal overweight and maternal obesity increased the risk of her children developing asthma threeand five-fold, respectively.

Key words
Asthma; Overweight; Obesity; Child; Pregnancy

Variables	N	%	Nutritional status of the mother						p
			Normal		Overweight		Obesity
			N=229	53.1%	N=115	26.7%	N=87	20.2%
Child sex									0.494
Female	143	33.2	71	49.6	43	30.1	29	20.3
Male	288	66.8	158	54.9	72	25.0	58	20.1
Child’s age (years)									0.257
2	105	24.4	54	51.4	33	31.4	18	17.2
3	147	34.1	83	56.5	41	27.9	23	15.6
4	97	22.5	50	51.6	24	24.7	23	23.7
5	82	19.0	42	51.2	17	20.7	23	28.1
Area of residence									0.236
Coast	206	47.8	109	52.9	56	27.2	41	19.9
Mountains	223	51.7	120	53.8	59	26.5	44	19.7
Jungle	2	0.5	0	-	0	-	2	100.0
Gestational age									<0.001
Preterm	45	10.4	12 ()	26.7	31	68.9	2	4.4
At term	386	89.6	217	56.2	84	21.8	85	22.0
Birth weight									<0.001
Low	10	2.3	1	10.0	7	70.0	2	20.0
Insufficient	35	8.1	9	25.7	24	68.6	2	5.7
Normal	386	89.6	219	56.7	84	21.8	83	21.5
Prematurity									<0.001
Not	386	89.6	217	56.2	84	21.8	85	22.0
Yes	45	10.4	12	26.7	31	68.9	2	4.4
Type of delivery									0.440
Natural	345	80	178	51.6	95	27.5	72	20.9
Cesarean section	86	20	51	59.3	20	23.3	15	17.4
APGAR score at 5 minutes after birth									<0.001
Severe depression	5	1.2	0	-	5	100.0	0	-
Moderate depression	21	4.8	4	19.1	13	61.9	4	19.0
Normal	405	94	225	55.6	97	23.0	83	20.4
Silverman and Anderson Test									<0.001
Without respiratory distress	406	94.2	226	55.7	99	24.4	81	19.9
Mild respiratory distress	20	4.6	3	15.0	11	55.0	6	30.0
Moderate respiratory distress	3	0.7	0	-	3	100.0	0	-
Severe respiratory distress	2	0.5	0	-	2	100.0	0	-
Family history of atopy									<0.001
No	351	81.4	212	60.4	75	21.4	64	18.2
Yes	80	18.6	17	21.3	40	50.0	23	28.7
Time of diagnosis of childhood asthma									<0.001
0 to 12 months	0	0	0	-	0	-	0	-
1 to 2 years	0	0	0	-	0	-	0	-
2 to 5 years	90	20.9	10	11.1	43	47.8	37	41.1
Do not have an asthma attack	341	79.1	219	64.2	72	21.1	50	14.7
Number of childhood asthma attacks in the last year									<0.001
0 to 4 attacks	0	0	0	-	0	-	0	-
5 to 9 attacks	52	12.1	8	15.4	26	50.0	18	34.6
10 or more attacks	38	8.8	2	5.3	17	44.7	19	50.0
Did not have any attacks	341	79.1	219	64.2	72	21.1	50	14.7
Age of the mother									0.342
Low tertile (21 to 26)	168	28	98	58.3	36	21.4	34	20.3
Intermediate tertile (27 to 31)	126	29.2	62	49.2	37	29.4	27	21.4
High tertile (32 to 39)	137	31.8	69	50.4	42	30.7	26	18.9
Educational level of the mother									0.023
Primary	14	3.2	8	57.1	5	35.7	1	7.2
Secondary	117	27.2	76	65.0	24	20.5	17	14.5
Higher	300	69.6	145	48.3	86	28.7	69	23.0
History of diabetes mellitus									0.383
Yes	254	58.9	131	51.6	74	29.1	49	19.3
History of high blood pressure									0.983
Yes	187	43.4	100	53.5	50	26.7	37	19.8
History of cardiovascular disease									0.793
Yes	210	48.7	111	52.9	54	25.7	45	21.4
History of respiratory disease during pregnancy									0.195
No	36	8.3	14	38.9	12	33.3	10	27.8
Yes	395	91.7	215	54.4	103	26.1	77	19.5
Consumption of harmful substances									<0.001
Tobacco	9	2.1	8	88.9	0	-	1	11.1
Alcohol	22	5.1	2	9.0	10	45.5	10	45.5
Drugs	4	0.9	1	25.0	3	75.0	0	-
None	396	91.9	218	55.0	102	25.8	76	19.2
Childhood asthma									<0.001
No	341	79.1	219	64.2	72	21.1	50	14.7
Yes	90	20.9	10	11.1	43	47.8	37	41.1

Variables	Childhood asthma				p
	No		Yes
	N=341	79.1%	N=90	20.9%
Nutritional status of the mother					<0.001
Normal	219	95.6	10	4.4
Overweight	72	62.6	43	37.4
Obesity	50	57.5	37	42.5
Child sex					0.590
Female	116	81.1	27	18.9
Male	237	82.3	51	17.7
Child’s age (years)					0.356
2	85	80.9	20	19.1
3	124	84.3	23	15.7
4	77	79.4	20	20.6
5	67	81.7	15	18.3
Area of residence					0.049
Coast	166	80.6	40	19.4
Mountains	186	83.4	37	16.6
Jungle	1	50.0	1	50
Gestational age					<0.001
Preterm	14	31.1	31	68.9
At term	339	87.8	47	12.2
Birth weight					<0.001
Low	0	-	10	100
Insufficient	11 ()	31.4	24	68.6
Normal	342 ()	88.6	44	11.4
Prematurity					<0.001
No	339	87.8	47	12.2
Yes	14	31.1	68	68.9
Type of delivery					0.241
Natural	281	81.4	64	18.6
Cesarean section	72	83.7	14	16.3
APGAR score at 5 minutes after birth					<0.001
Severe depression	0	-	5	100
Moderate depression	6	28.6	15	71.4
Normal	347	85.7	58	14.3
Silverman and Anderson Test					<0.001
Without respiratory distress	348	85.7	58	14.3
Mild respiratory distress	5	25.0	15	75
Moderate respiratory distress	0	-	3	100.0
Severe respiratory distress	0	-	2	100.0
Family history of atopy					<0.001
No	342	97.4	9	2.6
Yes	11	13.8	69	86.2
Time of diagnosis of childhood asthma					<0.001
0 to 12 months	0	-	0	-
1 to 2 years	0	-	0	-
2 to 5 years	0	-	90	100.0
Do not have an asthma attack	341	100.0	0	-
Number of childhood asthma attacks in the last year					<0.001
0 to 4 attacks	0	-	0	-
5 to 9 attacks	0	-	52	100.0
10 or more attacks	0	-	38	100.0
Did not have any attack	341	100.0	0	-
Age of the mother					0.688
Low tertile (21 to 26)	135	80.4	33	19.6
Intermediate tertile (27 to 31)	101	80.2	25	19.8
High tertile (32 to 39)	105	76.6	32	23.4
Educational level of the mother					0.101
Primary	10	71.4	4	28.6
Secondary	100	85.5	17	14.5
Higher	231	77	69	23
History of diabetes mellitus					0.623
Yes	203	79.9	51	20.1
History of high blood pressure					0.991
Yes	148	79.1	39	20.9
History of cardiovascular disease					0.222
Yes	161	76.7	49	23.3
History of respiratory disease during pregnancy					<0.001
No	17	47.2	19	52.8
Yes	324	82.0	71	18.0
Consumption of harmful substances					<0.001
Tobacco	9	100.0	0	-
Alcohol	2	9.1	20	90.9
Drugs	0	-	4	100.0
None	330	83.3	66	16.7

Nutritional status of the mother	Crude			Adjusted
Nutritional status of the mother	cRR	CI95%	p	aRR^* * Adjusted for: sex and age of the child, prematurity, type of delivery, family history of atopy, and mother age tertiles.	CI95%	p
Normal	Reference	-	-	Reference	-	-
Overweight	8.56	4.46-16.42	<0.001	2.94	1.54-5.60	0.001
Obesity	9.74	5.06-18.73	<0.001	5.10	2.73-9.51	<0.001

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[1] Associated Editor: Gabriela Buccini