PT  - JOURNAL ARTICLE
AU  - Stephen Turner
AU  - Shona Fielding
AU  - Graham Devereux
TI  - Fetal origins of persistent childhood asthma
AID  - 10.1183/13993003.congress-2016.OA3302
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - OA3302
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/OA3302.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/OA3302.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Introduction. Our previous work has linked reduced first (T1) and second (T2) trimester fetal size and increased risk for asthma to age ten years.Here we tested the hypothesis that reduced fetal size will be associated with reduced lung function and persistent asthma from ages 5 to 15 years.Methods. Two thousand mothers were recruited. Fetal size in the T1 and T2 was ascertained by ultrasound scan. Asthma status and spirometry were recorded at ages 5, 10 and 15 years. GEE was used to assess the relationship between T1 size and asthma at 5, 10 and 15 years. A linear mixed effects model described the trajectory of z-scores of fetal measurements and childhood lung function from T1 to 15 years and was then stratified for asthma outcome: ie no asthma, transient/late onset asthma or persistent asthma using data collected at 5 and 15 years.Results. Each z score increase in T1 size was associated with reduced risk for asthma at ages 5, 10 and 15 (OR 0.78 [95% CI 0.63,0.97] p=0.025, n=619), independent of confounders. Each increase in T1 z score was associated with a mean 0.13 z score increase in FEV1 [95% CI 0.03, 0.22] p=0.007, n=833, independent of covariates. Finally in the stratified model, persistent asthma was associated with reductions in T1 and T2 size and FEV1 at ages 5, 10 and 15 compared to the two other groups (n=587); there was no interaction between group and time indicating that the low trajectory for fetal size and FEV1 was maintained throughout for those with persistent asthma.Conclusion. First trimester fetal size (a surrogate for fetal lung size) is relevant to symptoms and respiratory physiology through to 15 years of age. These findings suggest that antenatal factors contribute to life-long respiratory wellbeing.