Asthma, Rhinitis, Other Respiratory Diseases
Maternal vaginal microflora during pregnancy and the risk of asthma hospitalization and use of antiasthma medication in early childhood,☆☆

https://doi.org/10.1067/mai.2002.125833Get rights and content

Abstract

Background: Infants with wheezing and allergic diseases have a microflora that differs from that of healthy infants. The fetus acquires microorganisms during birth when exposed to the maternal vaginal microflora. It is therefore conceivable that the maternal vaginal microflora might influence the establishment of the infant flora and, as a consequence, the development of wheezing and allergic diseases. Objective: We sought to study the associations between the composition of the maternal vaginal microflora and the development of wheezing and asthma in childhood. Methods: We performed a population-based cohort study in Denmark. Vaginal samples for bacterial analysis were obtained during pregnancy. A total of 2927 women (80% of the invited women) completed the study and had 3003 live infants. Infant wheezing was assessed as one or more hospitalizations for asthma between 0 and 3 years of age. Asthma was assessed as use of 3 or more packages of antiasthma medication between 4 and 5 years of age. Results: Maternal vaginal colonization with Ureaplasma urealyticum during pregnancy was associated with infant wheezing (odds ratio [OR], 2.0; 95% CI, 1.2-3.6), but not with asthma, during the fifth year of life. Maternal colonization with staphylococci (OR, 2.2; 95% CI, 1.4-3.4) and use of antibiotics in pregnancy (OR, 1.7; 95% CI, 1.1-2.6) were associated with asthma during the fifth year of life. Conclusion: The composition of the maternal vaginal micro-flora might be associated with wheezing and asthma in the offspring up to 5 years of age. (J Allergy Clin Immunol 2002;110:72-7.)

Section snippets

Subjects

The present study is based on a previously conducted study of risk factors for preterm delivery. Pregnant women attending prenatal care at the Department of Obstetrics and Gynecology, Odense University Hospital, Denmark, were invited to participate in that study at their first antenatal care visit between 8 and 24 full gestational weeks (mean of 17 full gestational weeks plus 1 day, SD 2 weeks plus 4 days) during the study period from November 1992 to February 1994. The inclusion criteria were

Clinical outcomes

Fifty-one (1.7%) of the 3003 children were hospitalized for asthma during the first 3 years of life, and 93 (3.4%) of the 2742 children who still lived in the county in 2000 used 3 or more packages of antiasthma medication between 4 and 5 years of age. Nine (20%) of the 46 children with a history of hospitalization still living in the county in 2000 used antiasthma medication.

The potential confounders-single motherhood, number of other children in the home, and season of birth-were not

Discussion

As hypothesized a priori, we found that maternal colonization with U urealyticum in pregnancy was a risk factor for infant wheezing. Maternal colonization with staphylococci and use of antibiotics in pregnancy were risk factors for asthma during the fifth year of life.

U urealyticum is a sexually transmitted human pathogen that can be found in the cervix or vagina of 40% to 80% of asymptomatic women of reproductive ages. Colonization is linked to young age, low socioeconomic status, and multiple

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  • Cited by (0)

    Supported by grants from The Danish Medical Research Council (9700560). The original study was supported by the Danish National Research Foundation and a grant from March of Dimes Birth Defects Foundation (#20-FY98-700), New York, and supported under a cooperative agreement from the Centers for Disease Control and Prevention, Atlanta, Ga, through the Association of Teachers of Preventive Medicine, Washington, DC. The activities of The Danish Epidemiology Science Centre are financed by a grant from The Danish National Research Foundation.

    ☆☆

    Reprint requests: Christine Stabell Benn, MD, Department of Epidemiology Research, Statens Serum Institut, 5 Artillerivej, DK-2300 Copenhagen S, Denmark.

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