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Childhood Asthma and Maternal Factors: Have We Hit a Goldmine?

At two-years-old, our middle son underwent what would end up being a non-conclusive colonoscopy, in our attempts to diagnose the cause of his chronic diarrhea.  Around the same time, he suffered from eczema—an itchy, red skin rash that made him miserable, and sometimes kept him awake at night.  A year after all that, he was diagnosed with asthma—a condition that still plagues him, today.  Our youngest son, born at the same hospital as his older brother, also suffered from eczema.  His allergic skin rash was so severe that he was literally covered in itchy, red plaques from head to toe.

What Do Asthma and Birth Have in Common?
As we work to get our asthmatic son through the final weeks of allergy season—his breathing compromised by the mold spores currently in the air— I read with interest this article, recently published on Reuter’s Health web site.  The article discusses a new study by John Penders, et al out of the Netherlands which suggests a link between mode and location of birth, and a child’s subsequent risk of developing allergies and asthma later in life.  More specifically, the study looked at colonization of an infant’s gut with particular bacteria—E  coli and C difficile—and found a greater association with colonization of C diff. at birth, and subsequent atopy  later in life.

A soon-to-be published cohort study (in the same journal) by Adrian Lowe, et al. looked at another possible predictor of childhood asthma:  maternal obesity.  189,783 children born to 129,239 mothers in Stockholm Sweden between 1998 and 2009 were included in this study.  The study’s primary goal was to assess the relationship between early pregnancy maternal BMI and subsequent asthma later in life of the children—as judged by prescriptive asthma medication purchase and hospital admissions for asthma.

Statistical regression models revealed a linear relationship between increasing maternal BMI and incidence of offspring asthma—although from my reading of the study, the relationship appeared to be modest, according to the odds ratios provided in the study’s data.  Study authors conclude that, “If the association between maternal BMI and asthma risk in the child is causal in nature, it might explain between 11% and 13% of childhood asthma.”  (Emphasis, mine.)

Another recent cohort study, published in the Journal of Pediatrics (Tollånes, et al, 2008) looked at the association between cesarean delivery and incidence of childhood asthma.  This large (1,756,700 singletons) study out of Norway revealed a 52% increase in asthma incidence among children born via c-section, compared to vaginal delivery.

Application to Childbirth Education and Maternity Care
What do these studies and numbers mean for those of us working with expectant families?  Is it realistic to pin the burden of potentially “causing” her child’s subsequent asthma on a pregnant woman of size?  Is it realistic to think a laboring woman will contemplate her child’s possible risk of asthma, when faced with the potential of delivering via c-section?  No, I would argue, neither of those scenarios are terribly realistic.  But what I think these studies do point to is the importance of preconception counseling and guidance:  in the form of impressing upon people of childbearing age the importance of preconception good health (including a reasonable BMI for height, build and activity levels) and the continued importance of decreasing the overall cesarean section rate.

More and more studies continue to emerge—not just out of the maternity care research industry, but out of several research fields (pediatrics and asthma/immunology being two)—that point out the importance of normalizing birth practices whenever possible.  Ask any family who deals with the frightening circumstance of childhood asthma, and they will tell you:  if there had been something we could do ahead of time to prevent our (son/daughter) from developing respiratory disease…we would have done it.  Perhaps, we have landed upon a couple of significant opportunities within our own industry to decrease asthma prevalence and incidence.  I, for one, would be more than happy to aid in the decrease of childhood respiratory disease.  And my son, I think, would be happy about that, too.

 

 

Posted by:  Kimmelin Hull, PA, LCCE, FACCE

 

Cesarean Birth, Maternal Obesity, New Research, News about Pregnancy, Preconception Care, Research , , , , ,

  1. avatar
    sara r.
    October 11th, 2011 at 14:47 | #1

    Gut and Psychology Syndrome by Natasha Campbell McBride explains the reasons behind the link between c-section delivery and childhood immune and behavioral issues in quite some detail. It’s a fascintaing book because she not only explains the causes, but also the solution through a special temporary diet. She cured her son’s autism, and many others who implement the diet have cured their children’s (and their own) allergies, excema, Celiac’s, and ulcerative colitis, as well as lupus and CFS. It’s really an amazing book, because as she points out- all disease begins in the gut and is a manifestation of each individual’s response to their own gut bacteria imbalances, or dysbiosis.
    C
    -section birth
    \,’.;/

  2. October 11th, 2011 at 16:05 | #2

    @sara r.
    Fascinating. Thanks for sharing, Sara.

  3. avatar
    sasha
    October 12th, 2011 at 09:46 | #3

    Of my two children, my oldest, born in hospital, and exposed to IV antibx through my labor because she was just before 36 weeks and therefore assumed high risk for group B strep (i had not been tested), born hypoxic and needing resusitation, later developed allergies and asthma. My 2nd, born later, and at home, has none of the same issues. Even before reading about this new research, I’ve wondered about the connection between birth circumstances and development of breathing difficulties. Simply the experience of having a tube down one’s throat, being aggressively suctioned, and an oxygen mask cover one’s face, as well as the disruption of the motherbaby dyad…….how could it not effect the infant? As a doula, i’ve seen so so many babies “helped” at birth w/ agressive suctioning, etc, sometimes w/o much clear reason, and i cringe. Add to this the problem of antibx overkill and motherbaby separation – we are certainly interfering to the detriment of many of these babies.

    As an aside, my midwife w/ my 2nd daughter watched the video of my first birth – she explained how she would have handled the situation – rubbing, talking, stimulating, keep cord intact (far too dangerous to cut early – which is what happened), warmth of mother’s body – and baby would have come around w/o all of the intervention and separation.

  4. October 12th, 2011 at 10:36 | #4

    Thank you for sharing, Sasha. There is so much to learn about supporting and protecting normal birth in the hospital environment. I believe it CAN be done there…but not when practices like you describe above are still routinely done. And yet, as this study suggests, even the situation of being in the hospital AT ALL may be a contributing factor to childhood asthma and allergies later in life.

  5. avatar
    Mamie F
    October 12th, 2011 at 14:14 | #5

    I have had asthma and severe allergies my whole life — I was started on immunotherapy at 18 months of age, the youngest ever in the allergy practice where I was treated for 18 years. Subsequent allergists seem surprised that I’m not confined to a bubble, or at least not confined to filtered, climate-controlled environments at all times. Also my whole life, I have watched my mother torture herself with what-if’s regarding things she might have done to “cause” my allergies. This is the dark side of the optimism with which you conclude — “I can prevent this” vs. “I have caused this”.

    While I am also interested in these findings, I suspect that the underlying causal link with overweight mothers is not simply body mass — after all, one of the links you review here is gut flora, and gut flora have been suggested to influence body weight (e.g., the study described here: http://www.sciencedaily.com/releases/2011/05/110525105836.htm). I have seen previously that lack of exposure to vaginal bacteria may explain the link between c-section birth and allergy. So just one possibility is that the gut flora transmitted to infants from overweight mothers are lacking specific protective bacteria, as in cases of c-section. This is not something that would be remedied by weight loss alone.

    I don’t know about the Swedish sample in the study you cite, but in the US, obesity is associated with poverty, which itself can be associated with exposure to environmental toxins (see, for example, writing on Louisiana’s “Chemical Corridor”, e.g. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1253744/) — another route through which obese mothers may be at increased risk for bearing children who develop asthma. Again, if this were the root cause, it would not be remedied simply by weight loss.

    To recommend maintaining “reasonable BMI” for preventing asthma without testing whether women’s lower prepregnancy weight actually mitigates the risk of allergy and asthma in their offspring is to potentially doom women, particularly underprivileged women, to failure and blame. Weight loss can be difficult to achieve due to economic, psychological and environmental factors (such as lack of safe spaces, time and energy to exercise). Getting to a “reasonable BMI” prior to pregnancy assumes a planned pregnancy, and underprivileged women are especially at risk for unplanned pregnancy due to lack of access to contraception; such a recommendation to all women of childbearing age may also entail a medical environment in which women are treated as childbearers first and independent beings second, disregarding their plans for themselves and their own hierarchy of medical concerns, in which childbearing may rank low.

    If the recommendations say, “overweight mothers increase their offsprings’ risk of developing asthma,” particularly if maternal body mass is not in itself causal, then the door is open to say, “you failed to achieve a ‘healthy’ weight before pregnancy, so this is at least in part your fault.” This — especially if it is not accurate — is not helpful to mother, child or society due to the lack of sympathy and support for treating illnesses that are considered preventable by what society considers “appropriate” behavior — the blame increases the emotional trauma surrounding the child’s diagnosis and treatment, creating an environment of negative emotion associated with the disorder.

    I can tell you from personal experience that this will complicate the family’s experience of disease — the child may even grow up to study social responses to illness, particularly illness-as-deviance and the tendency of behavioral recommendations to reify hegemonic cultural standards as healthful. :)

  6. October 12th, 2011 at 14:36 | #6

    Mamie F,
    You bring up many interesting and valid points. This study–being one of many concerning causes and potential causes of childhood asthma and allergies–represents one possibility out of oodles more. In our family’s case, I do not happen to be overweight or obese and yet, my son still developed allergies and asthma. So yes, to pin the “blame” on this one factor is unreasonable in and of itself. In fact, I am sure there are many women of size whose children do not have allergies or asthma–proving your sentient points, even further. However, to find a variety of ways to communicate to women of childbearing age (not just those immediately planning a pregnancy) the importance of overall health and wellness–so that healthy status might positively affect a subsequent pregnancy if and when it occurs, certainly can’t be considered a bad thing.

    Thank you for your insightful comments and additions to the conversation.

  7. avatar
    Lisa
    October 13th, 2011 at 12:19 | #7

    Given that overweight & obese women are subjected to far more interventions, including cesareans, than women of “normal” weight, I wouldn’t be surprised at all to find the increase of asthma in children in overweight women is down to the increase in cesareans and nothing inherent in being overweight. Or did the study differentiate between heavy women who had vaginal births & those who had cesareans?

  8. avatar
    Livia
    October 14th, 2011 at 06:52 | #8

    Fascinating stuff, thanks for reporting!

    I’d also would like to know more about the BMI angle. Was there a specific BMI range that causes higher risk (obese only, for example) or was being overweight enough?
    The previous question about higher levels of intervention also seems spot on to me.

    Even the comments are interesting and thought-provoking in this blog – it’s delightful! :)

  9. avatar
    Marie Pulito RN IBCLC
    October 21st, 2011 at 16:02 | #9

    Thanks so much for your article. I am so fascinated by the benefits of doing frequent skin-to-skin in the postpartum period. Vaginal birth leads to the colonization of the baby with the normal flora in the mother’s perineum. Skin-to-skin (baby lying on mother’s chest)appears to do the same thing. At Yale-New Haven, we are teaching the OB interns about breastfeeding and doing skin-to-skin. We are working towards getting every baby onto mother’s chest as soon as possible after birth. And we use skin-to-skin as a starting point for all breastfeeding sessions, because it leads to the easy baby-led latch. Wouldn’t it be great to find out that skin-to-skin (especially for c-section babies who miss out on the natural colonization)leads to less asthma and allergies!

  10. November 23rd, 2011 at 03:48 | #10

    DPT shot is also a documented raised risk of asthma.

    Delay in diphtheria, pertussis, tetanus vaccination is associated with a reduced risk of childhood asthma. J Allergy Clin Immunol. 2008 Mar;121(3):626-31.
    http://www.ncbi.nlm.nih.gov/pubmed/18207561

    [The effect of DPT and BCG vaccinations on atopic disorders].
    Arerugi. 2000 Jul;49(7):585-92. (Article translated from Japanese)
    http://www.ncbi.nlm.nih.gov/pubmed/10944825

    also see these

    Odent MR et al. Pertussis vaccination and asthma: Is there a link? JAMA 1994; 272(8): 592-593. http://www.ncbi.nlm.nih.gov/pubmed/8057511

    Kemp T et al. Is infant immunization a risk factor for childhood asthma or allergy? Epidemiology 1997 Nov; 8(6): 678-680.
    http://www.ncbi.nlm.nih.gov/pubmed/9345669

    Read more: http://www.care2.com/causes/asthma-kills-children.html#ixzz1eW55Jbxd

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