Background Antenatal factors and environmental exposures contribute to recurrent wheezing in early childhood. Aim To identify antenatal and environmental factors associated with recurrent wheezing in children from birth to 48 months in the mother and child in the environment cohort, using time-to-event analysis. Method Maternal interviews were administered during pregnancy and postnatally and children were followed up from birth to 48 months (May 2013–October 2019). Hybrid land-use regression and dispersion modelling described residential antenatal exposure to nitrogen dioxide (NO2) and particulate matter of 2.5 µm diameter (PM2.5). Wheezing status was assessed by a clinician. The Kaplan-Meier hazard function and Cox-proportional hazard models provided estimates of risk, adjusting for exposure to environmental tobacco smoke (ETS), maternal smoking, biomass fuel use and indoor environmental factors. Results Among 520 mother–child pairs, 85 (16%) children, had a single wheeze episode and 57 (11%) had recurrent wheeze. Time to recurrent wheeze (42.9 months) and single wheeze (37.8 months) among children exposed to biomass cooking fuels was significantly shorter compared with children with mothers using electricity (45.9 and 38.9 months, respectively (p=0.03)). Children with mothers exposed to antenatal ETS were 3.8 times more likely to have had recurrent wheeze compared with those not exposed (adjusted HR 3.8, 95% CI 1.3 to 10.7). Mean birth month NO2 was significantly higher among the recurrent wheeze category compared with those without wheeze. NO2 and PM2.5 were associated with a 2%–4% adjusted increased wheezing risk. Conclusion Control of exposure to ETS and biomass fuels in the antenatal period is likely to delay the onset of recurrent wheeze in children from birth to 48 months. Data are available on reasonable request.

中文翻译：

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与环境中出生队列中母亲和儿童早期复发性喘息相关的环境暴露：事件发生时间研究


背景 产前因素和环境暴露导致儿童早期反复喘息。目的 使用事件发生时间分析，确定环境队列中母亲和孩子从出生到 48 个月儿童复发性喘息相关的产前和环境因素。方法 在怀孕期间和产后进行产妇访谈，对儿童从出生到 48 个月 （2013 年 5 月至 2019 年 10 月） 进行随访。混合土地利用回归和分散模型描述了住宅产前暴露于二氧化氮 （NO2） 和直径为 2.5 μm 的颗粒物 （PM2.5）。喘息状态由临床医生评估。Kaplan-Meier 风险函数和 Cox 比例风险模型提供了风险估计值，并调整了暴露于环境烟草烟雾 （ETS）、孕产妇吸烟、生物质燃料使用和室内环境因素。结果 在 520 对母子中，85 例 （16%） 患儿有一次喘息发作，57 例 （11%） 有反复喘息。与母亲使用电力的儿童相比，暴露于生物质烹饪燃料的儿童复发性喘息（42.9 个月）和单次喘息（37.8 个月）的时间显著缩短（分别为 45.9 个月和 38.9 个月 （p=0.03））。与未暴露于产前 ETS 的儿童相比，母亲暴露于产前 ETS 的儿童复发性喘息的可能性高 3.8 倍（校正 HR 3.8,95% CI 1.3 至 10.7）。与无喘息的患者相比，复发性喘息类别的平均出生月份 NO2 显着升高。NO2 和 PM2.5 与调整后的喘息风险增加 2%-4% 相关。 结论 产前控制 ETS 和生物质燃料暴露可能会将儿童复发性喘息的发生从出生推迟到 48 个月。数据可应合理要求提供。