PAEDIATRIC LUNG DISEASE

Low birth weight for gestation and airway function in infancy: exploring the fetal origins hypothesis

C Dezateux¹, S Lum², A-F Hoo², J Hawdon³, K Costeloe⁴, J Stocks²

¹ Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
² Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health and Great Ormond Street NHS Trust, London, UK
³ University College London Hospital, London, UK
⁴ Barts and the London, Queen Mary School of Medicine and Dentistry, Homerton University Hospital, London, UK

Correspondence to:
Correspondence to:
Professor C Dezateux
Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK; c.dezateux{at}ich.ucl.ac.uk

Background: Poor fetal growth has been associated with impaired airway function in adult life, but evidence linking birth weight and airway function in early childhood is sparse. We examined the hypothesis that low birth weight for gestation is associated with impaired airway function shortly after birth and that this is independent of impaired postnatal somatic growth.

Methods: Airway function was measured using the raised volume technique in healthy white infants of low (10th centile) or appropriate (20th centile) birth weight for gestation and was expressed as forced expiratory volume in 0.4 s (FEV_0.4), forced vital capacity (FVC), and the maximal expired flow at 25% of forced vital capacity (MEF₂₅). Infant length and weight, maternal height and weight, maternal report of smoking prenatally and postnatally, and parental occupation were recorded.

Results: Mothers of low birth weight for gestation infants (n = 98) were lighter, shorter, and more likely to smoke and have partners in manual occupations. At 6 weeks their infants remained lighter and shorter than those of appropriate birth weight (n = 136). FEV_0.4, FVC, and MEF₂₅ were reduced in infants of low birth weight for gestation, in those whose mothers smoked in pregnancy, or who were in manual occupations. After adjusting for relevant maternal and infant characteristics, infants in the low birth weight for gestation group experienced a mean reduction of 11 ml in FEV_0.4 (95% CI 4 to 18; p = 0.002), of 12 ml in FVC (95% CI 4 to 19; p = 0.004), and of 28 ml/s in MEF₂₅ (95% CI 7 to 48; p = 0.03).

Conclusions: Airway function is diminished in early postnatal life as a consequence of a complex causal pathway which includes social disadvantage as indicated by maternal social class, smoking and height, birth weight as a proximal and related consequence of these factors, and genetic predisposition to asthma. Further work is needed to establish the relevance of these findings to subsequent airway growth and development in later infancy and early childhood.

Keywords: birth weight; fetal growth retardation; fetal origins hypothesis; airway function; infants

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Airwaves

Wisia Wedzicha
Thorax 2004 59: 1. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Kozlowska, W. J., Bush, A., Wade, A., Aurora, P., Carr, S. B., Castle, R. A., Hoo, A.-F., Lum, S., Price, J., Ranganathan, S., Saunders, C., Stanojevic, S., Stroobant, J., Wallis, C., Stocks, J., for the London Cystic Fibrosis Collaboration, (2008). Lung Function from Infancy to the Preschool Years after Clinical Diagnosis of Cystic Fibrosis. Am. J. Respir. Crit. Care Med. 178: 42-49 [Abstract] [Full Text]  
• Subbarao, P., Sears, M. R (2008). The chicken or the egg? Perhaps the egg. Arch. Dis. Child. 93: 552-553 [Full Text]  
• Canoy, D., Pekkanen, J., Elliott, P., Pouta, A., Laitinen, J., Hartikainen, A.-L., Zitting, P., Patel, S., Little, M. P, Jarvelin, M.-R. (2007). Early growth and adult respiratory function in men and women followed from the fetal period to adulthood. Thorax 62: 396-402 [Abstract] [Full Text]  
• Lum, S., Gustafsson, P., Ljungberg, H., Hulskamp, G., Bush, A., Carr, S. B, Castle, R., Hoo, A.-f., Price, J., Ranganathan, S., Stroobant, J., Wade, A., Wallis, C., Wyatt, H., Stocks, J., on behalf of the London Cystic Fibrosis Collaborat, (2007). Early detection of cystic fibrosis lung disease: multiple-breath washout versus raised volume tests. Thorax 62: 341-347 [Abstract] [Full Text]  
• Nepomnyaschy, L., Reichman, N. E. (2006). Low Birthweight and Asthma Among Young Urban Children. AJPH 96: 1604-1610 [Abstract] [Full Text]  
• Henschen, M., Stocks, J., Brookes, I., Frey, U. (2006). New aspects of airway mechanics in pre-term infants. Eur Respir J 27: 913-920 [Abstract] [Full Text]  
• Murphy, V. E., Smith, R., Giles, W. B., Clifton, V. L. (2006). Endocrine Regulation of Human Fetal Growth: The Role of the Mother, Placenta, and Fetus. Endocr. Rev. 27: 141-169 [Abstract] [Full Text]  
• (2005). ATS/ERS Statement: Raised Volume Forced Expirations in Infants: Guidelines for Current Practice. Am. J. Respir. Crit. Care Med. 172: 1463-1471 [Full Text]  
• Vrijlandt, E.J.L.E., Gerritsen, J. (2004). The womb and lung function later in life. Eur Respir J 24: 722-723 [Full Text]  
• Greenough, A., Yuksel, B., Cheeseman, P. (2004). Effect of in utero growth retardation on lung function at follow-up of prematurely born infants. Eur Respir J 24: 731-733 [Abstract] [Full Text]  
• Hoo, A.-F., Stocks, J., Lum, S., Wade, A. M., Castle, R. A., Costeloe, K. L., Dezateux, C. (2004). Development of Lung Function in Early Life: Influence of Birth Weight in Infants of Nonsmokers. Am. J. Respir. Crit. Care Med. 170: 527-533 [Abstract] [Full Text]