Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. e327-e332 (doi:10.1542/10.1542/peds.2003-0838-L)

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ELECTRONIC ARTICLE

Low-Normal Gestational Age as a Predictor of Asthma at 6 Years of Age

Benjamin A. Raby, MDCM, MPH^*,,, Juan C. Celedón, MD, DrPH^*,,, Augusto A. Litonjua, MD, MPH^*,,, Wanda Phipatanakul, MD^,||, Diane Sredl, MPH^*, Emily Oken, MD, MPH^¶, Louise Ryan, PhD^#, Scott T. Weiss, MD, MS^*,, and Diane R. Gold, MD, MPH^*,,

^* Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Harvard Medical School, Boston, Massachusetts
^|| Department of Pediatrics, Division of Allergy and Immunology, Children’s Hospital, Boston, Massachusetts
^¶ Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts
^# Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts

Background. Perinatal factors, including gestational age and birth weight, influence the development of atopy in early life. However, the role of these factors in the development of asthma in later life among children who do not develop perinatal respiratory disease remains unclear.

Methods. Four hundred fifty-four infants who had a history of allergy or asthma in at least 1 parent, were born in the 36th week of gestation or later, and did not develop perinatal respiratory distress were monitored for at least 6 years. Associations between predictor variables and asthma and wheeze were assessed with multivariate logistic regression and repeated-event analyses.

Results. Although we previously observed a relationship between low birth weight and persistent wheeze in the first 1 year of life, we did not observe similar associations between low birth weight and asthma at 6 years of age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 0.40–2.73). However, a strong relationship was found between low-normal gestational age and asthma at 6 years of age (OR: 4.7; 95% CI: 2.1–10.5). The effects of low-normal gestational age were significantly greater among boys than among girls (boys: OR: 8.15; 95% CI: 2.98–22.3; girls: OR: 1.90; 95% CI: 0.38–13.83). Longitudinal analysis of the relationship between gestational age and wheeze during the 6 years of observation confirmed these gender differences.

Conclusions. Among children at high risk of developing atopic disease, late prematurity might be an important additional determinant of asthma later in life, and these effects are gender specific.

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Key Words: asthma • gestational age • birth weight • longitudinal studies

Abbreviations: IgE, immunoglobulin E • OR, odds ratio • CI, confidence interval

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Accepted Apr 1, 2004.

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