Published online June 1, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1104-1112 (doi:10.1542/peds.2006-2837)
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ARTICLE

Maternal Asthma and Maternal Smoking Are Associated With Increased Risk of Bronchiolitis During Infancy

Kecia N. Carroll, MD, MPHa,b,c, Tebeb Gebretsadik, MPHd, Marie R. Griffin, MD, MPHe,f,g,h,i, William D. Dupont, PhDd,f, Edward F. Mitchel, MSf, Pingsheng Wu, PhDd,j, Rachel Enriquez, RN, PhDj and Tina V. Hartert, MD, MPHe,j,k,l,m

a Department of Pediatrics
e Department of Medicine
f Department of Preventive Medicine
d Department of Biostatistics, Divisions of
b Division of General Pediatrics
g Division of General Internal Medicine
j Division of Allergy, Pulmonary and Critical Care Medicine
c Division of Child and Adolescent Health Research Unit
h Division of Center for Education and Research on Therapeutics
k Division of Center for Health Services Research
l Division of General Clinical Research Center, Vanderbilt University School of Medicine, Nashville, Tennessee
i Mid-South Geriatric Research Education and Clinical Center and Clinical Research Center of Excellence, Veterans Affairs Tennessee Valley Health Care System, Nashville, Tennessee
m Meharry/Vanderbilt Center for Reducing Asthma Disparities, Nashville, Tennessee

OBJECTIVE. Our goal was to determine whether maternal asthma and maternal smoking during pregnancy are associated with the incidence and severity of clinically significant bronchiolitis in term, otherwise healthy infants without the confounding factors of small lung size or underlying cardiac or pulmonary disease.

PATIENTS AND METHODS. We conducted a population-based retrospective cohort study of term, non–low birth weight infants enrolled in the Tennessee Medicaid Program from 1995 to 2003. The cohort of infants was followed through the first year of life to determine the incidence and severity of bronchiolitis as determined by health care visits and prolonged hospitalization.

RESULTS. A total of 101245 infants were included. Overall, 20% of infants had ≥1 health care visit for bronchiolitis. Compared with infants with neither factor, the risk of bronchiolitis was increased in infants with maternal smoking only, maternal asthma only, or both. Infants with maternal asthma only or with both maternal smoking and asthma had the highest risks for emergency department visits and hospitalizations. Infants with a mother with asthma had the highest risk of a hospitalization >3 days, followed by infants with both maternal asthma and smoking, and maternal smoking only.

CONCLUSIONS. Maternal asthma and maternal smoking during pregnancy are independently associated with the development of bronchiolitis in term, non–low birth weight infants without preexisting cardiac or pulmonary disease. The risk of bronchiolitis among infants with mothers who both have asthma and smoke during pregnancy is ~50% greater than that of infants with neither risk factor. Efforts to decrease the illness associated with these 2 risk factors will lead to decreased morbidity from bronchiolitis, the leading cause of hospitalization for severe lower respiratory tract infections during infancy.

Key Words: bronchiolitis • risk factors • infant • smoking • asthma

Abbreviations: RSV—respiratory syncytial virus • ETS— environmental tobacco smoke • EGA—estimated gestational age • ICD-9— International Classification of Diseases, Ninth Revision • ED—emergency department • HR—hazard ratio • CI—confidence interval • OR—odds ratio

Accepted Feb 12, 2007.




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