Association between Caregiver Exposure to Toxics during Pregnancy and Childhood-onset Asthma: A Case-control Study
AbstractThe aim of this study was to evaluate the associations between caregiver-reported use of medications, alcohol, cigarette and/or waterpipe (WP), and exposure to pesticides/detergents during pregnancy with childhood-onset asthma. The study design consisted of a case-control study, conducted between December 2015 and April 2016, recruited 1503 children, aged between 3-16 years old. A questionnaire assessed the sociodemographic characteristics (age, gender, education level of both parents), the family history of asthma, and other known risk factors of asthma (heating system at home, child history of recurrent otitis, humidity in the house, child went to a daycare, smoking and drinking alcohol during pregnancy, exposure to pesticides and detergents). The multivariate analysis showed that children living in North and South Lebanon and the children living in areas where pesticides are frequently used had an increased risk of asthma (ORa=1.625, CI 1.034-2.554, p=0.035, ORa=13.65, CI 3.698-50.385; p<0.001 and ORa=3.307, CI 1.848-5.918, p<0.001 respectively). Smoking WP during pregnancy and cigarette during lactation would increase the risk of asthma in children (ORa=6.11; CI 1.244-30.008; p=0.026 and ORa=3.44; CI 1.024-11.554; p=0.046 respectively). We conclude that asthma may originate from the environmental exposure to toxics such as pesticides and tobacco (cigarettes and WP) or to alcohol and prescribed medications during pregnancy and lactation. Spreading awareness by health professionals about these preventable causes can help educate the parents and children to prevent asthma and its exacerbation.
1. Postma DS, Boezen HM. Rationale for the Dutch hypothesis: allergy and airway hyperresponsiveness as genetic factors and their interaction with environment in the development of asthma and COPD. Chest 2004; 126(2_suppl_1):96S-104S.2. Li YF, Langholz B, Salam MT, Gilliland FD. Maternal and grandmaternal smoking patterns are associated with early childhood asthma. Chest 2005; 127(4):1232-41.3. Arshad SH, Kurukulaaratchy RJ, Fenn M, Matthews S. Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age. Chest 2005; 127(2):502-8.4. Arif AA, Delclos GL, Lee ES, Tortolero SR, Whitehead LW. Prevalence and risk factors of asthma and wheezing among US adults: an analysis of the NHANES III data. Eur Respir J 2003; 21(5):827-33.5. Waked M, Salameh P. Maternal waterpipe smoke exposure and the risk of asthma and allergic diseases in childhood: a post hoc analysis. Int J Occup Med Environ Health 2015; 28(1):147-56.6. Ayres JG, Clark TJ. Alcoholic drinks and asthma: a survey. Br J Dis Chest 1983; 77(4):370-5.7. Vally H, de Klerk N, Thompson PJ. Alcoholic drinks: important triggers for asthma. J Allergy Clin Immunol 2000; 105(3):462-7.8. Vena GA, Foti C, Angelini G. Sulfite contact allergy. Contact Dermatitis 1994; 31(3):172-5.9. Simcox NJ, Fenske RA, Wolz SA, Lee IC, Kalman DA. Pesticides in household dust and soil: exposure pathways for children of agricultural families. Environ Health Perspect 1995; 103(12):1126-34.10. Gladen BC, Sandler DP, Zahm SH, Kamel F, Rowland AS, Alavanja MC. Exposure opportunities of families of farmer pesticide applicators. Am J Ind Med 1998; 34(6):581-7.11. Azaroff LS. Biomarkers of exposure to organophosphorous insecticides among farmers' families in rural El Salvador: factors associated with exposure. Environ Res 1999; 80(2 Pt 1):138-47.12. Lu C, Fenske RA, Simcox NJ, Kalman D. Pesticide exposure of children in an agricultural community: evidence of household proximity to farmland and take home exposure pathways. Environ Res 2000; 84(3):290-302.13. Loewenherz C, Fenske RA, Simcox NJ, Bellamy G, Kalman D. Biological monitoring of organophosphorus pesticide exposure among children of agricultural workers in central Washington State. Environ Health Perspect 1997; 105(12):1344-53.14. Fenske RA, Kissel JC, Lu C, Kalman DA, Simcox NJ, Allen EH, et al. Biologically based pesticide dose estimates for children in an agricultural community. Environ Health Perspect 2000; 108(6):515-20.15. Koch D, Lu C, Fisker-Andersen J, Jolley L, Fenske RA. Temporal association of children's pesticide exposure and agricultural spraying: report of a longitudinal biological monitoring study. Environ Health Perspect 2002; 110(8):829-33.16. Salameh P, Waked M, Baldi I, Brochard P, Saleh BA. Respiratory diseases and pesticide exposure: a case-control study in Lebanon. J Epidemiol Community Health 2006;60(3):256-61.17. Zock JP, Plana E, Jarvis D, Anto JM, Kromhout H, Kennedy SM, et al. The use of household cleaning sprays and adult asthma: an international longitudinal study. Am J Respir Crit Care Med 2007; 176(8):735-41.18. Le Moual N, Varraso R, Siroux V, Dumas O, Nadif R, Pin I, et al. Domestic use of cleaning sprays and asthma activity in females. Eur Respir J 2012; 40(6):1381-9.19. Di Pasquale E, Morin D, Monteau R, Hilaire G. Serotonergic modulation of the respiratory rhythm generator at birth: an in vitro study in the rat. Neurosci Lett 1992; 143(1-2):91-5.20. McKeever TM, Lewis SA, Smith C, Hubbard R. The importance of prenatal exposures on the development of allergic disease: a birth cohort study using the West Midlands General Practice Database. Am J Respir Crit Care Med 2002; 166(6):827-32.21. Rusconi F, Galassi C, Forastiere F, Bellasio M, De Sario M, Ciccone G, et al. Maternal complications and procedures in pregnancy and at birth and wheezing phenotypes in children. Am J Respir Crit Care Med 2007; 175(1):16-21.22. Rachidi S, Awada S, Al-Hajje A, Bawab W, Zein S, Saleh N, et al. Risky substance exposure during pregnancy: a pilot study from Lebanese mothers. Drug Healthc Patient Saf 2013; 5:123-31.23. Hallit S, Salameh P. Exposure to toxics during pregnancy and childhood and asthma in children: A pilot study. J Epidemiol Global Health (2017), http://dx.doi.org/10.1016/j.jegh.2017.04.004 class="EndNoteBibliography">24. Society AT. Achieving healthy indoor air. Report of the ATS Workshop: Santa Fe, New Mexico, November 16-19, 1995. Am J Respir Crit Care Med 1997; 156 (3 pt 2):33-64.25. Asher M, Weiland S. The International Study of Asthma and Allergies in Childhood (ISAAC). ISAAC Steering Committee. Clin Exp Allergy 1998; 28:52-66.26. Hallit S, Bou Assi T, Hallit R, Salameh P. Allergic diseases, smoking, and environmental exposure among university students in Lebanon. J Asthma 2017:1-8.27. Hallit S, Raherison C, Waked M, Salameh P. Validation of asthma control questionnaire and risk factors affecting uncontrolled asthma among the Lebanese children's population. Respir Med 2017; 122:51-7.28. Hallit S, Raherison C, Abou Abdallah R, Hallit R. Salameh, P. Correlation of types of food and asthma diagnosis in childhood: A case-control study. J Asthma 2017;1-9.29. Faul F, Erdfelder E, Lang A-G, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007; 39(2):175-91.30. Porsbjerg C, von Linstow ML, Ulrik CS, Nepper-Christensen S, Backer V. Risk factors for onset of asthma: a 12-year prospective follow-up study. Chest 2006; 129(2):309-16.31. Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy 2008; 2:1-7.32. Richardson G, Eick S, Jones R. How is the indoor environment related to asthma?: literature review. J Adv Nurs 2005; 52(3):328-39.33. Neuman A, Hohmann C, Orsini N, Pershagen G, Eller E, Kjaer HF, et al. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts. Am J Respir Crit Care Med 2012; 186(10):1037-43.34. Simons E, To T, Moineddin R, Stieb D, Dell SD. Maternal second-hand smoke exposure in pregnancy is associated with childhood asthma development. J Allergy Clin Immunol Pract 2014; 2(2):201-7.35. Magnus MC, DeRoo LA, Haberg SE, Magnus P, Nafstad P, Nystad W, et al. Prospective study of maternal alcohol intake during pregnancy or lactation and risk of childhood asthma: the Norwegian Mother and Child Cohort Study. Alcohol Clin Exp Res 2014; 38(4):1002-11.36. Senthilselvan A, McDuffie HH, Dosman JA. Association of asthma with use of pesticides. Results of a cross-sectional survey of farmers. Am Rev Respir Dis 1992; 146(4):884-7.37. Whitemore RW, Immerman FW, Camann DE, Bond AE, Lewis RG, Schaum JL. Non-occupational exposures to pesticides for residents of two U.S. cities. Arch Environ Contam Toxicol 1994; 26(1):47-59.38. Vizcaya D, Mirabelli MC, Orriols R, Anto JM, Barreiro E, Burgos F, et al. Functional and biological characteristics of asthma in cleaning workers. Respir Med 2013; 107(5):673-83.