Review
Birth Weight and Subsequent Risk of Asthma: A Systematic Review and Meta-Analysis

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Background

Previous studies suggest that birth weight is related to later risk of asthma. However, few meta-analyses have investigated these associations. Therefore, we performed a meta-analysis with different classifications to further validate the relationship between birth weight and asthma.

Methods

PubMed (1990-2013), ScienceDirect (1990-2013), EMBASE(1990-2013),EBSCO (1990-2013) and Springer (1990-2013) were searched for articles. The following MeSH terms were used: “birth weight”, “fetal growth retardation”, “intrauterine growth restriction”, “asthma”, “wheezing”.

Results

We included 18 studies with data from a total of over 90,000 children and adults. (1) Low birth weight (<2,500 g) as compared with BW > 2,500 g and BW = 2500–4000 g was associated with increased risk of asthma (Children: OR, 1.28; 95% CI, 1.09–1.50, P < 0.05; OR, 1.34; 95% CI, 1.13–1.60, P < 0.05, Adults: OR, 1.25; 95% CI, 1.12–1.39, P < 0.05; OR, 1.25; 95% CI, 1.12–1.40, P < 0.05). (2) High birth weight (>4,000 g) was not associated with the risk of asthma when BW < 4,000 g and BW = 2500–4000 g were used as the reference.

Conclusions

These results suggest that low birth weight (<2,500 g) is associated with increased risk of asthma both in children and adults and may serve as a mediator between prenatal influences and later disease risk; but high birth weight (>4,000 g) was not associated with increased risk of asthma.

Introduction

Asthma is a major cause of morbidity and mortality among children, and the prevalence of asthma has been steadily rising over the past two decades. [1] Around the world, over 300 million people suffer from this disease. [2] Although many treatments for asthma are available, there is no current cure and the morbidity of asthma remains high. [3] The lack of curative options seems to be largely due to the unknown aetiology of asthma. [4] In epidemiological studies it is has been suggested that factors such as air pollution, environmental tobacco smoke, smaller family size, and decreased exposure to infectious agents may be attributed to asthma, but it has not yet been fully explained. [5], [6], [7] One possible hypothesis is that asthma is related to intrauterine and postnatal environments. [7] Intrauterine development may ‘programme’ foetal anatomy, physiology, and metabolism and thus may affect the risk of diseases including asthma in later life. [8], [9], [10], [11], [12]

In recent years, evidence supporting the effect of intrauterine development on the risk of disease later in life has been accumulated. [13] Birth weight (BW) is frequently used as an indicator of the conditions experienced in utero. [14], [15] At present, studies on the effect of birth weight on asthma have no entirely consistent results. Many authors have found, on either side of the ‘J’ and ‘U’, shaped relationships between birth weight and the prevalence of asthma which are seen for the low (<2,500 g) and high (>4,000 g) birth weights. [8], [15], [16], [17], [18], [19], [20], [21], [22], [23], [25] However, some researchers claimed that BW had little effect on asthma. [10], [24], [26], [27], [28] Therefore, we present here a systematic review and meta-analysis to estimate the direction and magnitude of the association between birth weight and asthma among children and adults.

Section snippets

Methods

We carried out a systematic review and meta-analyses according to the Cochrane methodology and the recommendations for reporting proposed by the Meta-analysis of Observational Studies in Epidemiology group. [29]

Overview of studies included in the systematic review

Overall, 540 non-duplicated titles and abstracts were identified, 523 of which were excluded based on the reasons listed in Fig. 1. The score of one study [21] was smaller than six studies which were considered low in methodological quality (Appendix 1). Sixteen articles reporting 17 original studies [8], [16], [17], [18], [19], [20], [21], [22], [10], [23], [24], [25], [26], [27], [28], [29] (one article [22] described two studies) were included in the systematic review, including 15 cohort [8]

Discussion

The present comprehensive systematic review and meta-analyses found that consistently reported low BW (<2500 g) was associated with increased risk of asthma when BW>2,500 g and BW = 2500–4000 g were used as the reference for both children and adults. By contrast, there is no association between high BW (>4000 g) and asthma when compared with BW>2,500 g and BW = 2500–4000 g for both children and adults. Analysis based on growth and developmental stage also revealed that low BW increased the risk of asthma

Acknowledgements

All authors declared no conflicts of interest. The authors’ contributions were as follows. M.M. contributed to development of the study hypothesis, reviewed the literature, collected the data, conducted the statistical analysis, provided interpretation of results, drafted and edited the manuscripts. The main investigator: S.Y., G.L.L, S.F.W., J.S., B.M.J. All authors contributed to the discussion and interpretation of the data and to the writing of the manuscript. We are sincerely grateful to

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