RESULTS
The cohort included 339 pregnant women/offspring enrolled during 2014-2016. Complete data were available for 307 (91%) dyads, including 44 preschoolers with API+ and 263 with API– at 30 months (Table 1). There were no significant differences in baseline characteristics between mothers of API+ and API– children (Table 2). Mothers of API+ toddlers had slightly higher body mass index (BMI), prior contraceptive use, and higher education level, but these did not achieve statistical significance.
At the time of birth, API+ and API– children were similar in terms of most sociodemographic and perinatal characteristics (Table 2); API+ children had slightly higher birth weight and heavier placenta than API– children, but again the differences did not reach statistical significance (Table 2).
During the bi-annual follow-up surveys (Table 3), API+ children had a significantly higher prevalence of symptoms associated with asthma than API– children, including cough after crying, laughing or agitation; as well as higher prevalence reported croup, pneumonia, and antibiotics for respiratory infections. API+ children were also younger at the first episode of bronchiolitis compared to API– children. The API+ group had a higher prevalence of reported physician diagnosis of asthma than the API– group; as well as more frequent oral corticosteroid (OCS) courses, inhaled corticosteroid (ICS) use, ED visits for wheezing, and hospitalizations for wheezing (Table 3). There were no consistent differences between groups in terms of GERD, AOM, paracetamol use, pets at home, or second-hand tobacco smoking (Table 3).
API+ children also had significantly higher adiponectin in cord blood and higher IL-10 at 30 months than API– children, but there were no other significant differences in adipokines or cytokines (Suppl Table 1). The proportion of detectable Phadiatop at 30 months was also similar between API groups (Suppl Table 1).
In order to test the diagnostic accuracy for the API with the physician-diagnosed asthma during the first 30 months, the stringent API+ had sensitivity=48.2% [95%CI: 46.5-50.0], specificity=92.4% [92.2-92.7], positive predicted value (PPV)=61.4% [59.2-63.5], negative predictive value (NPV)=87.78% [87.5-88.0], positive LR=6.4 [3.8-10.9], negative LR=0.56 [0.4-0.7], overall accuracy=83.6% [0.79-0.88], and adjusted odds for asthma=11.4 [5.5-23.4].
After adjusting for potential confounders, including history of bronchiolitis and pneumonia, the API+ was independently associated with physician-diagnosed asthma at age 30 months (adjOR= 5.7 [2.6-12.3]), Table 4.