Risk and protective factors for childhood asthma and wheezing disorders in the first 1,000 days of life: a systematic review of meta-analyses

  • Karoliny dos Santos Postgraduate Program in Health Sciences, University of Southern Santa Catarina (UNISUL), Palhoça, Santa Catarina
  • Nicolas Isoppo University Hospital Professor Polydoro Ernani de São Thiago, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina
Keywords: asthma, child, protective factors, risk factors


Introduction: The first 1,000 days of life of a child, the period from conception to the end of the second year, is a critical stage for the development of respiratory and immune systems. Many factors occurred in this period may be associated to risk of asthma in childhood. Objective: To condense evidence about risk and protective factors for childhood asthma and/or wheezing disorders occurred in the first 1,000 days of life. Methods: MEDLINE, CINAHL, and SCOPUS databases were searched. Systematic reviews with meta-analysis, or metaanalysis of observational and interventional studies on risk or protective factors for childhood asthma/wheeze, emphasizing the period between the conception and two first years of age, were included. The quality of studies was evaluated by the Assess Systematic Reviews tool. The pooled odds ratio, 95% confidence interval and homogeneity among studies were analyzed. Results: Thirty-five studies met the inclusion criteria, with good methodological quality. Parental history of asthma; maternal weight gain during pregnancy, urogenital infections, psychological stress, and smoking; caesarean section; preterm birth; birth weight; and neonatal hyperbilirrubinemia are risk factors for asthma/wheeze in childhood. Intake of fish oil, zinc and vitamin E during pregnancy appear as protective factors, as well as breastfeeding, fish intake in the first two years, and BCG vaccination. Conclusion: Several modifiable behaviors or exposures can be  associated with asthma and wheezing in childhood. The knowledge about these behaviors and exposures can improve early prevention strategies with a view to ensuring a beneficial impact on respiratory health.


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