title: Perinatal characteristics and obstetric complications as risk factors for asthma, allergy and eczema at the age of 6 years.
abstract: BACKGROUND
  Considerable effort has been put into identifying early determinants for atopic disorders. Many studies have evaluated the role of fetal development and obstetric complications. However, the results are not unequivocal.
  
  
  OBJECTIVE
  To assess the relationship between perinatal characteristics and obstetric complications, and the presence of reported current asthma, allergy and eczema at the age of 6 years in the framework of a previously conducted study.
  
  
  METHODS
  Seven hundred families in the Netherlands with index children born in 1988-1990 were retrospectively selected. Data were extracted from the Municipal Health Service's records of health examinations of these children and their siblings. These examinations were carried out at the age of 6 years. The records contained data on reported atopic disorders and perinatal characteristics.
  
  
  RESULTS
  Gestational age was inversely related to the risk of asthma (P for trend: 0.03). Children with low birth weight tended to have a lower risk of any allergy, albeit not significant (P=0.07). However, no link was found between neonatal head circumference and atopic disorders. The ratio of neonatal head circumference to birth weight was positively associated with the risk of atopic disorders, especially with the risk of asthma (odds ratio (OR)=1.87; 95% confidence interval (CI(95%))=[1.11, 3.15]). Vacuum extraction was a risk factor for allergy (OR=1.84, CI(95%)=[1.03, 3.28]), but not for asthma. Induced labour was positively associated with the risk of inhalant allergy (OR=2.22, CI(95%)=[1.09, 4.51]) and, to a lesser extent, asthma (OR=1.72, CI(95%)=[0.95, 3.10]). For caesarean section and forcipal extraction there were no such relationships.
  
  
  CONCLUSIONS
  Prematurity is a risk factor for asthma reported at 6 years. A high ratio of head circumference to birth weight is a risk factor for any atopic disorder. Vacuum extraction was associated with a higher risk of allergy, and induced labour is a risk factor for inhalant allergy. All results should be viewed with the possibility of residual confounding.
authors.affiliation: The Netherlands Department of General Practice, Erasmus MC-University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. r.bernsen@erasmusmc.nl
authors.forename: R M D
authors.initials: RM
authors.lastname: Bernsen
authors.forename: J C
authors.initials: JC
authors.lastname: de Jongste
authors.forename: B W
authors.initials: BW
authors.lastname: Koes
authors.forename: H A
authors.initials: HA
authors.lastname: Aardoom
authors.forename: J C
authors.initials: JC
authors.lastname: van der Wouden
mesh_terms: D001249:Asthma / Q000196:embryology / Q000209:etiology*; D001724:Birth Weight; D002508:Cephalometry; D002648:Child; D015986:Confounding Factors, Epidemiologic; D004485:Eczema / Q000209:etiology / Q000276:immunology*; D005260:Female; D047109:Fetal Development / Q000276:immunology*; D005865:Gestational Age; D006801:Humans; D006967:Hypersensitivity / Q000196:embryology / Q000209:etiology*; D007231:Infant, Newborn; D007234:Infant, Premature; D007751:Labor, Induced; D016014:Linear Models; D008297:Male; D009426:Netherlands; D007744:Obstetric Labor Complications / Q000276:immunology*; D011247:Pregnancy; D012307:Risk Factors