title: Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy.
abstract: OBJECTIVE
  Our goal was to determine whether maternal asthma and maternal smoking during pregnancy are associated with the incidence and severity of clinically significant bronchiolitis in term, otherwise healthy infants without the confounding factors of small lung size or underlying cardiac or pulmonary disease.
  
  
  METHODS
  We conducted a population-based retrospective cohort study of term, non-low birth weight infants enrolled in the Tennessee Medicaid Program from 1995 to 2003. The cohort of infants was followed through the first year of life to determine the incidence and severity of bronchiolitis as determined by health care visits and prolonged hospitalization.
  
  
  RESULTS
  A total of 101,245 infants were included. Overall, 20% of infants had > or = 1 health care visit for bronchiolitis. Compared with infants with neither factor, the risk of bronchiolitis was increased in infants with maternal smoking only, maternal asthma only, or both. Infants with maternal asthma only or with both maternal smoking and asthma had the highest risks for emergency department visits and hospitalizations. Infants with a mother with asthma had the highest risk of a hospitalization > 3 days, followed by infants with both maternal asthma and smoking, and maternal smoking only.
  
  
  CONCLUSIONS
  Maternal asthma and maternal smoking during pregnancy are independently associated with the development of bronchiolitis in term, non-low birth weight infants without preexisting cardiac or pulmonary disease. The risk of bronchiolitis among infants with mothers who both have asthma and smoke during pregnancy is approximately 50% greater than that of infants with neither risk factor. Efforts to decrease the illness associated with these 2 risk factors will lead to decreased morbidity from bronchiolitis, the leading cause of hospitalization for severe lower respiratory tract infections during infancy.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA. tina.hartert@vanderbilt.edu
authors.forename: Kecia N
authors.initials: KN
authors.lastname: Carroll
authors.forename: Tebeb
authors.initials: T
authors.lastname: Gebretsadik
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
authors.forename: William D
authors.initials: WD
authors.lastname: Dupont
authors.forename: Edward F
authors.initials: EF
authors.lastname: Mitchel
authors.forename: Pingsheng
authors.initials: P
authors.lastname: Wu
authors.forename: Rachel
authors.initials: R
authors.lastname: Enriquez
authors.forename: Tina V
authors.initials: TV
authors.lastname: Hartert
mesh_terms: D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology; D001988:Bronchiolitis / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008425:Maternal Behavior; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*