Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns

Secondary Analysis of a Randomized Trial

Trial of Late Surfactant (TOLSURF) Study Group

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design: We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results: Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Conclusions: Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration: ClinicalTrials.gov: NCT01022580.

Original languageEnglish (US)
Pages (from-to)201-208.e3
JournalJournal of Pediatrics
Volume198
DOIs
StatePublished - Jul 1 2018

Fingerprint

Respiratory Sounds
Gestational Age
Mothers
Newborn Infant
Bronchopulmonary Dysplasia
Insurance Coverage
Human Milk
Diet
Biological Factors
Birth Weight
Caregivers
Survivors
Asthma
Parents
Parturition
Pregnancy

Keywords

  • asthma
  • prematurity
  • socioeconomic factors

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

Cite this

Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns : Secondary Analysis of a Randomized Trial. / Trial of Late Surfactant (TOLSURF) Study Group.

In: Journal of Pediatrics, Vol. 198, 01.07.2018, p. 201-208.e3.

Research output: Contribution to journalArticle

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title = "Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial",
abstract = "Objective: To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design: We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results: Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57{\%} male, 34{\%} maternal black race), 189 (45{\%}) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95{\%} CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69{\%} of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8{\%}, 12{\%}, and 10{\%}, respectively. Conclusions: Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration: ClinicalTrials.gov: NCT01022580.",
keywords = "asthma, prematurity, socioeconomic factors",
author = "{Trial of Late Surfactant (TOLSURF) Study Group} and Wai, {Katherine C.} and Hibbs, {Anna M.} and Steurer, {Martina A.} and Black, {Dennis M.} and Asselin, {Jeanette M.} and Eichenwald, {Eric C.} and Ballard, {Philip L.} and Ballard, {Roberta A.} and Keller, {Roberta L.} and Strong, {Suzanne Hamilton} and Jill Immamura-Ching and Margaret Orfanos-Villalobos and Cassandra Williams and Durand, {David J.} and Merrill, {Jeffrey D.} and Dolia Horton and Loretta Pacello and April Willard and Truog, {William E.} and Cheryl Gauldin and Anne Holmes and Patrice Johnson and Kerrie Meinert and Reynolds, {Anne Marie} and Janine Lucie and Patrick Conway and Michael Sacilowski and Michael Leadersdorff and Pam Orbank and Karen Wynn and Steinhorn, {Robin H.} and Maria deUngria and Khan, {Janine Yasmin} and Karin Hamann and Molly Schau and Brad Hopkins and James Jenson and Carmen Garcia and Aruna Parekh and Jila Shariff and Rose McGovern and Jeff Adelman and Adrienne Combs and Mary Tjersland and Mayock, {Dennis E.} and Elizabeth Howland and Susan Walker and Jim Longoria and Bendel, {Catherine M} and Georgieff, {Michael K}",
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T2 - Secondary Analysis of a Randomized Trial

AU - Trial of Late Surfactant (TOLSURF) Study Group

AU - Wai, Katherine C.

AU - Hibbs, Anna M.

AU - Steurer, Martina A.

AU - Black, Dennis M.

AU - Asselin, Jeanette M.

AU - Eichenwald, Eric C.

AU - Ballard, Philip L.

AU - Ballard, Roberta A.

AU - Keller, Roberta L.

AU - Strong, Suzanne Hamilton

AU - Immamura-Ching, Jill

AU - Orfanos-Villalobos, Margaret

AU - Williams, Cassandra

AU - Durand, David J.

AU - Merrill, Jeffrey D.

AU - Horton, Dolia

AU - Pacello, Loretta

AU - Willard, April

AU - Truog, William E.

AU - Gauldin, Cheryl

AU - Holmes, Anne

AU - Johnson, Patrice

AU - Meinert, Kerrie

AU - Reynolds, Anne Marie

AU - Lucie, Janine

AU - Conway, Patrick

AU - Sacilowski, Michael

AU - Leadersdorff, Michael

AU - Orbank, Pam

AU - Wynn, Karen

AU - Steinhorn, Robin H.

AU - deUngria, Maria

AU - Khan, Janine Yasmin

AU - Hamann, Karin

AU - Schau, Molly

AU - Hopkins, Brad

AU - Jenson, James

AU - Garcia, Carmen

AU - Parekh, Aruna

AU - Shariff, Jila

AU - McGovern, Rose

AU - Adelman, Jeff

AU - Combs, Adrienne

AU - Tjersland, Mary

AU - Mayock, Dennis E.

AU - Howland, Elizabeth

AU - Walker, Susan

AU - Longoria, Jim

AU - Bendel, Catherine M

AU - Georgieff, Michael K

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objective: To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design: We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results: Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Conclusions: Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration: ClinicalTrials.gov: NCT01022580.

AB - Objective: To evaluate the relationship between maternal self-reported race/ethnicity and persistent wheezing illness in former high-risk, extremely low gestational age newborns, and to quantify the contribution of socioeconomic, environmental, and biological factors on this relationship. Study design: We assessed persistent wheezing illness determined at 18-24 months corrected (for prematurity) age in survivors of a randomized trial. Parents/caregivers were surveyed for wheeze and inhaled asthma medication use quarterly to 12 months, and at 18 and 24 months. We used multivariable analysis to evaluate the relationship of maternal race to persistent wheezing illness, and identified mediators for this relationship via formal mediation analysis. Results: Of 420 infants (25.2 ± 1.2 weeks of gestation and 714 ± 166 g at birth, 57% male, 34% maternal black race), 189 (45%) had persistent wheezing illness. After adjustment for gestational age, birth weight, and sex, infants of black mothers had increased odds of persistent wheeze compared with infants of nonblack mothers (OR = 2.9, 95% CI 1.9, 4.5). Only bronchopulmonary dysplasia, breast milk diet, and public insurance status were identified as mediators. In this model, the direct effect of race accounted for 69% of the relationship between maternal race and persistent wheeze, whereas breast milk diet, public insurance status, and bronchopulmonary dysplasia accounted for 8%, 12%, and 10%, respectively. Conclusions: Among former high-risk extremely low gestational age newborns, infants of black mothers have increased odds of developing persistent wheeze. A substantial proportion of this effect is directly accounted for by race, which may reflect unmeasured environmental influences, and acquired and innate biological differences. Trial registration: ClinicalTrials.gov: NCT01022580.

KW - asthma

KW - prematurity

KW - socioeconomic factors

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DO - 10.1016/j.jpeds.2018.02.032

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SP - 201-208.e3

JO - Journal of Pediatrics

JF - Journal of Pediatrics

SN - 0022-3476

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