Early-life exposures affect pediatric respiratory health, but healthy lifestyle behaviors during pregnancy can mitigate these risks.

A study explored the influence of different early-life exposure profiles on respiratory health. However, even exposure to high levels of risk factors can be offset by a healthy maternal lifestyle during pregnancy, reported a study at the 2023 ERS International Congress.

Previous studies have identified multiple environmental and lifestyle factors independently associated with respiratory health. In particular, the prenatal period and early childhood seem to be a critical window of exposure that may influence life-long risks for impaired lung function. Associations between many environmental factors and respiratory diseases were demonstrated in the literature. “Most of these studies focused on only one exposure while we know that all of these exposures could have a combined effect on health,” said Alicia Guillien, PhD. This was the rationale for comprehensively assessing the role of early-life environmental factors on pediatric respiratory health. Therefore, the researchers identified different profiles of exposure and associated the exposure profiles in the pre- and postnatal periods with respiratory health.

Data came from the HELIX cohort including 1,033 mother-child pairs exposed to eight different types of exposure (ie, water disinfection by-products, road traffic, climate, air pollutants, built environment, lifestyle, and road traffic noise). During pregnancy, there were 38 exposures; in childhood, there were 84 exposures. Respiratory outcomes were asthma (ever), wheezing (past 12 months), and rhinitis (past 12 months) assessed through questionnaires. In addition, respiratory outcomes were assessed through spirometry. Outcomes were associated with the different exposure profiles.

The children were from six European countries and had a mean age of 8.1±1.6 years. Two early-life exposure profiles were associated with lower levels of FEV₁, compared with the profile with globally low exposures. One exposure profile was characterized by globally low exposure to all factors except high exposure to UV and high temperature: This profile was also associated with a higher risk for ever-asthma (OR, 2.93; P<0.01). Another profile associated with adverse respiratory outcomes was high exposure to a built environment and road traffic, which was associated with lower levels of FEV₁.

A profile characterized by a high level of exposure to all risk factors, but a healthy lifestyle of the mother during pregnancy was associated with a decreased risk for wheezing and rhinitis (OR for wheezing, 0.38; P=0.01; OR for rhinitis, 0.64; P=0.08).

As Dr. Guillien pointed out, a strength of this study is that assessing the combined effects through exposure profiles is in accordance with the multifactorial etiology of asthma, allergy, and lung function. “This study highlights the need for studies with combined exposure to improve preventive strategies,” Dr Guillien concluded.

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