Carme Puig

Exposición prenatal y posnatal al tabaco y síntomas respiratorios y alérgicos en los primeros años de vida

BACKGROUND AND OBJECTIVES To analyse the relationship between prenatal and postnatal tobacco exposure and the development of respiratory and allergy symptoms during the first 4 years of life. PATIENTS AND METHODS Prospective and multicentred cohort study that included the subjects belonging to AMICS (Asthma Multicentred Infant Cohort Study) located in Ashford (England), Barcelona and Minorca (Spain). We recruited 1611 children, followed from the pregnancy to the 4th year of life, whose parents annually answered a questionnaire on their tobacco consumption and their childrens respiratory and allergy health. In the Barcelona cohort (n=487) a tobacco exposure biomarker (cotinine) was analysed on several matrices. RESULTS Prenatal tobacco exposure is associated with a greater risk of hospitalisation due to respiratory infection, particularly in the second year of life, whereas postnatal tobacco exposure is associated more strongly with the presence of late wheezing presence and increases in the chance of being diagnosed with asthma at 4 years of age. The children prenatally and postnatally exposed had more persistent wheezing, persistent rhoncus, early cough, a higher number of upper respiratory infections per year and a greater number were diagnosed with asthma. The higher the levels of cotinine measured, the higher was the risk for wheezing. No relationship was seen between tobacco exposure and atopic symptoms. CONCLUSIONS Passive smoke exposure during pregnancy and childhood has very distinct clinical respiratory effects in children. Therefore, smoking cessation of childbearing age women must be a priority of preventive medicine.

Efectos neonatales del hábito tabáquico durante el embarazo y determinantes sociodemográficos en Barcelona

Fundamento El consumo de tabaco durante el embarazo representa un riesgo para la salud delfeto y posteriormente para la del nino y el adulto, con una mayor probabilidad de presentar problemasrespiratorios. El objetivo de este trabajo fue conocer la posible correlacion entre el consumode tabaco durante el embarazo y las caracteristicas neonatales y los determinantes sociodemograficosdel habito tabaquico de las mujeres durante la gestacion. Sujetos y metodo Los sujetos del estudio fueron 419 madres y sus recien nacidos, participantesen un estudio de cohortes en Barcelona. Los datos sobre el habito tabaquico se recogieron empleandoun cuestionario estructurado. Para valorar estos datos, y como biomarcador de exposicional tabaco, se determino la concentracion de cotinina (principal metabolito de la nicotina)en sangre del cordon umbilical mediante radioinmunoanalisis. Resultados Un 29% de todas las madres entrevistadas declararon el consumo diario de tabacodurante el ultimo trimestre del embarazo, a la vez que el biomarcador demostro que el 34% deellas fumaban al final de la gestacion. El habito tabaquico durante el embarazo, ya fuera medidocon el cuestionario o con el biomarcador, se asocio significativamente de forma negativacon las medidas somatometricas (peso, talla y perimetro craneal) del recien nacido. En cambio,no se asocio con la clase social o la edad, si bien fue menor en las primiparas. Conclusiones A diferencia de otros paises europeos, en Espana existe un consumo de tabacomuy extendido durante el embarazo, independientemente de la clase social y la edad de lasmadres. La reduccion de la exposicion al tabaco y de su consumo constituye un elemento claveen la prevencion de la morbilidad y la mortalidad asociadas, entre otras, a la reduccion de lasmedidas somatometricas del recien nacido.

Domestic aeroallergen levels in Barcelona and Menorca (Spain)

Exposure to common indoor allergens is known to be associated with sensitization and triggers of asthma. Levels of allergens have been barely described in Mediterranean countries. This study reports domestic allergen levels among the general population of two regions of Spain. Dust samples were collected from living rooms and mattresses in homes of infants in Barcelona (n = 366) and Menorca (n = 475) and assayed for house dust mite (Der p 1) and cat allergen (Fel d 1) concentrations by enzyme‐linked immunoabsorbent assay (ELISA). Geometric mean values (95% CI) of Der p 1 were 0.77 µg/g (0.65, 0.92) in living rooms and 0.68 (0.56, 0.82) in childrens mattresses in Barcelona, and 9.06 (7.93–10.34) and 3.12 (2.71–3.59) in Menorca, respectively. Fel d 1 levels were 0.37 µg/g (0.31, 0.45) and 0.14 (0.12, 0.18) in Barcelona, and 0.42 (0.35, 0.50) and 0.20 (0.18, 0.24) in Menorca. Home characteristics were not consistently related to levels of aeroallergens in either location. Differences in Der p 1 levels in the two locations indicate that levels cannot be extrapolated from one part of a country to another with any certainty. Additionally, allergen reduction measures related to indoor sources must be specific to each location.

Assessment of prenatal exposure to tobacco smoke by cotinine in cord blood for the evaluation of smoking control policies in Spain

BackgroundOver the last few years a decreasing trend in smoking has occurred not only in the general population but also during pregnancy. Several countries have implemented laws requiring all enclosed workplace and public places to be free of second hand smoke (SHS). In Spain, legislation to reduce SHS was implemented in 2005. The present study examines the possible effect of this legislation on prenatal SHS exposure.MethodsMothers and newborns were recruited from 3 independent studies performed in Hospital del Mar (Barcelona) and approved by the local Ethics Committee: 415 participated in a study in 1996-1998, 283 in 2002-2004 and 207 in 2008. A standard questionnaire, including neonatal and sociodemographic variables,tobacco use and exposure during pregnancy, was completed at delivery for all the participants in the three study groups. Fetal exposure to tobacco was studied by measuring cotinine in cord blood by radioimmunoassay (RIA).Results32.8% of the pregnant women reported to smoke during pregnancy in 1996-1998, 25.9% in 2002-2004 and 34.1% in 2008. In the most recent group, the percentage of no prenatal SHS exposure (cord blood cotinine 0.2-1 ng/mL) showed an increase compared to the previous groups while the percentages of both: low (1.1-14 ng/mL) and very high (> 100 ng/mL) prenatal SHS exposure showed a decrease.DiscussionThe results of the three study periods (1996-2008) demonstrated a significant increase in the percentage of newborns free from SHS exposure and a decrease in the percentage of newborns exposed to SHS during pregnancy, especially at the very high levels of exposure. A significant maternal smoking habit was noted in this geographical area with particular emphasis on immigrant pregnant smoking women.ConclusionsOur study indicates that there is a significant maternal smoking habit in this geographical area. Our recommendation is that campaigns against smoking should be directed more specifically towards pregnant women with particular emphasis on non-native pregnant smokers due to the highest prevalence of tobacco consumption in the immigrant women.

Neonatal nicotine withdrawal syndrome

Editor,—We have been assessing the recent in utero exposure to tobacco smoke in newborns from the Barcelona cohort of the AMICS study (Asthma Multicentre Infants Cohort Study).1The nursing personnel reported observational symptoms suggesting a possible neonatal nicotine withdrawal syndrome in some of the newborns from smoking mothers. The published data about this syndrome are scant and include conflicting positions. Whereas some papers admit a neonatal nicotine withdrawal syndrome,2 others reject it.3Although some investigators have shown neuroanatomic disorders in fetus and newborns exposed to smoke during pregnancy,4 5 we have not found any study published about the clinical consequences …

Relationship between lower respiratory tract infections in the first year of life and the development of asthma and wheezing in children

Introduction: There is limited knowledge on the relationship between lower respiratory tract infections (LRTI) and asthma and wheezing during infancy, as there are few studies with prospective design, birth cohort and in non selected population. The objectives of the present study were to determine the prevalence of asthma and recurrent wheezing in childhood and to analyse the relationship between LTRI during the first year of life and the development of asthma and/or wheezing in childhood. Patients and Methods: Prospective birth cohort study conducted in the Hospital del Mar (Barcelona, Spain). We recruited 487 children, followed up from the pregnancy to the 6th year of life. As outcomes we studied: the presence of asthma and wheezing. As independent variables we studied: LTRI occurring during the first year of life, and some covariables including, among others: prematurity, birth weight, maternal history of asthma and atopy, breastfeeding, prenatal exposure to tobacco. Results: The asthma prevalence at 6 years of age was 9.3%. The variables associated with the development of asthma were LTRI, prematurity, atopic mother and formula breastfeeding. LTRI during the first year of life were also related with early recurrent wheezing and persistent wheezing. Conclusions: Our results confirm that LTRI during the first year of life are related to the diagnosis of asthma and with the clinical phenotypes of early wheezing and persistent wheezing. These results are in accordance with the concept that LTRI occurring during a critical period of development, as are the first years of life, have an important role in the later development of asthma and recurrent wheezing.

Perinatal exposure to tobacco and respiratory and allergy symptoms in first years of life

Abstract Background and objectives To analyse the relationship between prenatal and postnatal tobacco exposure and the development of respiratory and allergy symptoms during the first 4 years of life. Patients and methods Prospective and multicentred cohort study that included the subjects belonging to AMICS (Asthma Multicentred Infant Cohort Study) located in Ashford (England), Barcelona and Minorca (Spain). We recruited 1611 children, followed from the pregnancy to the 4th year of life, whose parents annually answered a questionnaire on their tobacco consumption and their childrens respiratory and allergy health. In the Barcelona cohort (n=487) a tobacco exposure biomarker (cotinine) was analysed on several matrices. Results Prenatal tobacco exposure is associated with a greater risk of hospitalisation due to respiratory infection, particularly in the second year of life, whereas postnatal tobacco exposure is associated more strongly with the presence of late wheezing presence and increases in the chance of being diagnosed with asthma at 4 years of age. The children prenatally and postnatally exposed had more persistent wheezing, persistent rhoncus, early cough, a higher number of upper respiratory infections per year and a greater number were diagnosed with asthma. The higher the levels of cotinine measured, the higher was the risk for wheezing. No relationship was seen between tobacco exposure and atopic symptoms. Conclusions Passive smoke exposure during pregnancy and childhood has very distinct clinical respiratory effects in children. Therefore, smoking cessation of childbearing age women must be a priority of preventive medicine.

Relación entre las infecciones respiratorias de vías bajas durante el primer año de vida y el desarrollo de asma y sibilancias en niños

INTRODUCTION There is limited knowledge on the relationship between lower respiratory tract infections (LRTI) and asthma and wheezing during infancy, as there are few studies with prospective design, birth cohort and in non selected population. The objectives of the present study were to determine the prevalence of asthma and recurrent wheezing in childhood and to analyse the relationship between LTRI during the first year of life and the development of asthma and/or wheezing in childhood. PATIENTS AND METHODS Prospective birth cohort study conducted in the Hospital del Mar (Barcelona). We recruited 487 children, followed up from the pregnancy to the 6th year of life. As outcomes we studied: the presence of asthma and wheezing. As independent variables we studied: LTRI occurring during the first year of life, and some covariables including, among others: prematurity, birth weight, maternal history of asthma and atopy, breastfeeding, prenatal exposure to tobacco. RESULTS The asthma prevalence at 6 year of age was 9.3%. The variables associated with the development of asthma were LTRI, prematurity, atopic mother and formula breastfeeding. LTRI during the first year of life were also related with early recurrent wheezing and persistent wheezing. CONCLUSIONS Our results confirm that LTRI during the first year of life are related to the diagnosis of asthma and with the clinical phenotypes of early wheezing and persistent wheezing. These results are in accordance with the concept that LTRI occurring during a critical period of development, as are the first years of life, have an important role on in the later development of asthma and recurrent wheezing.

Prenatal and Postnatal Exposure to DDT by Breast Milk Analysis in Canary Islands

Introduction The use of p,p′-dichlorodiphenyltrichloroethane (DDT) has been banned since the late 1970s due to its toxicity. However, its long half-life makes it persistent in the environment and, consequently, almost everyone has DDT residues in the body. Human milk constitutes an ideal non-conventional matrix to investigate environmental chronic exposure to organochlorine compounds (OCs) residues. The study aimed to identify potential population risk factors of exposure to DDT due to the proximity to countries where it is still used. Methods Seventy-two consecutive lactating women were prospectively included in Tenerife, Canary Islands (Spain). A validated questionnaire was used to obtain socioeconomic, demographics data, and daily habits during pregnancy. DDT levels in breast milk were measured by gas chromatography with-electron capture detector (GC-ECD). Anthropometrics measurements in newborns were obtained. Results Thirty-four out of 72 (47.2%) of the analysed milk samples presented detectable levels of DDT (mean: 0.92 ng/g), ranging between 0.08 to 16.96 ng/g. The socio-demographic variables did not significantly differ between detectable DDT and non-detectable DDT groups. We found positive association between DDT levels and vegetables (OR (95%CI): 1.23 (1.01–1.50)) and poultry meat (OR (95%CI): 2.05 (1.16–3.60)) consumption, and also between the presence of DDT in breast milk and gestational age (OR (95%CI): 0.59 (0.40–0.90)). Conclusions DDT is present in breast milk of women at the time of delivery. Residual levels and the spread from countries still using DDT explain DDT detection from vegetables and from animal origin food. The presence of this compound in breast milk represents a pre- and postnatal exposure hazard for foetuses and infants due to chronic bioaccumulation and poor elimination, with possible deleterious effects on health. This data should be used to raise awareness of the risks of OCs exposure and to help establish health policies in order to avoid its use worldwide and thus, to prevent its propagation.

Fetal exposure to cocaine and infections during the first 18 months of life in infants from a Mediterranean city.

Aim: The incidence of infections during the first 18 months of life was investigated in 36 infants prenatally exposed to cocaine and in 72 non‐exposed controls from Barcelona, Spain.