Association between Fetal Alcohol Spectrum Disorders and Asthma Diagnosis in Children Open Access

Abstract

BACKGROUND: Prenatal alcohol exposure leads to a myriad of health outcomes that are known as Fetal Alcohol Spectrum Disorders (FASDs). In animal models, in utero ethanol exposure has been shown to be associated with diminished lung size and function as well as reduced immune strength. The current study attempts to provide further understanding of the relationship between prenatal alcohol exposure and lung development by hypothesizing that there is an association between having been diagnosed with FASD and having been diagnosed asthma.

METHODS: Information on asthma diagnoses in 619 children between the ages of 1 and 15 with a diagnosis of FASD and who attend the Emory Neurodevelopmental Exposure Clinic (ENEC) was compared with similar information collected about 708 children subjects who attend ENEC, but who do not have a diagnosis FASD and 23,889 children for whom information on asthma diagnoses was obtained through the National Health and Nutrition Examination Survey (NHANES). Logistic regression models were run to examine the association between FASD diagnosis and the cumulative incidence of asthma.

RESULTS: A similar proportion of children with FASD and those attending ENEC for other reasons had been diagnosed with asthma, even after adjusting for potential confounding factors (ORadj = 0.96, 95% CI = 0.71, 1.29). In contrast, compared to participants in NHANES, children with FASD were 30% more likely to have been diagnosed with asthma (ORadj= 1.29; 95% CI 1.03 to 1.61).

CONCLUSIONS: Depending on the comparison group, children with FASD were more likely than expected to have been diagnosed with asthma. However, there is significant concern about selection bias, residual confounding and differential misclassification, and these biases are likely to affect the two comparison groups differently. Therefore, there is insufficient evidence to support an association between FASD-exposure and asthma diagnosis. Future, prospective study that properly controls for confounding by several factors is needed.

Table of Contents

Table of Contents

INTRODUCTION 1

BACKGROUND AND LITERATURE REVIEW 2

Fetal Alcohol Spectrum Disorders 2

In Utero Alcohol Exposure and Fetal Development 4

Childhood Asthma 8

Summary 10

METHODS 11

Study Question 11

Hypothesis 11

Study Design 11

Participants 12

Variable and Data Measures 14

Analytic Methods 17

RESULTS 19

Univariate Analyses of Covariates 19

Bivariate Analyses 20

Logistic Regression 20

DISCUSSION 22

Interpretation of Results 22

Strengths and Limitations 22

Strengths 22

Limitations & Sensitivity Analyses 24

FUTURE DIRECTIONS AND CONCLUSIONS 33

Suggestions for Future Research 33

Conclusions 34

REFERENCES 35

TABLES 38

FIGURES 41

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	Fetal Alcohol Spectrum Disorders In Utero Alcohol Exposure Fetal Alcohol Syndrome Childhood Asthma Fetal Alcohol Exposure
Committee Chair / Thesis Advisor	Drews-Botsch, Carolyn D, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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