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ChiesiPro | Kongress | European Respiratory Society | Lung health starts early

Lung health starts early

The foetal lungs develop in five different stages before birth, so the timing and type of insults to this development will determine the impact. New data shows that antenatal insults may impact lung function over decades.

ChiesiPro | Kongress | European Respiratory Society | Lung health starts early

Antenatal factors affecting lung development 

Speaker: Allan Jenkinson, King’s college London

The foetal lungs develop in five different stages before birth, so the timing and type of insults to this development will determine the impact. Preterm births of viable infants occur in the last two development phases, when terminal sacs and alveoli are forming, and the lungs start producing surfactant, preparing the baby’s lungs for the first breath of air.

Preterm birth and long-term lung function

Following preterm birth, male infants have poorer neonatal outcomes due to relative lung immaturity compared to female infants. Allan Jenkinson presented data from the UKOS study (United Kingdom Oscillatory Study), following a cohort of preterm babies up to 19 years of age, concluding that even into adulthood, the males – still-had poorer lung function than the females1.

Fetal growth restriction

In twin pregnancies, it happens that one sibling takes up more space, leaving the other with less space to grow. This is called selective foetal growth restriction (sFGR) and is defined by a birthweight difference of 20% or more. Not only does has the smaller sibling less space to grow their lungs (reduced volume), but it also has an impact on lung diffusion capacity. Looking at sFGR in identical twins in their late teens, the reduction in static and dynamic lung volume and reduced lung diffusion was persistent, the smaller twin having significantly higher airway resistance2.

Antenatal insults – with you for life

Thanks to great advancements in neonatal care and survival of more preterm babies, it is now possible to study long term consequences of prematurity and associated risks. Among those identified risks are prematurity-associated wheeze3 and increased risk of COPD4. Other antenatal factors associated with poorer respiratory outcomes are chorioamnionitis5, malnutrition (specifically Vitamin A 6 deficiency) and maternal smoking7.

Given the high potential for increased susceptibility for respiratory morbidity later in life, it is important to continue to monitor the respiratory health of those born prematurely.

Referenser

  1. Harris C, Lunt A, Peacock J, Greenough A. Lung function at 16-19 years in males and females born very prematurely. Pediatr Pulmonol. 2023 Jul;58(7):2035-2041. doi: 10.1002/ppul.26428. Epub 2023 May 5. PMID: 37144861.
  2. Spekman JA, Israëls J, de Vreede I, Los M, Geelhoed MJJ, van Zwet EW, Haak MC, Roest AAW, van Klink JMM, Lopriore E, Groene SG. Reduced lung function during childhood in identical twins with discordant fetal growth: a cohort study. EClinicalMedicine. 2024 Apr 10;72:102600. doi: 10.1016/j.eclinm.2024.102600. PMID: 38633574; PMCID: PMC11019090.
  3. Crist AP, Hibbs AM. Prematurity-associated wheeze: current knowledge and opportunities for further investigation. Pediatr Res. 2023 Jul;94(1):74-81. doi: 10.1038/s41390-022-02404-1. Epub 2022 Dec 3. PMID: 36463364; PMCID: PMC10238677.
  4. Pulakka A, Risnes K, Metsälä J, Alenius S, Heikkilä K, Nilsen SM, Näsänen-Gilmore P, Haaramo P, Gissler M, Opdahl S, Kajantie E. Preterm birth and asthma and COPD in adulthood: a nationwide register study from two Nordic countries. Eur Respir J. 2023 Jun 22;61(6):2201763. doi: 10.1183/13993003.01763-2022. PMID: 36990472; PMCID: PMC10285109.
  5. Jeffreys E, Jenkinson A, Dassios T, Greenough A. Chorioamnionitis and respiratory outcomes in prematurely born children: a systematic review and meta analysis. J Perinat Med. 2024 Aug 28;52(8):797-803. doi: 10.1515/jpm-2024-0232. PMID: 39214862.
  6. Checkley W, West KP Jr, Wise RA, Baldwin MR, Wu L, LeClerq SC, Christian P, Katz J, Tielsch JM, Khatry S, Sommer A. Maternal vitamin A supplementation and lung function in offspring. N Engl J Med. 2010 May 13;362(19):1784-94. doi: 10.1056/NEJMoa0907441. Erratum in: N Engl J Med. 2010 Aug 19;363(8):798. Erratum in: N Engl J Med. 2010 Dec 30;363(27):2674. PMID: 20463338.
  7. Neuman Å, Hohmann C, Orsini N, Pershagen G, Eller E, Kjaer HF, Gehring U, Granell R, Henderson J, Heinrich J, Lau S, Nieuwenhuijsen M, Sunyer J, Tischer C, Torrent M, Wahn U, Wijga AH, Wickman M, Keil T, Bergström A; ENRIECO Consortium. Maternal smoking in pregnancy and asthma in preschool children: a pooled analysis of eight birth cohorts. Am J Respir Crit Care Med. 2012 Nov 15;186(10):1037-43. doi: 10.1164/rccm.201203-0501OC. Epub 2012 Sep 5. PMID: 22952297.

ID 13759-12.03.2025

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