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Randomized Controlled Trial
. 2018 Jul:198:201-208.e3.
doi: 10.1016/j.jpeds.2018.02.032. Epub 2018 Apr 4.

Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial

Katherine C Wai  1 , Anna M Hibbs  2 , Martina A Steurer  3 , Dennis M Black  4 , Jeanette M Asselin  5 , Eric C Eichenwald  6 , Philip L Ballard  7 , Roberta A Ballard  7 , Roberta L Keller  8 ; Trial of Late Surfactant (TOLSURF) Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Maternal Black Race and Persistent Wheezing Illness in Former Extremely Low Gestational Age Newborns: Secondary Analysis of a Randomized Trial

Katherine C Wai et al. J Pediatr. 2018 Jul.

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Relationships of confounders and mediators for the association of maternal race and persistent wheeze. 1A, Diagram representing complex interactions between potential confounders and possible mediators of the relationship between maternal race and persistent wheeze. 1B, Mediation framework for statistical conditions that must be satisfied to be considered a mediator. In formal mediation analysis: (1) represents the direct effect of maternal race on persistent wheezing illness (2 and 3) represents the indirect effect of maternal race through a mediator.
Figure 2
Figure 2
online. Patient flow diagram. Deaths and study withdrawals prior to neonatal discharge detailed in Ballard et al, 2016 .
See this image and copyright information in PMC

Comment in

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