The Association of Prenatal C-Reactive Protein Levels With Childhood Asthma and Atopy

Prenatal maternal health has been linked to allergic disease in children. The current study sought to describe the association of maternal systemic inflammation, measured by plasma C-reactive protein (CRP), with childhood allergic rhinitis, asthma, and eczema.

The authors performed an ancillary analysis of the vitamin D Antenatal Asthma Reduction Trial, a controlled trial that randomized 881 pregnant women to 4400 IU or 400 IU of daily vitamin D. Inclusion criteria required a personal history of asthma or atopy in the pregnant woman or child’s biologic father, and that participants were nonsmoking at the time of enrollment. A total of 522 maternal-offspring pairs with available inflammatory biomarkers during pregnancy and complete clinical outcome data at 6 years were included in the current analysis.

Prenatal plasma CRP was obtained between weeks 10 and 18 of gestation and between weeks 32 and 38 of gestation. Clinical outcomes in offspring were based on parental report of diagnosis of allergic rhinitis, asthma, or eczema by a health care provider by 6 years. Logistic regression models were used to determine associations between childhood outcomes and log-transformed continuous CRP in early and late pregnancy, and biomarker increase versus decrease during pregnancy.

Elevated early and late prenatal CRP and an increase in CRP in pregnancy were associated with asthma diagnosis by 6 years. There was a significant association between increased CRP from early to late pregnancy and eczema in offspring only at age 6 years. There was no association between prenatal CRP and allergic rhinitis. However, the association between prenatal CRP and childhood asthma was strengthened among pediatric patients with aeroallergen sensitizations and decreased in those without aeroallergen sensitizations.

Elevated prenatal CRP and an increase in CRP during pregnancy are associated with childhood asthma. Evidence found through mediation analysis suggest that Vitamin D sufficiency in early pregnancy and normal prepregnancy BMI are protective against elevated prenatal CRP.

Previous studies have reported associations between prenatal CRP and asthma or wheezing in early childhood. In the current study, the authors note modifiable maternal health characteristics, for which interventions before conception may benefit pediatric health. Given a prominent atopic family history in the study population (55% with maternal or paternal asthma compared with 8% in the general population), there may be benefit for targeted preconception education and counseling strategies in young adults with atopic disease.