Katri Backman

Background: Maternal fruit and vegetable intake during pregnancy has been associated with improved pregnancy and newborn outcomes. However, the role of individual foods—specifically avocados, which are rich in key micronutrients—has not been studied in relation to perinatal health. Thus, this study aimed to examine expectant mother avocado consumption and its association with pregnancy and newborn outcomes using the Kuopio Birth Cohort (KuBiCo)—a prospective cohort study. Methods: Maternal avocado intake was assessed using a validated food frequency questionnaire in the first and third trimesters. Avocado consumers were defined as participants who reported consuming any avocado (> 0 g) during pregnancy, and avocado non‐consumers were defined as those who didn't report consuming any avocado (0 g). Pregnancy outcomes included preeclampsia, gestational hypertension, gestational diabetes, excessive bleeding during childbirth, and delivery by cesarean section. Early neonatal outcomes included being large or small for gestational age, low birth weight, macrosomia, preterm delivery, admission to neonatal intensive care, diagnosis of developmental disorder, and Apgar scores at 1 and 5 min. Logistic regression models were used to estimate associations between maternal avocado consumption and pregnancy and neonatal outcomes, adjusting for relevant covariates. Results: Pregnant individuals who consumed avocados (mean intake: 19.5 g/day) had 26.5% lower odds of undergoing a cesarean delivery compared to those who did not, even when adjusting for relevant covariates (e.g., overall diet quality). No statistically significant associations were observed for other pregnancy and newborn outcomes. Conclusion: Avocado consumption during pregnancy was associated with lower odds of cesarean delivery, even when accounting for potential confounding covariates.

Purpose: Intrauterine and early neonatal exposures, including maternal, obstetric, and postnatal factors, may influence the risk of atopic sensitization in offspring. However, their independent associations with inhalant and food sensitization remain underexplored. Methods: In the prospective Kuopio Birth Cohort, allergen-specific serum immunoglobulin E (IgE) levels for six food and eight inhalant allergens were measured in 619 children aged 5 years. Atopic sensitization was defined as IgE ≥ 0.70 kU/L. Information on maternal, obstetric, neonatal, breastfeeding, and environmental factors was collected from questionnaires and hospital records. Results: Overall, 31.3% of children were sensitized, including 22.9% to inhalant and 18.7% to food allergens. Lower maternal weight was associated with higher odds of any sensitization, inhalant sensitization, and food sensitization. Maternal smoking was associated with increased odds of any sensitization, whereas twin pregnancy was associated with reduced odds. Cesarean delivery increased the odds of inhalant sensitization by 1.7–1.9-fold but was not associated with food sensitization. Keeping cats indoors during pregnancy was linked to a 50% lower risk of any sensitization and inhalant sensitization. By contrast, maternal pregestational diabetes and hypertension showed stronger associations with increased odds of food allergen sensitization. Other maternal and perinatal factors showed no significant associations. Conclusion: Prenatal and perinatal factors may differentially influence sensitization to inhalant and food allergens, with cesarean delivery and early-life cat exposure being associated primarily with inhalant sensitization.

Background: Maternal exposures during pregnancy play a critical role in offspring’s health outcomes. This study aimed to investigate how maternal avocado consumption during pregnancy relates to offspring allergic health outcomes using the Kuopio Birth Cohort (KuBiCo) Study. Methods: This prospective cohort study used data from KuBiCo. Avocado consumption was assessed using an online food frequency questionnaire in trimesters (T) 1 and 3. Avocado consumers were defined as participants who reported consuming any avocado (>0 grams) in T1 and/or 3, and avocado non-consumers were defined as those who didn’t report consuming any avocado (0 grams) in both T1 and 3. The 12-month follow-up questionnaire captured offspring allergic outcomes (rhinitis, paroxysmal wheezing, atopic eczema, and food allergy). Results: Of 4647 participants, 2272 met the criteria and were included in the analysis. Compared to avocado non-consumers (during pregnancy), avocado consumers (during pregnancy) had 43.6% lower odds of reporting food allergy among their children at the 12-month follow-up questionnaire while adjusted for relevant covariates. No significant associations were noted in the other three allergic health outcomes in the fully adjusted model. Conclusion: Avocado consumption during pregnancy was associated with lower odds of infant food allergies at 12 months, even when accounting for potential covariates. Impact: Maternal exposures, such as nutrition during pregnancy, can affect offspring health outcomes. Consuming certain nutrients, which are found in avocados, during pregnancy have been associated with lower allergic health outcomes in children. Avocado consumption during pregnancy is found to be associated with lower odds of infant food allergies at 12 months, even when accounting for potential covariates.

Aim: The first evidence‐based Finnish guidelines for paediatric lower respiratory tract infections (LRTIs) were published in 2014 and completely updated in 2023. This paper, by the interdisciplinary working group that developed the 2023 guidelines, summarises the main recommendations.Methods: The 2023 guidelines were produced after a systematic review. Strong evidence was at least two separate, high‐quality studies, moderate evidence was at least one high‐quality study and weak evidence was at least one satisfactory study. The authors have now summarised the key points.Results: There was strong evidence that antitussives and beta‐sympathomimetics were not effective for bronchitis‐related cough and that laryngitis should be treated with oral corticosteroids, with adrenaline inhalations added in severe cases. Also, that amoxicillin for 5 days provided sufficient treatment for paediatric community‐acquired pneumonia and that children with apparent viral pneumonia could be observed without antimicrobial therapy. There was moderate evidence that corticosteroids or inhaled agents were not effective for bronchiolitis and that administering salbutamol with a holding chamber could relieve symptoms of wheezing bronchitis. Also, pertussis should be considered for unvaccinated infants with coughs.Conclusion: The 2023 guidelines aim to improve acute evidence‐based treatment of LRTIs, through appropriate antibiotics, inhaled drugs, corticosteroids, radiology and laboratory testing.

Background and Aims: There is an increased risk of asthma after viral wheezing episodes in early childhood, but unfortunately, prospective longitudinal data until adulthood are mostly lacking. The aim of this cohort study was to evaluate the risk of asthma in young adulthood after hospitalization for viral wheezing episodes in early childhood.Methods: The original cohort comprised 100 individuals aged <24 months who were hospitalized for viral wheezing episodes in 1992–1993. After the index episode, data on a diagnosis of asthma 1 year later and at median ages of 4.0, 7.2, and 12.3 years were recorded in follow‐up visits. Forty‐nine individuals attended the latest follow‐up visit at the age of 17–20 years. Current asthma was diagnosed based on symptoms at the time of the last follow‐up, use of inhaled corticosteroids and peak expiratory flow monitoring.Results: A total of 26 (53%) of the 49 cohort individuals had asthma at a mean age of 18.8 years. In multivariate analyses, a diagnosis of asthma 1 year after index hospitalization and at ages 4.0, 7.2, and 12.3 years were significant risk factors for current asthma (adjusted odds ratios [aORs] of 7.13, 8.86, 8.05, and 21.16, respectively). Atopic dermatitis in infancy (aOR: 4.20) and eosinophilia on admission (5.18) were also significant predictive factors for asthma.Conclusion: Over half (26/49) of the participants who had been hospitalized for viral wheezing episodes in early childhood had asthma in young adulthood. An asthma diagnosis at any age during childhood, as well as eosinophilia in early childhood, were independent significant predictive factors for asthma.

Background: Wheezing in early childhood has implications for respiratory morbidity in later life. Objectives: We evaluated respiratory health-related quality of life (HRQoL) in young adults ages 17‐20 years with a history of early childhood wheezing. Methods: Between 1992 and 1993, 100 children ages < 24 months were treated in the hospital for a lower respiratory tract infection with wheezing, and we followed up this cohort. In 2010, 49 of the patients (cases) and 60 population-based controls attended a clinical follow-up. St. George’s Respiratory Questionnaire (SGRQ) was used to evaluate respiratory HRQoL, expressed as symptom, activity, impact, and total scores. Results: The median (interquartile range) SGRQ symptom scores were higher (13.7 [3.8‐29.1]) in the 49 subjects (cases) with early childhood wheezing compared with the 60 population controls (7.8 [0.0‐18.3]; p = 0.019). However, there were no between-group differences in total scores or in other SGRQ domains. Current asthma was a major risk factor for reduced HRQoL. In univariate analyses, the median symptom scores were 20.2 in those with asthma and 7.8 in those without asthma (p < 0.001), and, in multivariate analyses, the odds ratio (OR) was 8.7 for high total scores (95% confidence intervals, 2.1‐36.6). Other factors associated with reduced HRQoL were current allergy (OR 4.4 for symptom scores), overweight (OR 3.3 for activity scores), tobacco smoking (OR 4.3 for symptom scores), and female sex (OR 3.2 for impact score). Furthermore, we performed post hoc analyses by excluding those with asthma and those who smoked, and found no significant differences on SGRQ scores between the subjects (cases) and the controls. Conclusion: Hospitalization for wheezing in early childhood mainly had indirect effects on HRQoL by increasing the risk of asthma.

A Finnish joint research effort Kuopio Birth Cohort (KuBiCo) seeks to evaluate the effects of genetics, epigenetics and different risk factors (medication, nutrition, lifestyle factors and environmental aspects) during pregnancy on the somatic and psychological health status of the mother and the child. KuBiCo will ultimately include information on 10,000 mother-child pairs who have given their informed consent to participate in this cohort. Identification of foetal health risk factors that can potentially later manifest as disease requires a repository of relevant biological samples and a flexible open up-to-date data handling system to register, store and analyse biological, clinical and questionnaire-based data. KuBiCo includes coded questionnaire-based maternal background data gathered before, during and after the pregnancy and bio-banking of maternal and foetal samples that will be stored in deep freezers. Data from the questionnaires and biological samples will be collected into one electronic database. KuBiCo consists of several work packages which are complementary to each other: Maternal, foetal and placental metabolism and omics; Paediatrics; Mental wellbeing; Prenatal period and delivery; Analgesics and anaesthetics during peripartum period; Environmental effects; Nutrition; and Research ethics. This report describes the set-up of the KuBiCo and descriptive analysis from 3532 parturients on response frequencies and feedback to KuBiCo questionnaires gathered from June 2012 to April 2016. Additionally, we describe basic demographic data of the participants (n = 1172). Based on the comparison of demographic data between official national statistics and our descriptive analysis, KuBiCo represents a cross-section of Finnish pregnant women.

Summary: Background: Viral aetiology of infection has a significant role in the long‐term outcome of early‐childhood wheezing.Objective: This study examines asthma and lung function in adulthood after early‐childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV).Methods: A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1‐3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow‐up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FE_NO) measurements.Results: Current asthma was present in 64% of the cases with RV‐induced wheezing (OR 17.0 [95%CI 3.9‐75.3] vs controls), in 43% of the cases with RSV‐induced wheezing episode (6.1 [1.5‐24.9] vs controls), and in 12% of the controls. The RV group showed significantly higher mean FE_NO values than the RSV group and controls. RV‐positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV‐positive cases had lower FVC than controls before bronchodilation.Conclusion: Cases with RV‐ and RSV‐induced early‐childhood wheezing had increased risk for asthma in adulthood, and RV‐positive cases had significantly higher FE_NO values than RSV‐positive cases and controls. Compared to controls, RV‐positive cases showed more bronchial reactivity, and RSV‐positive cases showed lower FVC before bronchodilation in lung function testing.Clinical relevance: Children with RV‐ or RSV‐induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.