(380) Breathtaking Consequences: Prenatal Armed Conflict Exposure and Offspring Respiratory Morbidity

Exposure to maternal stress during pregnancy has been associated with adverse outcomes in offspring. However, little is known about the long-term health consequences of in utero exposure to war-related conflict. We hypothesize that in utero exposure to maternal stress induced by armed conflict, particularly during first trimester, disrupts fetal pulmonary development, thereby increasing the risk of long-term respiratory morbidity, including asthma, in childhood.This study aimed to evaluate whether prenatal exposure to war is associated with increased risk for respiratory morbidities and complications in childhood.

Study Design:

A population-based study was conducted, using birth and health records from a single large medical center and the largest HMO in the country. The exposed group included children whose mothers were pregnant during periods of war conflict. We assessed diagnoses of respiratory illnesses and complications during childhood as the primary outcomes. Multivariable Cox regression models were used to estimate associations, adjusting for season of birth, maternal age, preterm delivery, and pregnancy complications. A subgroup analyses focusing on exposure limited to the first trimester was also conducted.

Results:
Of the 130656 offspring in the study, 22481 (17.2%) were exposed in-utero to war, and 8922 (6.8%) were exposed specifically during first trimester (Tabe). Offspring exposed in utero to war had a higher risk of respiratory morbidities (42.6% versus 34.7%, OR=1.40; 1.34-1.46), and specifically more likely to be diagnosed with asthma (40.3% versus 32.3%, OR 1.41, 95% CI 1.37-1.45). The risk for respiratory diseases was higher, regardless of the trimester of exposure, gestational age at delivery, gestational diabetes, maternal age and ethnicity (aHR=1.08; 1.04-1.12).

Conclusion:
Prenatal exposure to war conflict was associated with increased risk of respiratory morbidity in offspring, persisting into childhood. These findings highlight the need for long-term follow-up on offspring exposed to conflict environments during early life, and targeted support for pregnant individuals.