{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T10:49:58Z","timestamp":1776422998032,"version":"3.51.2"},"reference-count":28,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T00:00:00Z","timestamp":1761609600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20210416"],"award-info":[{"award-number":["20210416"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003793","name":"Hj\u00e4rt-Lungfonden","doi-asserted-by":"publisher","award":["20240974"],"award-info":[{"award-number":["20240974"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Karolinska Institutet, Strategic Research Program in Epidemiology","award":["no award\/grant number"],"award-info":[{"award-number":["no award\/grant number"]}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2017-00641"],"award-info":[{"award-number":["2017-00641"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2018-02640"],"award-info":[{"award-number":["2018-02640"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"crossref","award":["2023-02327"],"award-info":[{"award-number":["2023-02327"]}],"id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100010234","name":"Astma- och Allergif\u00f6rbundet","doi-asserted-by":"publisher","award":["2020-0008"],"award-info":[{"award-number":["2020-0008"]}],"id":[{"id":"10.13039\/501100010234","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010234","name":"Astma- och Allergif\u00f6rbundet","doi-asserted-by":"publisher","award":["2024-0010"],"award-info":[{"award-number":["2024-0010"]}],"id":[{"id":"10.13039\/501100010234","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006741","name":"Stiftelsen Frimurare Barnhuset i Stockholm","doi-asserted-by":"publisher","award":["no award\/grant number"],"award-info":[{"award-number":["no award\/grant number"]}],"id":[{"id":"10.13039\/501100006741","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100011727","name":"Stockholm l\u00e4ns landsting","doi-asserted-by":"publisher","award":["DNR: 20200868"],"award-info":[{"award-number":["DNR: 20200868"]}],"id":[{"id":"10.13039\/501100011727","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2025,10,3]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Numerous studies have found associations between parental socio-economic position (SEP) and offspring asthma. Obesity and tobacco smoking during pregnancy (SDP) are more prevalent in lower SEP groups and have been identified as risk factors for childhood asthma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The aim of this study was to explore and quantify the role of the modifiable risk factors\u2014obesity, body mass index (BMI) and SDP\u2014in the association between maternal SEP and offspring asthma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This Swedish register-based cohort study included n=1 265 933 children born between 2006 and 2018, with information on asthma during the third and sixth years of life obtained from the National Patient Register and the Swedish Prescribed Drug Register. Maternal education was used as a measure of SEP. We used logistic regression to estimate exposure-outcome associations and applied the counterfactual approach to mediation analysis to estimate the proportion of the maternal SEP-offspring asthma association that could be explained by maternal obesity, BMI and SDP, with and without adjustment for birth year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>The OR was 1.15 (95% CI 1.13 to 1.16) for the association between maternal education and asthma during the third year of life and slightly lower during the sixth year (OR 1.09, 95% CI 1.07 to 1.10). Out of the excess risks, 20%\u201330% could be explained by obesity or BMI through mediation and mediated interaction, while 15%\u201320% could be explained by SDP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our results indicate that supporting young women and mothers-to-be to healthy weight and to abstain from tobacco smoking, in particular during pregnancy, could reduce child morbidity and improve health equity in childhood.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2025-223330","type":"journal-article","created":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T08:25:53Z","timestamp":1761639953000},"page":"457-463","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Maternal BMI and smoking partly explain the association between maternal socio-economic position and offspring asthma"],"prefix":"10.1136","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6546-3650","authenticated-orcid":false,"given":"Cecilia","family":"Lundholm","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3367-694X","authenticated-orcid":false,"given":"Emma","family":"Caffrey Osvald","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Astrid Lindgren Children\u2019s Hospital, Paediatric Allergy and Pulmonology Unit, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5798-2875","authenticated-orcid":false,"given":"Samuel","family":"Rhedin","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Sachsska Children\u2019s and Youth Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1045-1898","authenticated-orcid":false,"given":"Catarina","family":"Almqvist","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Astrid Lindgren Children\u2019s Hospital, Paediatric Allergy and Pulmonology Unit, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,28]]},"reference":[{"key":"2026041604050847000_81.5.457.1","unstructured":"World Health Organization . Operational framework for monitoring social determinants of health equity. Geneva World Health Organization; 2024."},{"key":"2026041604050847000_81.5.457.2","unstructured":"WHO Regional office for Europe . Understanding the drivers of health equity: the power of political participation. Copenhagen WHO Regional office for Europe; 2020."},{"key":"2026041604050847000_81.5.457.3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/jech-2023-220726","article-title":"Early family socioeconomic status and asthma-related outcomes in school-aged children: Results from seven birth cohort studies","volume":"79","author":"Yang-Huang","year":"2024","journal-title":"J Epidemiol Community Health"},{"key":"2026041604050847000_81.5.457.4","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.023531"},{"key":"2026041604050847000_81.5.457.5","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.028092"},{"key":"2026041604050847000_81.5.457.6","doi-asserted-by":"publisher","DOI":"10.1111\/cea.14037"},{"key":"2026041604050847000_81.5.457.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0106579","article-title":"Parental socioeconomic status, childhood asthma and medication use--a population-based study","volume":"9","author":"Gong","year":"2014","journal-title":"PLoS One"},{"key":"2026041604050847000_81.5.457.8","doi-asserted-by":"publisher","DOI":"10.1177\/1403494816683878"},{"key":"2026041604050847000_81.5.457.9","doi-asserted-by":"crossref","first-page":"168","DOI":"10.18176\/jiaci.0361","article-title":"Early Life Origins of Asthma: A Review of Potential Effectors","volume":"29","author":"Bobolea","year":"2019","journal-title":"J Investig Allergol Clin Immunol"},{"key":"2026041604050847000_81.5.457.10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1111\/cea.13593","article-title":"Smoking and snuff use in pregnancy and the risk of asthma and wheeze in pre-schoolchildren-A population-based register study","volume":"50","author":"Lundholm","year":"2020","journal-title":"Clin Exp Allergy"},{"key":"2026041604050847000_81.5.457.11","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2020.00134","article-title":"Pre-pregnancy Maternal Weight and Gestational Weight Gain Increase the Risk for Childhood Asthma and Wheeze: An Updated Meta-Analysis","volume":"8","author":"Liu","year":"2020","journal-title":"Front Pediatr"},{"key":"2026041604050847000_81.5.457.12","doi-asserted-by":"crossref","first-page":"2556","DOI":"10.1111\/all.15803","article-title":"Maternal body mass index in pregnancy and offspring asthma and food allergy","volume":"78","author":"Mubanga","year":"2023","journal-title":"Allergy"},{"key":"2026041604050847000_81.5.457.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0232971","article-title":"Changing social inequalities in smoking, obesity and cause-specific mortality: Cross-national comparisons using compass typology","volume":"15","author":"Teng","year":"2020","journal-title":"PLoS One"},{"key":"2026041604050847000_81.5.457.14","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-016-0117-y"},{"key":"2026041604050847000_81.5.457.15","doi-asserted-by":"publisher","DOI":"10.1177\/140349489001800209"},{"key":"2026041604050847000_81.5.457.16","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-009-9350-y"},{"key":"2026041604050847000_81.5.457.17","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00511-8"},{"key":"2026041604050847000_81.5.457.18","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/s10654-022-00947-5","article-title":"The Swedish medical birth register during five decades: documentation of the content and quality of the register","volume":"38","author":"Cnattingius","year":"2023","journal-title":"Eur J Epidemiol"},{"key":"2026041604050847000_81.5.457.19","article-title":"Cotinine Validation of Self-Reported Smoking During Pregnancy in the Swedish Medical Birth Register","volume":"18","author":"Mattsson","year":"2016","journal-title":"NICTOB"},{"key":"2026041604050847000_81.5.457.20","doi-asserted-by":"publisher","DOI":"10.1002\/pds.3465"},{"key":"2026041604050847000_81.5.457.21","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"},{"key":"2026041604050847000_81.5.457.22","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1294"},{"key":"2026041604050847000_81.5.457.23","unstructured":"VanderWeele TJ . Explanation in causal inference: methods for mediation and interaction. 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