Adverse perinatal outcomes and housing conditions as determinants of early-life respiratory health: Evidence from Ireland

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Adverse perinatal outcomes—prematurity, low birth weight (LBW), and neonatal intensive care unit (NICU) admission—combined with poor housing conditions may heighten the risk of asthma and wheezing in childhood. However, their independent and interactive effects remain underexplored within a cumulative disadvantage framework. Methods Data from the nationally representative Growing Up in Ireland Cohort’08 were analysed, following children at 9 months, 3 years, and 9 years. Logistic regression models, including interaction terms to test moderating effects, were fitted to assess associations between adverse perinatal outcomes, housing conditions, and asthma and wheezing. Analyses were adjusted for sociodemographic characteristics and birth outcomes. Results Prematurity, LBW, and NICU admission were associated with higher odds of asthma and wheezing in childhood; the effects persisted for prematurity and NICU admission but weakened for LBW by age 9. Poor housing increased respiratory risk at 9 months and 3 years only. Interactions showed that prematurity and LBW combined with inadequate household warmth markedly increased asthma risk. Male sex and maternal chronic illness were consistent predictors, while maternal university education was protective. Conclusion Adverse perinatal outcomes and poor housing conditions independently and interactively increase early respiratory risks. Improving housing conditions may help reduce long-term health inequalities, especially among socioeconomically disadvantaged or medically vulnerable children. Social Determinants of Health Perinatal Outcomes Childhood Asthma Environmental Exposure Figures Figure 1 Figure 2 Figure 3 Introduction Perinatal health determines the initial health status of individuals and is tightly related to the maternal environment: genetics, lifestyle, education, or healthcare access influence newborn outcomes and are shaped by parental socioeconomic status (SES)[ 1 ]. Lower maternal resources often act as stressors, increasing the risk of adverse perinatal outcomes [ 2 , 3 ]. These outcomes, such as low birth weight (LBW) or prematurity, have been linked to lifelong health, neurocognitive development, education, and future employment and income [ 4 – 6 ]. The relationship between perinatal health and later life outcomes can be explained through the cumulative (dis)advantage framework [ 7 ]. Individuals starting life at disadvantage are less likely to overcome these initial setbacks if they lack the necessary resources to mitigate their effects, like stable housing, healthcare access, or higher parental SES. They are also more likely to face future challenges from a position of vulnerability, increasing the risk of entering a self-reinforcing cycle of accumulating disadvantages. Perinatal health and respiratory morbidity From an epidemiological perspective, the development of respiratory diseases is widely related to adverse perinatal outcomes. LBW can increase the risk of future asthma up to 16% compared to normal weight [ 8 ]. An international meta-analysis found that prematurity significantly raises the risk of childhood wheezing disorders, including asthma, with an odds ratio of 1.71 (95% CI: 1.57, 1.87) [ 9 ] Both outcomes are associated with transient early wheeze [ 10 ], a risk factor itself for the onset of asthma. Foetal size and maturity are determining factors for lung development. Intrauterine growth restriction and subsequent LBW [ 11 ], can disrupt lung growth, leading to smaller airway calibre relative to lung size, pathophysiology known as dysanapsis [ 12 ]. This can compromise lung function and trigger respiratory symptoms: LBW is associated with indicators of restrictive lung function (FVC, forced vital capacity) and worse pulmonary function overall [ 13 ]. Additionally, foetal growth disturbances can impair immunocompetence, heightening the incidence of respiratory symptoms [ 11 , 12 ]. However, as the airways grow in absolute size with age, the increased risk of symptoms in term LBW children may gradually ameliorate with somatic growth. This can lead to a more transient nature of the risk, with a lung function that might remain suboptimal but asymptomatic [ 12 ]. Prematurity is associated with an interruption of lung development during the alveolar phase, with deranged parenchymal and vascular growth. This results in structural abnormalities that impair long-term lung function [ 14 ]. Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity [ 15 ], characterized by a reduced septation and dysmorphic pulmonary microvessel growth, that results in fewer, larger alveoli, which significantly decreases the surface area available for gas exchange. Small airways may also be affected, with epithelial damage leading to bronchoconstriction [ 16 ]. Preterm infants with BPD have a much higher risk of developing asthma [ 17 ], though respiratory impairment can affect all preterm infants. Expiratory airflow limitations can persist into school age and later, even in preterm infants without BPD, and prematurity may also compromise the innate immune response involved in airway regulation [ 18 ]. Asthma, characterized by inflammation and narrowing of the airways, presents a wide heterogeneity of symptoms and develops through complex interactions between early-life exposures and allergen sensitisation. These exposures include prenatal factors, respiratory infections, stress, poor nutrition or air pollution, and are often closely linked to social disadvantage [ 19 ]. Distinguishing asthma from wheezing in early life is often challenging, as wheezing is a common symptom of asthma but can also arise from respiratory infections or allergic responses. Moreover, the diagnosis of asthma by a healthcare professional may be influenced by socioeconomic factors, potentially leading to underdiagnosis in disadvantaged groups [ 20 ]. In this context, wheezing may serve as a more sensitive marker of undiagnosed respiratory conditions [ 21 ]. Unlike asthma, which may go undiagnosed for years, neonatal intensive care unit (NICU) admission occurs at birth under medical supervision and is typically well-documented. A study in Northern Ireland reported a 19% higher NICU admission rate in the most deprived areas, reflecting a well-established association between social deprivation and neonatal morbidity [ 22 ]. Around 50% of NICU admissions are due to prematurity [ 23 ], though full-term infants may also require care for medical conditions, most commonly respiratory distress syndrome or transient tachypnoea of the newborn [ 24 ]. While supplemental oxygen is often essential, prolonged exposure can impair lung and immune development [ 18 ]. The Irish context As a consequence of the 2008 financial crash, Ireland has faced a prolonged housing crisis, deteriorating access to secure housing and living conditions [ 25 ], factors known to be crucial to early childhood health and development. Poor housing conditions and the country's climate itself, characterised by an average of 199 to 273 rain days per year [ 26 ], can lead to dampness and black mould production in the household, a problem exacerbated by inadequate heating [ 27 ]. Ireland has the fourth highest asthma prevalence globally, with an increasing trend over the past three decades. Asthma is the most common chronic disease in childhood and the leading respiratory condition nationally, affecting approximately 21.5% of children. Hospitalisation rates also increased notably, indicating a growing population-level burden [ 28 ]. Exposure to poor housing and indoor air quality can affect both the respiratory health of newborns [ 29 ] and young children [ 30 ]. In-home exposure data across early childhood enables a better understanding of its role in the onset and progression of these pathologies. For instance, exposure to mould within the household has been shown to increase the risk of childhood asthma by approximately 2.4 times [ 31 ]. Consistent evidence links water-damaged and damp indoor environments with elevated asthma prevalence, affecting both allergic and non-allergic phenotypes [ 32 ]. Mould, mycotoxins and bacteria can trigger infection, toxicity, allergy and inflammation [ 33 ], processes especially dangerous for children already suffering from respiratory diseases. However, in asthma, differentiating between an enhancement of symptoms and disease onset is a challenge. As stated by the WHO [ 34 ], despite sufficient epidemiological evidence linking dampness or mould to several health conditions, the underlying mechanisms by which non-infectious microbial exposures cause damage remain largely unknown. This study focuses on a specific high-risk group: children who experienced adverse perinatal outcomes, such LBW, prematurity or NICU admission, and examines whether these early disadvantages increase the likelihood of asthma or wheezing diagnoses at 9 months, 3 years, and 9 years of age, compared to those without such outcomes. It further examines whether housing conditions moderate this relationship. Specifically, it is hypothesized that children exposed to both adverse perinatal outcomes and poor housing environments face a heightened risk of respiratory health issues in later childhood. By tracking the same children from birth, this article offers a longitudinal perspective on how early-life disadvantage shapes health trajectories. Ultimately, it tries to identify modifiable social factors that could mitigate the long-term health impacts of early disadvantages. Methods Study design and data The research is based on data from Growing Up in Ireland Cohort’08 (GUI Infant Cohort), a nationally representative longitudinal study following children’s development from the age of 9 months onward, starting in 2008. Follow-up waves have been conducted when the child was aged 3, 5, 7/8 (via postal survey), 9 and 13 years, gathering information from diverse sources, including parents, carers, or teachers. Data is accessible upon written request via the Irish Social Science Data Archive ( www.ucd.ie/issda ). Participants A total of 11,134 participants and their families completed the first wave of interviews at 9 months, followed by 9,973 at age 3 and 8,032 at age 9. Data was statistically re-weighted to ensure that the sample remained representative of the Irish population across key socio-demographic variables, accounting for attrition and non-response. Outcome variables: respiratory health Outcome variables: respiratory health Infants’ respiratory health was assessed in all waves using three outcome variables: asthma, reported wheezing episodes, and respiratory allergies. Each of these variables are operationalized as dichotomous (yes/no), based on diagnosis by a medical professional. In addition, a variable capturing the presence of respiratory symptoms was included, reflecting caregiver-reported signs rather than a formal diagnosis. Health risk factors Early-life events, such as adverse perinatal outcomes, are a health risk factor for the development of respiratory diseases [ 8 , 35 ]. In the first wave of the GUI Cohort’08, detailed retrospective delivery information was reported by the child’s primary caregiver, typically the mother. Based on this information, a set of dichotomous variables were constructed to capture key indicators of adverse perinatal outcomes: LBW (less than 2,500 grams), prematurity (born before 37 weeks of gestation) and whether the newborn required NICU admission following birth. Exposure variables Cold housing conditions were assessed at all waves using two indicators drawn from the set of material deprivation questions defined for the Irish context by the European Anti-Poverty Network (EAPN): whether the home was adequately warm and whether the household had been unable to afford heating in the past 12 months. In addition, caregiver reports of damp, drafts, or leaks in the home at child ages 3 and 9 were included, due to their known link to indoor mould and respiratory problems. Together, these variables reflect housing and indoor air quality relevant to children’s respiratory health [ 30 ]. A composite variable—warmth deprivation—was created by combining reports of damp, drafts, and cold housing into a single indicator. Confounding variables Based on prior literature, several variables were identified as potential confounders. The following measures were included: baby gender, household income, maternal smoking during pregnancy, household smoking, maternal age [ 36 ], maternal country of birth (Irish-born vs. non-Irish-born), maternal health (diagnosed with any chronic condition), maternal educational level, being primiparous, antibiotic use in infancy [ 37 ], and child’s body mass index (BMI). BMI was classified according to age- and gender-specific thresholds from the International Task Force on Obesity. Statistical analysis Logistic regression models were fitted to examine associations between adverse perinatal outcomes and respiratory health, and between poor housing conditions and respiratory health at 9 months, 3 years, and 9 years. Interaction terms were included to examine whether housing conditions—specifically dampness and inadequate warmth—moderate the effects of early disadvantage. Models adjust for key sociodemographic confounders. Given the binary nature of the outcomes (e.g., asthma, wheezing), logistic regression is appropriate; odds ratios with 95% confidence intervals are reported to quantify relative risks, and predicted probabilities are presented to illustrate interaction effects across subgroups. Results Descriptive evidence Weighted prevalences of respiratory outcomes by maternal and birth characteristics (Additional file 1a-c) show higher prevalence of asthma and wheezing among boys, children of mothers with chronic conditions, those exposed to household smoking, and those from lower-income households. Elevated prevalence was also observed among children of younger mothers, those who received antibiotics in the past year, and those classified as overweight. However, some associations should be interpreted with caution, as younger mothers are more likely to experience socioeconomic disadvantage and higher rates of adverse perinatal outcomes, and antibiotic use may be a consequence rather than a cause of respiratory illness. A full set of descriptive evidence is available in Additional files 2a–2c. A second prevalence analysis was conducted to address the endogeneity inherent in the phenomenon under study. This article posits a specific harm mechanism: poor housing conditions lead to dampness and black mould, thereby compromising indoor air quality and promoting the development of respiratory diseases. This form of disadvantage disproportionately affects socioeconomically deprived households, though it is not the sole relevant factor. Table 1 stratifies households by poverty status—above and below the standard poverty threshold—and by material deprivation, distinguishing among households with no deprivation, those experiencing material deprivation unrelated to housing, and those specifically deprived in terms of housing adequacy (i.e., dampness, lack of heating, or inadequate indoor temperature), in order to better isolate the health impact of poor housing conditions. Table 1 Weighted prevalences of asthma, wheezing, and respiratory allergies at 9 years of age, by type of deprivation experienced (material deprivation, inadequate warmth, and presence of dampness in the household, or no deprivation). Source: Authors’ calculations using data from the Growing Up in Ireland (GUI) Cohort’08 Study. No deprivation Material deprivation Warmth deprivation Above poverty line Asthma: 8.2 (7.3, 9.2) Asthma: 11.9 (6.9, 16.9) Asthma: 7.9 (5.6, 10.2) Wheezing: 14.6 (13.4, 15.8) Wheezing: 15 (9.6–20.4) Wheezing: 14.8 (11.7, 17.8) Respiratory allergy: 2.9 (2.4, 3.5) Respiratory allergy: 3.7 (0.7, 6.8) Respiratory allergy: 3.1 (1.7, 4.5) Below poverty line Asthma: 11.6 (8.4, 14.7) Asthma: 8.8 (3.2, 14.5) Asthma: 13.7 (9, 18.5) Wheezing: 16.8 (13.2, 20.3) Wheezing: 19 (11.3, 26.7) Wheezing: 23.7 (18.2, 29.2) Respiratory allergy: 2.1 (0.9, 3.3) Respiratory allergy: 0 (0, 0) Respiratory allergy: 2.7 (0.5, 4.8) The table shows limited effects of poverty on asthma and wheezing among those without material deprivation, with the smallest difference across groups for asthma (8.2% to 11.6%) and wheezing (14.6% to 16.8%). For those experiencing only material deprivation unrelated to housing (e.g., clothing, diet), the poverty line distinction appears less meaningful: asthma prevalence is actually lower below the poverty line (8.8%) than above it (11.9%), while wheezing is slightly higher (19% vs. 15%). In contrast, when deprivation specifically involves housing conditions, the largest difference emerges, with asthma prevalence rising from 8% to 13.7% and wheezing from 14.8% to 23.7%. These differences support the existence of a specific harm mechanism among those experiencing deprivation in housing conditions, particularly when they lack the economic resources to mitigate its potential adverse effects. Multivariate analysis An initial set of logistic regressions was conducted to evaluate the first hypothesis: children who experience adverse perinatal outcomes are more likely to be diagnosed with asthma or other respiratory problems. The results of the main outcome variables are shown in Fig. 1 . Prematurity was consistently associated with higher odds of respiratory conditions across all waves, reaching statistical significance for nearly all outcomes, including asthma at 9 months (adjusted odds ratio, AOR = 1.59, p < 0.05), wheezing at age 3 (AOR = 1.52, p < 0.001), and asthma (AOR = 1.50, p < 0.05) and wheezing (AOR = 1.53, p < 0.01) at age 9, after controlling for relevant covariates. Both LBW and NICU admission were also significantly associated with increased odds of respiratory conditions during childhood, particularly in early years. LBW was strongly linked to asthma at 9 months (OR = 1.89, p < 0.01) and to wheezing at age 3 (OR = 1.41, p < 0.01), with associations attenuating by age 9. Children who had been admitted to NICU showed consistently elevated odds of all respiratory outcomes across all ages, including asthma at 9 months (OR = 1.73, p < 0.001) at age 3 (OR = 1.43, p < 0.001) and asthma at age 9 (OR = 1.54, p < 0.001), as well as wheezing at age 3 (OR = 1.41, p < 0.01) and at age 9 (OR = 1.29, p < 0.01). Several indicators of inadequate housing conditions were associated with increased odds of asthma and wheezing, particularly in early life, as shown in Fig. 2 . These models use the immediately preceding, but not current, indicator of housing conditions to capture the impact of previously experienced material deprivation, independent of present circumstances. At 9 months, inadequate household warmth was significantly associated with higher odds of asthma (AOR = 1.21, p < 0.05), though associations with general respiratory symptoms or later outcomes were not statistically significant. In contrast, inability to use heating was linked to increased odds of respiratory outcomes at 9 months, with significant associations for asthma (AOR = 1.43, p < 0.05) and respiratory symptoms (AOR = 1.46, p < 0.01). The effect of lack of adequate heating persisted through age 3, particularly for wheezing (AOR = 1.36, p < 0.01), but not at age 9. Warmth deprivation showed the strongest and most consistent associations. It was significantly related to asthma (AOR = 1.67, p < 0.01) and symptoms at 9 months (AOR = 1.46, p < 0.01), and to wheezing at 3 years (AOR = 1.35, p < 0.01). No associations reached significance at age 9. Finally, dampness was associated with increased odds of wheezing at age 3 (AOR = 1.49, p < 0.05), but no consistent patterns were observed across other ages or outcomes. Maternal chronic illness emerged as a strong predictor of respiratory problems across all ages, with odds ratios above 1.41 for all outcomes and significance at p < 0.05 or lower (covariates’ coefficients are available at Additional files 3 and 4). Male sex was also a persistent risk factor, significantly increasing the likelihood of both asthma and wheezing at every age. Maternal university-level education has a consistent protective effect. Child overweight at age 9 is a significant risk factor, associated with higher odds of both asthma and wheezing. In contrast, and somewhat unexpectedly, household smoking showed weak and inconsistent associations with respiratory outcomes, with most effects small and statistically non-significant. This might reflect underreporting due to social desirability bias. A further set of interaction models tested whether inadequate housing conditions exacerbated the association between adverse perinatal outcomes and the risk of asthma at 9 months, as shown in Fig. 3 . A significant interaction (coefficients available at Additional file 6) was found between prematurity and inadequate household warmth, with children exposed to both risks showing substantially higher odds of asthma (AOR = 5.96; p < 0.05). Likewise, LBW combined with inadequate household warmth was associated with a markedly elevated asthma risk (AOR = 8.91; p < 0.01). These findings suggest that cold homes may exacerbate the respiratory risks associated with early-life disadvantage. No significant interactions emerged for NICU admission, although the combination with inadequate warmth suggested a possible increase in risk. While each indicator of heating problems was independently linked to increased risk, their interactions did not amplify this effect. Some, such as the LBW–heating problems interaction (AOR = 0.04; p < 0.01), appeared attenuated or even protective. These findings should be interpreted with caution due to potential measurement limitations or data sparsity. Several robustness checks (available from the author upon request) were conducted to assess the validity of the main findings. First, an alternative proxy for maternal SES was used, using low-income household’s [ 38 ] vs the rest, no relevant changes were identified. Whether the families move or not is only recorded at age 3, but no evidence was found that household mobility moderates the relationship between perinatal risk factors and respiratory outcomes in early childhood. Discussion This study examined how early health risk factors, measured through adverse perinatal outcomes, and poor housing conditions affect the risk of developing respiratory problems during early childhood in Ireland. Using nationally representative data, independent and interactive effects of perinatal outcomes and inadequate home environments were measured on asthma and wheezing across three developmental stages. In independent analyses, prematurity, LBW, and NICU admission were consistently associated with higher odds of asthma and wheezing. These results remained stable over time for prematurity and NICU admission, but weakened by age 9 for LBW, likely reflecting natural growth of airways during childhood. This aligns with previous literature [ 12 ] and suggests a distinct developmental trajectory compared to the more persistent effects of disrupted lung maturation due to prematurity or NICU care. Independent analyses of poor housing conditions showed that inadequate warmth, inability to use heating, and warmth deprivation were associated with higher odds of asthma at 9 months, and with wheezing and respiratory symptoms at 3 years, though these effects were not significant by age 9. Dampness, examined only at later ages, was associated with wheezing at age 3 but not with outcomes at age 9. Early-life exposure to suboptimal housing may impair respiratory development. Poor housing conditions act as a distinct risk factor that contributes to cumulative disadvantage through compromised indoor air quality and increased respiratory morbidity. Maternal education was one of the sociodemographic factors that showed a protective effect; children of mothers with low educational attainment show higher risks of asthma and wheezing compared to those of highly educated mothers [ 39 ], underscoring the scaring effect on respiratory health associated with chronic exposure to socioeconomically deprived environments. As maternal history of asthma is a risk factor for the development of respiratory conditions in offspring, a proxy was constructed to identify mothers diagnosed with any chronic illness, capturing asthma [ 40 ] and other health conditions. Studies indicate that other pathologies [ 41 ] (including poor maternal mental health [ 42 ]) may also be associated with the onset of asthma or wheezing. Maternal chronic illness emerged as a consistent predictor for adverse respiratory outcomes across all ages, reflecting both genetic predisposition—especially in cases of maternal asthma—and potential intrauterine effects such as medication exposure, inflammation, or stress impacting foetal development. Male sex stands as an independent risk factor for all respiratory outcomes and at all ages, supported by existing evidence showing greater respiratory vulnerability among boys before puberty, likely driven by anatomical and hormonal differences that reverse the trend in adolescence [ 43 ]. Understanding how these patterns change over time is relevant for identifying periods of heightened vulnerability and designing targeted interventions. In contrast with the well-documented impact of tobacco exposure on early respiratory health [ 44 ], it did not emerge as a significant risk factor for asthma or wheezing, potentially hiding a problem in the reporting of smoking behaviour. The interactions show how inadequate household warmth and warmth deprivation heighten the risk for asthma for children with prematurity, LBW and NICU admission, while only reaching significance for inadequate household warmth. The unexpected attenuation effects observed in some models that explore the inadequate heating variables, may reflect limitations in how these were reported or measured, as mentioned for smoking behaviour. This study has several strengths, including the use of a longitudinal nationally representative sample, which ensures that the findings are representative of the children in Ireland. Additionally, the comprehensive range of factors analysed provides an insightful view of the matter, offering a robust approach that includes several health risk factors, exposure, and outcome variables. Some potential limitations should be addressed. The wide CI observed in some interactions reflect smaller subgroup sizes, a common issue when working with multiple events that have low prevalence in the population. Nevertheless, results remained statistically significant, and the association appears robust, coherent with proposed mechanisms, and of clinical importance. Future research with larger samples would help refine these estimates. In conclusion, this study identifies adverse perinatal outcomes and poor housing conditions as independent risk factors for childhood respiratory illness, with early interactive effects observed for asthma risk. Vulnerabilities are particularly pronounced among children of mothers with lower socioeconomic resources, pre-existing health conditions, or male. These findings show that targeted interventions towards avoiding exposure to poor housing conditions, a modifiable risk factor, especially among those who are born experiencing early disadvantage, could help mitigate long-term respiratory health inequalities and break the cycle of accumulating disadvantages. Abbreviations AOR Adjusted Odds Ratio BMI Body mass index BPD Bronchopulmonary dysplasia CI Confidence interval EAPN European Anti-Poverty Network FVC Forced vital capacity GUI Growing up in Ireland LBW Low birth weight NICU Neonatal intense care unit OR Odds ratio SES Socioeconomic status WHO World Health Organization Declarations Ethics approval and consent to participate Ethics approval for the Growing Up in Ireland study was granted by the Health Research Board’s Research Ethics Committee and overseen by a committee established by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). Written informed consent to participate was obtained from parents or legal guardians of all children under the age of 16, and assent was sought from children where appropriate. The study was conducted in accordance with the Declaration of Helsinki (1964) and its later amendments, as well as the Statistics Act (1993), which ensures strict confidentiality. The present analyses are based on anonymised secondary data and did not require additional ethical approval, in line with the regulations of the Central Statistics Office of Ireland. Trial registration Not applicable. Consent for publication Not applicable. Availability of data and materials Access to the anonymised microdata files is subject to legal and ethical restrictions and therefore not publicly available. Researchers may apply for access through the Irish Social Science Data Archive (ISSDA), University College Dublin: https://www.ucd.ie/issda. Competing interests The author declares no conflicts of interest. Funding The research has received funding from COORDINATE under the European Union H2020 Grant Agreement No. 101008589. This work was also supported by the Spanish Ministry of Science and Innovation, grants PID2019-111564RB-I00/AEI/10.13039/501100011033 and PRE2020-094473. 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Available from: https://irishthoracicsociety.com/wp-content/uploads/2019/04/Chapter-6-Asthma.pdf Accessed 7 July 2025. Lu C, Xiao F, Norbäck D, Yang X, Zhang Y, Li B, et al. Long-term exposure to mould/damp stains and mouldy odour increases low birth weight. Build Environ. 2022;222:109366. 10.1016/j.buildenv.2022.109418 . Holden KA, Lee AR, Hawcutt DB, Sinha IP. The impact of poor housing and indoor air quality on respiratory health in children. Breathe (Sheff). 2023;19(1):220158. 10.1183/20734735.0058-2023 . Jaakkola JJK, Hwang BF, Jaakkola N. Home dampness and molds, parental atopy, and asthma in childhood: a six-year population-based cohort study. Environ Health Perspect. 2005;113(3):357–61. 10.1289/ehp.7242 . Mendell MJ, Mirer AG, Cheung K, Tong M, Douwes J. Respiratory and allergic health effects of dampness, mold, and dampness-related agents: a review of the epidemiologic evidence. Environ Health Perspect. 2011;119(6):748–56. 10.1289/ehp.1002410 . Hope J. A review of the mechanism of injury and treatment approaches for illness resulting from exposure to water-damaged buildings, mold, and mycotoxins. Sci World J. 2013;2013:767482. 10.1155/2013/767482 . World Health Organization Regional Office for Europe. WHO guidelines for indoor air quality: dampness and mould. Copenhagen: WHO Regional Office for Europe. 2009. Available from: https://iris.who.int/handle/10665/164348 Accessed 7 July 2025. Patelarou E, Chochlidaki M, Vivilaki V, Brokalaki H. Is there a link between wheezing in early childhood and adverse birth outcomes? A systematic review. Int J Environ Res Public Health. 2009;6(11):2752–61. 10.3390/ijerph6112752 . Infante-Rivard C. Young maternal age: a risk factor for childhood asthma? Epidemiology. 1995;6(2):178–80. Marra F, Marra CA, Richardson K, Lynd LD, Kozyrskyj A, Patrick DM, et al. Antibiotic use in children is associated with increased risk of asthma. Pediatrics. 2009;123(3):1003–10. 10.1542/peds.2008-1146 . Kozyrskyj AL, Kendall GE, Jacoby P, Sly PD, Zubrick SR. Association between socioeconomic status and the development of asthma: analyses of income trajectories. Am J Public Health. 2010;100(3):540–6. 10.2105/AJPH.2008.150771 . Lewis KM, Ruiz M, Goldblatt P, Morrison J, Porta D, Forastiere F, et al. Mother’s education and offspring asthma risk in 10 European cohort studies. Eur J Epidemiol. 2017;32(9):797–805. 10.1007/s10654-017-0309-0 . Venter C, Palumbo MP, Sauder KA, Glueck DH, Liu AH, Yang IV, et al. Incidence and timing of offspring asthma, wheeze, allergic rhinitis, atopic dermatitis, and food allergy and association with maternal history of asthma and allergic rhinitis. World Allergy Organ J. 2021;14(2):100512. 10.1016/j.waojou.2021.100526 . Yang DH, Chin CS, Chao WC, Lin CH, Chen YW, Chen YH, et al. Association of the risk of childhood asthma at age 6 with maternal allergic or immune-mediated inflammatory diseases: a nationwide population-based study. Front Med (Lausanne). 2021;8:631644. 10.3389/fmed.2021.713262 . Dos Santos LM, Dos Santos DN, Rodrigues LC, Barreto ML. Maternal mental health and social support: effect on childhood atopic and non-atopic asthma symptoms. J Epidemiol Community Health. 2012;66(11):1011–6. 10.1136/jech-2011-200278 . Naeem A, Silveyra P. Sex differences in paediatric and adult asthma. Eur Med J Respir. 2019;7(1):106–12. Cunningham J, O’Connor GT, Dockery DW, Speizer FE. Environmental tobacco smoke, wheezing, and asthma in children in 24 communities. Am J Respir Crit Care Med. 1996;153(1):218–24. 10.1164/ajrccm.153.1.8542119 . Additional Declarations No competing interests reported. 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19:06:19","extension":"xml","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109057,"visible":true,"origin":"","legend":"","description":"","filename":"4d396dd1f1924e809090445a412722481structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/4b059fa0daf3b48f657c86e1.xml"},{"id":94223059,"identity":"e5bd073d-0394-44a0-8d39-147f7ddade19","added_by":"auto","created_at":"2025-10-23 19:06:20","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":121931,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/57a46841208d8c8b4a903bb1.html"},{"id":94224011,"identity":"03ec098a-a1a8-4000-bd55-e3d83e6dc816","added_by":"auto","created_at":"2025-10-23 19:14:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29349,"visible":true,"origin":"","legend":"\u003cp\u003eAdjusted odds ratios (AORs) and 95% confidence intervals for respiratory outcomes by health risk factors (LBW, prematurity, and NICU admission), at 9 months, 3 years, and 9 years. Models adjusted for maternal health, household smoking, child sex, maternal education, and, where available, child overweight. Outcomes: asthma (red), wheezing (dark blue), and symptoms only (light blue). Full models are available in the Additional files. Source: Author’ calculations using data from the Growing Up in Ireland (GUI) Cohort’08 Study.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/33f4c8ca1206c8fb296ee42f.png"},{"id":94223053,"identity":"50f85031-f8f4-4603-b4f0-0dc22c888699","added_by":"auto","created_at":"2025-10-23 19:06:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36292,"visible":true,"origin":"","legend":"\u003cp\u003eAdjusted odds ratios (AORs) and 95% confidence intervals for respiratory outcomes by housing conditions, at 9 months, 3 years, and 9 years. Models adjusted for maternal health, household smoking, child sex, maternal education, and, where available, child overweight. Outcomes: asthma (red), wheezing (dark blue), and symptoms only (light blue). Full models are available in the Additional files. Source: Author’ calculations using data from the Growing Up in Ireland (GUI) Cohort’08 Study.\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/c5023b6d8a0a840ed8d1280b.png"},{"id":94224010,"identity":"bd324314-c9fa-4a6b-b70d-67802f153aec","added_by":"auto","created_at":"2025-10-23 19:14:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":32426,"visible":true,"origin":"","legend":"\u003cp\u003ePredicted probabilities of asthma at 9 months by exposure to adverse housing conditions and health risk factors. Panels show interactions between three perinatal outcomes (prematurity, LBW, and NICU admission) and three housing condition indicators (inadequate household warmth, heating problems and warmth deprivation). Results are based on predicted probabilities from logistic regression models. Full models are available in the Additional files. Source: Author’ calculations using data from the Growing Up in Ireland (GUI) Cohort’08 Study.\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/279226e2eb4af100d85143a8.png"},{"id":94224013,"identity":"6df65ea8-2b0f-47a4-b3e3-afe10506bb4b","added_by":"auto","created_at":"2025-10-23 19:14:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":784150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/d6b2a85a-ff26-464d-9170-4359e45163fb.pdf"},{"id":94223048,"identity":"451ad84f-d50b-40bc-92e7-35fa0cb7f54a","added_by":"auto","created_at":"2025-10-23 19:06:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":62201,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterialsBMC.docx","url":"https://assets-eu.researchsquare.com/files/rs-7564778/v1/191d02fefb0fb2e9be60fc87.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adverse perinatal outcomes and housing conditions as determinants of early-life respiratory health: Evidence from Ireland","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePerinatal health determines the initial health status of individuals and is tightly related to the maternal environment: genetics, lifestyle, education, or healthcare access influence newborn outcomes and are shaped by parental socioeconomic status (SES)[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Lower maternal resources often act as stressors, increasing the risk of adverse perinatal outcomes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These outcomes, such as low birth weight (LBW) or prematurity, have been linked to lifelong health, neurocognitive development, education, and future employment and income [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe relationship between perinatal health and later life outcomes can be explained through the cumulative (dis)advantage framework [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Individuals starting life at disadvantage are less likely to overcome these initial setbacks if they lack the necessary resources to mitigate their effects, like stable housing, healthcare access, or higher parental SES. They are also more likely to face future challenges from a position of vulnerability, increasing the risk of entering a self-reinforcing cycle of accumulating disadvantages.\u003c/p\u003e\n\u003ch3\u003ePerinatal health and respiratory morbidity\u003c/h3\u003e\n\u003cp\u003eFrom an epidemiological perspective, the development of respiratory diseases is widely related to adverse perinatal outcomes. LBW can increase the risk of future asthma up to 16% compared to normal weight [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. An international meta-analysis found that prematurity significantly raises the risk of childhood wheezing disorders, including asthma, with an odds ratio of 1.71 (95% CI: 1.57, 1.87) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Both outcomes are associated with transient early wheeze [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], a risk factor itself for the onset of asthma.\u003c/p\u003e\u003cp\u003eFoetal size and maturity are determining factors for lung development. Intrauterine growth restriction and subsequent LBW [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], can disrupt lung growth, leading to smaller airway calibre relative to lung size, pathophysiology known as dysanapsis [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This can compromise lung function and trigger respiratory symptoms: LBW is associated with indicators of restrictive lung function (FVC, forced vital capacity) and worse pulmonary function overall [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additionally, foetal growth disturbances can impair immunocompetence, heightening the incidence of respiratory symptoms [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, as the airways grow in absolute size with age, the increased risk of symptoms in term LBW children may gradually ameliorate with somatic growth. This can lead to a more transient nature of the risk, with a lung function that might remain suboptimal but asymptomatic [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePrematurity is associated with an interruption of lung development during the alveolar phase, with deranged parenchymal and vascular growth. This results in structural abnormalities that impair long-term lung function [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Bronchopulmonary dysplasia (BPD) is the most common complication of prematurity [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], characterized by a reduced septation and dysmorphic pulmonary microvessel growth, that results in fewer, larger alveoli, which significantly decreases the surface area available for gas exchange. Small airways may also be affected, with epithelial damage leading to bronchoconstriction [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Preterm infants with BPD have a much higher risk of developing asthma [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], though respiratory impairment can affect all preterm infants. Expiratory airflow limitations can persist into school age and later, even in preterm infants without BPD, and prematurity may also compromise the innate immune response involved in airway regulation [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAsthma, characterized by inflammation and narrowing of the airways, presents a wide heterogeneity of symptoms and develops through complex interactions between early-life exposures and allergen sensitisation. These exposures include prenatal factors, respiratory infections, stress, poor nutrition or air pollution, and are often closely linked to social disadvantage [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Distinguishing asthma from wheezing in early life is often challenging, as wheezing is a common symptom of asthma but can also arise from respiratory infections or allergic responses. Moreover, the diagnosis of asthma by a healthcare professional may be influenced by socioeconomic factors, potentially leading to underdiagnosis in disadvantaged groups [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this context, wheezing may serve as a more sensitive marker of undiagnosed respiratory conditions [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eUnlike asthma, which may go undiagnosed for years, neonatal intensive care unit (NICU) admission occurs at birth under medical supervision and is typically well-documented. A study in Northern Ireland reported a 19% higher NICU admission rate in the most deprived areas, reflecting a well-established association between social deprivation and neonatal morbidity [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Around 50% of NICU admissions are due to prematurity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], though full-term infants may also require care for medical conditions, most commonly respiratory distress syndrome or transient tachypnoea of the newborn [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. While supplemental oxygen is often essential, prolonged exposure can impair lung and immune development [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eThe Irish context\u003c/h2\u003e\u003cp\u003eAs a consequence of the 2008 financial crash, Ireland has faced a prolonged housing crisis, deteriorating access to secure housing and living conditions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], factors known to be crucial to early childhood health and development. Poor housing conditions and the country's climate itself, characterised by an average of 199 to 273 rain days per year [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], can lead to dampness and black mould production in the household, a problem exacerbated by inadequate heating [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Ireland has the fourth highest asthma prevalence globally, with an increasing trend over the past three decades. Asthma is the most common chronic disease in childhood and the leading respiratory condition nationally, affecting approximately 21.5% of children. Hospitalisation rates also increased notably, indicating a growing population-level burden [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eExposure to poor housing and indoor air quality can affect both the respiratory health of newborns [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and young children [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In-home exposure data across early childhood enables a better understanding of its role in the onset and progression of these pathologies. For instance, exposure to mould within the household has been shown to increase the risk of childhood asthma by approximately 2.4 times [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Consistent evidence links water-damaged and damp indoor environments with elevated asthma prevalence, affecting both allergic and non-allergic phenotypes [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Mould, mycotoxins and bacteria can trigger infection, toxicity, allergy and inflammation [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], processes especially dangerous for children already suffering from respiratory diseases. However, in asthma, differentiating between an enhancement of symptoms and disease onset is a challenge. As stated by the WHO [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], despite sufficient epidemiological evidence linking dampness or mould to several health conditions, the underlying mechanisms by which non-infectious microbial exposures cause damage remain largely unknown.\u003c/p\u003e\u003cp\u003eThis study focuses on a specific high-risk group: children who experienced adverse perinatal outcomes, such LBW, prematurity or NICU admission, and examines whether these early disadvantages increase the likelihood of asthma or wheezing diagnoses at 9 months, 3 years, and 9 years of age, compared to those without such outcomes. It further examines whether housing conditions moderate this relationship. Specifically, it is hypothesized that children exposed to both adverse perinatal outcomes and poor housing environments face a heightened risk of respiratory health issues in later childhood. By tracking the same children from birth, this article offers a longitudinal perspective on how early-life disadvantage shapes health trajectories. Ultimately, it tries to identify modifiable social factors that could mitigate the long-term health impacts of early disadvantages.\u003c/p\u003e\u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and data\u003c/h2\u003e\u003cp\u003eThe research is based on data from Growing Up in Ireland Cohort\u0026rsquo;08 (GUI Infant Cohort), a nationally representative longitudinal study following children\u0026rsquo;s development from the age of 9 months onward, starting in 2008. Follow-up waves have been conducted when the child was aged 3, 5, 7/8 (via postal survey), 9 and 13 years, gathering information from diverse sources, including parents, carers, or teachers. Data is accessible upon written request via the Irish Social Science Data Archive (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.ucd.ie/issda\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.ucd.ie/issda\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eParticipants\u003c/h3\u003e\n\u003cp\u003eA total of 11,134 participants and their families completed the first wave of interviews at 9 months, followed by 9,973 at age 3 and 8,032 at age 9. Data was statistically re-weighted to ensure that the sample remained representative of the Irish population across key socio-demographic variables, accounting for attrition and non-response.\u003c/p\u003e\n\u003ch3\u003eOutcome variables: respiratory health\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eOutcome variables: respiratory health\u003c/div\u003e\u003cp\u003eInfants\u0026rsquo; respiratory health was assessed in all waves using three outcome variables: asthma, reported wheezing episodes, and respiratory allergies. Each of these variables are operationalized as dichotomous (yes/no), based on diagnosis by a medical professional. In addition, a variable capturing the presence of respiratory symptoms was included, reflecting caregiver-reported signs rather than a formal diagnosis.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eHealth risk factors\u003c/h2\u003e\u003cp\u003eEarly-life events, such as adverse perinatal outcomes, are a health risk factor for the development of respiratory diseases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In the first wave of the GUI Cohort\u0026rsquo;08, detailed retrospective delivery information was reported by the child\u0026rsquo;s primary caregiver, typically the mother. Based on this information, a set of dichotomous variables were constructed to capture key indicators of adverse perinatal outcomes: LBW (less than 2,500 grams), prematurity (born before 37 weeks of gestation) and whether the newborn required NICU admission following birth.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExposure variables\u003c/h3\u003e\n\u003cp\u003eCold housing conditions were assessed at all waves using two indicators drawn from the set of material deprivation questions defined for the Irish context by the European Anti-Poverty Network (EAPN): whether the home was adequately warm and whether the household had been unable to afford heating in the past 12 months. In addition, caregiver reports of damp, drafts, or leaks in the home at child ages 3 and 9 were included, due to their known link to indoor mould and respiratory problems. Together, these variables reflect housing and indoor air quality relevant to children\u0026rsquo;s respiratory health [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A composite variable\u0026mdash;warmth deprivation\u0026mdash;was created by combining reports of damp, drafts, and cold housing into a single indicator.\u003c/p\u003e\n\u003ch3\u003eConfounding variables\u003c/h3\u003e\n\u003cp\u003eBased on prior literature, several variables were identified as potential confounders. The following measures were included: baby gender, household income, maternal smoking during pregnancy, household smoking, maternal age [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], maternal country of birth (Irish-born vs. non-Irish-born), maternal health (diagnosed with any chronic condition), maternal educational level, being primiparous, antibiotic use in infancy [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and child\u0026rsquo;s body mass index (BMI). BMI was classified according to age- and gender-specific thresholds from the International Task Force on Obesity.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eLogistic regression models were fitted to examine associations between adverse perinatal outcomes and respiratory health, and between poor housing conditions and respiratory health at 9 months, 3 years, and 9 years. Interaction terms were included to examine whether housing conditions\u0026mdash;specifically dampness and inadequate warmth\u0026mdash;moderate the effects of early disadvantage. Models adjust for key sociodemographic confounders. Given the binary nature of the outcomes (e.g., asthma, wheezing), logistic regression is appropriate; odds ratios with 95% confidence intervals are reported to quantify relative risks, and predicted probabilities are presented to illustrate interaction effects across subgroups.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive evidence\u003c/h2\u003e\u003cp\u003eWeighted prevalences of respiratory outcomes by maternal and birth characteristics (Additional file 1a-c) show higher prevalence of asthma and wheezing among boys, children of mothers with chronic conditions, those exposed to household smoking, and those from lower-income households. Elevated prevalence was also observed among children of younger mothers, those who received antibiotics in the past year, and those classified as overweight. However, some associations should be interpreted with caution, as younger mothers are more likely to experience socioeconomic disadvantage and higher rates of adverse perinatal outcomes, and antibiotic use may be a consequence rather than a cause of respiratory illness. A full set of descriptive evidence is available in Additional files 2a\u0026ndash;2c.\u003c/p\u003e\u003cp\u003eA second prevalence analysis was conducted to address the endogeneity inherent in the phenomenon under study. This article posits a specific harm mechanism: poor housing conditions lead to dampness and black mould, thereby compromising indoor air quality and promoting the development of respiratory diseases. This form of disadvantage disproportionately affects socioeconomically deprived households, though it is not the sole relevant factor. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e stratifies households by poverty status\u0026mdash;above and below the standard poverty threshold\u0026mdash;and by material deprivation, distinguishing among households with no deprivation, those experiencing material deprivation unrelated to housing, and those specifically deprived in terms of housing adequacy (i.e., dampness, lack of heating, or inadequate indoor temperature), in order to better isolate the health impact of poor housing conditions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eWeighted prevalences of asthma, wheezing, and respiratory allergies at 9 years of age, by type of deprivation experienced (material deprivation, inadequate warmth, and presence of dampness in the household, or no deprivation).\u003c/p\u003e \u003cdiv class=\"Credit\"\u003e\u003cp\u003eSource: Authors\u0026rsquo; calculations using data from the Growing Up in Ireland (GUI) Cohort\u0026rsquo;08 Study.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo deprivation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMaterial deprivation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWarmth deprivation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eAbove poverty line\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsthma: 8.2 (7.3, 9.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAsthma: 11.9 (6.9, 16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAsthma: 7.9 (5.6, 10.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWheezing: 14.6 (13.4, 15.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWheezing: 15 (9.6\u0026ndash;20.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWheezing: 14.8 (11.7, 17.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRespiratory allergy: 2.9 (2.4, 3.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRespiratory allergy: 3.7 (0.7, 6.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespiratory allergy: 3.1 (1.7, 4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eBelow poverty line\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAsthma: 11.6 (8.4, 14.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAsthma: 8.8 (3.2, 14.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAsthma: 13.7 (9, 18.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWheezing: 16.8 (13.2, 20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eWheezing: 19 (11.3, 26.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWheezing: 23.7 (18.2, 29.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRespiratory allergy: 2.1 (0.9, 3.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRespiratory allergy: 0 (0, 0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRespiratory allergy: 2.7 (0.5, 4.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe table shows limited effects of poverty on asthma and wheezing among those without material deprivation, with the smallest difference across groups for asthma (8.2% to 11.6%) and wheezing (14.6% to 16.8%). For those experiencing only material deprivation unrelated to housing (e.g., clothing, diet), the poverty line distinction appears less meaningful: asthma prevalence is actually lower below the poverty line (8.8%) than above it (11.9%), while wheezing is slightly higher (19% vs. 15%). In contrast, when deprivation specifically involves housing conditions, the largest difference emerges, with asthma prevalence rising from 8% to 13.7% and wheezing from 14.8% to 23.7%. These differences support the existence of a specific harm mechanism among those experiencing deprivation in housing conditions, particularly when they lack the economic resources to mitigate its potential adverse effects.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMultivariate analysis\u003c/h2\u003e\u003cp\u003eAn initial set of logistic regressions was conducted to evaluate the first hypothesis: children who experience adverse perinatal outcomes are more likely to be diagnosed with asthma or other respiratory problems. The results of the main outcome variables are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Prematurity was consistently associated with higher odds of respiratory conditions across all waves, reaching statistical significance for nearly all outcomes, including asthma at 9 months (adjusted odds ratio, AOR\u0026thinsp;=\u0026thinsp;1.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), wheezing at age 3 (AOR\u0026thinsp;=\u0026thinsp;1.52, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and asthma (AOR\u0026thinsp;=\u0026thinsp;1.50, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and wheezing (AOR\u0026thinsp;=\u0026thinsp;1.53, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) at age 9, after controlling for relevant covariates.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eBoth LBW and NICU admission were also significantly associated with increased odds of respiratory conditions during childhood, particularly in early years. LBW was strongly linked to asthma at 9 months (OR\u0026thinsp;=\u0026thinsp;1.89, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and to wheezing at age 3 (OR\u0026thinsp;=\u0026thinsp;1.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), with associations attenuating by age 9. Children who had been admitted to NICU showed consistently elevated odds of all respiratory outcomes across all ages, including asthma at 9 months (OR\u0026thinsp;=\u0026thinsp;1.73, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) at age 3 (OR\u0026thinsp;=\u0026thinsp;1.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and asthma at age 9 (OR\u0026thinsp;=\u0026thinsp;1.54, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as well as wheezing at age 3 (OR\u0026thinsp;=\u0026thinsp;1.41, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and at age 9 (OR\u0026thinsp;=\u0026thinsp;1.29, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cp\u003eSeveral indicators of inadequate housing conditions were associated with increased odds of asthma and wheezing, particularly in early life, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. These models use the immediately preceding, but not current, indicator of housing conditions to capture the impact of previously experienced material deprivation, independent of present circumstances. At 9 months, inadequate household warmth was significantly associated with higher odds of asthma (AOR\u0026thinsp;=\u0026thinsp;1.21, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), though associations with general respiratory symptoms or later outcomes were not statistically significant. In contrast, inability to use heating was linked to increased odds of respiratory outcomes at 9 months, with significant associations for asthma (AOR\u0026thinsp;=\u0026thinsp;1.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and respiratory symptoms (AOR\u0026thinsp;=\u0026thinsp;1.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The effect of lack of adequate heating persisted through age 3, particularly for wheezing (AOR\u0026thinsp;=\u0026thinsp;1.36, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), but not at age 9. Warmth deprivation showed the strongest and most consistent associations. It was significantly related to asthma (AOR\u0026thinsp;=\u0026thinsp;1.67, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and symptoms at 9 months (AOR\u0026thinsp;=\u0026thinsp;1.46, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and to wheezing at 3 years (AOR\u0026thinsp;=\u0026thinsp;1.35, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). No associations reached significance at age 9. Finally, dampness was associated with increased odds of wheezing at age 3 (AOR\u0026thinsp;=\u0026thinsp;1.49, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), but no consistent patterns were observed across other ages or outcomes.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMaternal chronic illness emerged as a strong predictor of respiratory problems across all ages, with odds ratios above 1.41 for all outcomes and significance at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 or lower (covariates\u0026rsquo; coefficients are available at Additional files 3 and 4). Male sex was also a persistent risk factor, significantly increasing the likelihood of both asthma and wheezing at every age. Maternal university-level education has a consistent protective effect. Child overweight at age 9 is a significant risk factor, associated with higher odds of both asthma and wheezing. In contrast, and somewhat unexpectedly, household smoking showed weak and inconsistent associations with respiratory outcomes, with most effects small and statistically non-significant. This might reflect underreporting due to social desirability bias.\u003c/p\u003e\u003cp\u003eA further set of interaction models tested whether inadequate housing conditions exacerbated the association between adverse perinatal outcomes and the risk of asthma at 9 months, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A significant interaction (coefficients available at Additional file 6) was found between prematurity and inadequate household warmth, with children exposed to both risks showing substantially higher odds of asthma (AOR\u0026thinsp;=\u0026thinsp;5.96; p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Likewise, LBW combined with inadequate household warmth was associated with a markedly elevated asthma risk (AOR\u0026thinsp;=\u0026thinsp;8.91; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). These findings suggest that cold homes may exacerbate the respiratory risks associated with early-life disadvantage. No significant interactions emerged for NICU admission, although the combination with inadequate warmth suggested a possible increase in risk. While each indicator of heating problems was independently linked to increased risk, their interactions did not amplify this effect. Some, such as the LBW\u0026ndash;heating problems interaction (AOR\u0026thinsp;=\u0026thinsp;0.04; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), appeared attenuated or even protective. These findings should be interpreted with caution due to potential measurement limitations or data sparsity.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eSeveral robustness checks (available from the author upon request) were conducted to assess the validity of the main findings. First, an alternative proxy for maternal SES was used, using low-income household\u0026rsquo;s [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] vs the rest, no relevant changes were identified. Whether the families move or not is only recorded at age 3, but no evidence was found that household mobility moderates the relationship between perinatal risk factors and respiratory outcomes in early childhood.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined how early health risk factors, measured through adverse perinatal outcomes, and poor housing conditions affect the risk of developing respiratory problems during early childhood in Ireland. Using nationally representative data, independent and interactive effects of perinatal outcomes and inadequate home environments were measured on asthma and wheezing across three developmental stages.\u003c/p\u003e\u003cp\u003eIn independent analyses, prematurity, LBW, and NICU admission were consistently associated with higher odds of asthma and wheezing. These results remained stable over time for prematurity and NICU admission, but weakened by age 9 for LBW, likely reflecting natural growth of airways during childhood. This aligns with previous literature [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and suggests a distinct developmental trajectory compared to the more persistent effects of disrupted lung maturation due to prematurity or NICU care.\u003c/p\u003e\u003cp\u003eIndependent analyses of poor housing conditions showed that inadequate warmth, inability to use heating, and warmth deprivation were associated with higher odds of asthma at 9 months, and with wheezing and respiratory symptoms at 3 years, though these effects were not significant by age 9. Dampness, examined only at later ages, was associated with wheezing at age 3 but not with outcomes at age 9. Early-life exposure to suboptimal housing may impair respiratory development. Poor housing conditions act as a distinct risk factor that contributes to cumulative disadvantage through compromised indoor air quality and increased respiratory morbidity.\u003c/p\u003e\u003cp\u003eMaternal education was one of the sociodemographic factors that showed a protective effect; children of mothers with low educational attainment show higher risks of asthma and wheezing compared to those of highly educated mothers [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], underscoring the scaring effect on respiratory health associated with chronic exposure to socioeconomically deprived environments.\u003c/p\u003e\u003cp\u003eAs maternal history of asthma is a risk factor for the development of respiratory conditions in offspring, a proxy was constructed to identify mothers diagnosed with any chronic illness, capturing asthma [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] and other health conditions. Studies indicate that other pathologies [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] (including poor maternal mental health [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]) may also be associated with the onset of asthma or wheezing. Maternal chronic illness emerged as a consistent predictor for adverse respiratory outcomes across all ages, reflecting both genetic predisposition\u0026mdash;especially in cases of maternal asthma\u0026mdash;and potential intrauterine effects such as medication exposure, inflammation, or stress impacting foetal development.\u003c/p\u003e\u003cp\u003eMale sex stands as an independent risk factor for all respiratory outcomes and at all ages, supported by existing evidence showing greater respiratory vulnerability among boys before puberty, likely driven by anatomical and hormonal differences that reverse the trend in adolescence [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Understanding how these patterns change over time is relevant for identifying periods of heightened vulnerability and designing targeted interventions. In contrast with the well-documented impact of tobacco exposure on early respiratory health [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], it did not emerge as a significant risk factor for asthma or wheezing, potentially hiding a problem in the reporting of smoking behaviour.\u003c/p\u003e\u003cp\u003eThe interactions show how inadequate household warmth and warmth deprivation heighten the risk for asthma for children with prematurity, LBW and NICU admission, while only reaching significance for inadequate household warmth. The unexpected attenuation effects observed in some models that explore the inadequate heating variables, may reflect limitations in how these were reported or measured, as mentioned for smoking behaviour.\u003c/p\u003e\u003cp\u003eThis study has several strengths, including the use of a longitudinal nationally representative sample, which ensures that the findings are representative of the children in Ireland. Additionally, the comprehensive range of factors analysed provides an insightful view of the matter, offering a robust approach that includes several health risk factors, exposure, and outcome variables. Some potential limitations should be addressed. The wide CI observed in some interactions reflect smaller subgroup sizes, a common issue when working with multiple events that have low prevalence in the population. Nevertheless, results remained statistically significant, and the association appears robust, coherent with proposed mechanisms, and of clinical importance. Future research with larger samples would help refine these estimates.\u003c/p\u003e\u003cp\u003eIn conclusion, this study identifies adverse perinatal outcomes and poor housing conditions as independent risk factors for childhood respiratory illness, with early interactive effects observed for asthma risk. Vulnerabilities are particularly pronounced among children of mothers with lower socioeconomic resources, pre-existing health conditions, or male. These findings show that targeted interventions towards avoiding exposure to poor housing conditions, a modifiable risk factor, especially among those who are born experiencing early disadvantage, could help mitigate long-term respiratory health inequalities and break the cycle of accumulating disadvantages.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBody mass index\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBronchopulmonary dysplasia\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eConfidence interval\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEAPN\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEuropean Anti-Poverty Network\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFVC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eForced vital capacity\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGUI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGrowing up in Ireland\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLBW\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow birth weight\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNeonatal intense care unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOdds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSES\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSocioeconomic status\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval for the Growing Up in Ireland study was granted by the Health Research Board\u0026rsquo;s Research Ethics Committee and overseen by a committee established by the Department of Children, Equality, Disability, Integration and Youth (DCEDIY). Written informed consent to participate was obtained from parents or legal guardians of all children under the age of 16, and assent was sought from children where appropriate. The study was conducted in accordance with the Declaration of Helsinki (1964) and its later amendments, as well as the Statistics Act (1993), which ensures strict confidentiality. The present analyses are based on anonymised secondary data and did not require additional ethical approval, in line with the regulations of the Central Statistics Office of Ireland.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eTrial registration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccess to the anonymised microdata files is subject to legal and ethical restrictions and therefore not publicly available. Researchers may apply for access through the Irish Social Science Data Archive (ISSDA), University College Dublin: https://www.ucd.ie/issda.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declares no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research has received funding from COORDINATE under the European Union H2020 Grant Agreement No. 101008589. This work was also supported by the Spanish Ministry of Science and Innovation, grants PID2019-111564RB-I00/AEI/10.13039/501100011033 and PRE2020-094473. Beyond funding, these institutions were not involved in the research and/or preparation of the article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN.B.-I. is the sole author and responsible for all aspects of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author thanks the Growing Up in Ireland team, the COORDINATE Network, and Orla Doyle for hosting support and feedback on the article design.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAizer A, Currie J. The intergenerational transmission of inequality: Maternal disadvantage and health at birth. 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Am J Respir Crit Care Med. 1996;153(1):218\u0026ndash;24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1164/ajrccm.153.1.8542119\u003c/span\u003e\u003cspan address=\"10.1164/ajrccm.153.1.8542119\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Social Determinants of Health, Perinatal Outcomes, Childhood, Asthma, Environmental Exposure","lastPublishedDoi":"10.21203/rs.3.rs-7564778/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7564778/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEarly-life disadvantage contributes to the accumulation of health risks across the life course. Adverse perinatal outcomes—prematurity, low birth weight (LBW), and neonatal intensive care unit (NICU) admission—combined with poor housing conditions may heighten the risk of asthma and wheezing in childhood. However, their independent and interactive effects remain underexplored within a cumulative disadvantage framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from the nationally representative Growing Up in Ireland Cohort’08 were analysed, following children at 9 months, 3 years, and 9 years. Logistic regression models, including interaction terms to test moderating effects, were fitted to assess associations between adverse perinatal outcomes, housing conditions, and asthma and wheezing. Analyses were adjusted for sociodemographic characteristics and birth outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrematurity, LBW, and NICU admission were associated with higher odds of asthma and wheezing in childhood; the effects persisted for prematurity and NICU admission but weakened for LBW by age 9. Poor housing increased respiratory risk at 9 months and 3 years only. Interactions showed that prematurity and LBW combined with inadequate household warmth markedly increased asthma risk. Male sex and maternal chronic illness were consistent predictors, while maternal university education was protective.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdverse perinatal outcomes and poor housing conditions independently and interactively increase early respiratory risks. Improving housing conditions may help reduce long-term health inequalities, especially among socioeconomically disadvantaged or medically vulnerable children.\u003c/p\u003e","manuscriptTitle":"Adverse perinatal outcomes and housing conditions as determinants of early-life respiratory health: Evidence from Ireland","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 19:06:14","doi":"10.21203/rs.3.rs-7564778/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-10-09T17:21:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T04:25:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T21:46:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-19T15:23:46+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-09-19T15:20:23+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"be43a612-de30-41f5-b3d9-5a22950102d8","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T19:06:14+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 19:06:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7564778","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7564778","identity":"rs-7564778","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}