Perinatal Exposures and Kawasaki Disease in Washington State: A Population-based, Case-Control Study

Background: This study tested the hypothesis that selected perinatal exposures are associated with Kawasaki Disease (KD) in later childhood. Methods: A retrospective, population-based, case-control study was performed. Children hospitalized for KD in Washington State from 1987 to 2007 (n = 995) were identified through hospital discharge records and were linked to birth certificates and birth hospitalization discharge records. Controls were randomly selected from remaining birth records. Maternal and infant exposure information was obtained from hospital discharge records. Unconditional logistic regression was used to obtain adjusted relative risk estimates and to explore the effect of gender on observed associations. Results: After adjusting for race, gender and birth year, the following were significantly associated with KD: maternal age = 35 years (odds ratio [OR] 1.65; [95% confidence interval: 1.20-2.27]); mother of foreign birth (OR 1.36; [1.06-1.75]); maternal Group B streptococcal colonization (OR 0.51; [0.26-0.97]); and early infancy hospitalization (OR 1.42; [1.04-1.93]). Early hospitalization for bacterial illness was associated with a 2.8-fold increased risk of KD (OR 2.84; [1.59-5.06]). There was weak evidence to suggest that the association between early hospitalization and KD varies by gender. Conclusions: This study provides preliminary evidence of association between certain perinatal exposures and KD and raises the possibility of late biological effects of immune exposures during infancy. The association between KD and early infectious exposures deserves further study.