Prenatal Depression, Stress Linked to Childhood Asthma Risk

Laurie Barclay, MD

July 18, 2011

July 18, 2011 — Depression, anxiety, and stress during pregnancy are linked to a risk for childhood asthma in the offspring, according to the results of a cohort study reported in the July issue of the Annals of Allergy, Asthma & Immunology.

"Approximately 70 percent of mothers who said they experienced high levels of anxiety or depression while they were pregnant reported their child had wheezed before age 5," said lead author Marilyn Reyes, BA, from Columbia Center for Children's Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, in a news release. "Understanding how maternal depression affects a child's respiratory health is important in developing effective interventions."

The goal of the study was to examine the association of maternal demoralization, or psychological distress, with wheeze, specific wheeze phenotypes, and seroatopy in children residing in a low-income, urban community.

"Prior research has linked maternal prenatal and postnatal mental health with the subsequent development of asthma in children," the study authors write. "However, this relationship has not been examined in inner-city African Americans and Hispanics, populations at high risk for asthma."

The study cohort consisted of 279 pregnant African American and Dominican women 18 to 35 years old who were living in the Bronx and Northern Manhattan areas of New York City. A validated questionnaire was used to assess prenatal and postnatal maternal demoralization. Outcomes measured at birth and at ages 2, 3, and 5 years were wheeze, determined by questionnaire, and total and indoor allergen-specific immunoglobulin E (IgE) levels. Wheeze was characterized as transient (birth to age 2.5 years), late onset (3 - 5 years), and persistent (birth to age 5 years).

The association of demoralization with wheeze and atopy was evaluated with logistic regression with generalized estimating equations, and associations between demoralization and specific wheeze phenotypes were examined with multinomial regression.

Prenatal demoralization was significantly associated with overall wheeze (adjusted odds ratio [OR], 1.66; 95% confidence interval [CI], 1.29 - 2.14), transient wheeze (OR, 2.25; 95% CI, 1.34 - 3.76), and persistent wheeze (OR, 2.69; 95% CI, 1.52 - 4.77), but not with IgE after adjustment (total IgE: OR, 1.04; 95% CI, 0.74 - 1.45; any specific IgE: OR, 0.96; 95% CI, 0.57 - 1.60).

"In this inner-city cohort, prenatal demoralization was associated with transient and persistent wheeze," the study authors write. "Understanding how maternal demoralization influences children's respiratory health may be important for developing effective interventions among disadvantaged populations."

Limitations of this study include possible misclassification of the wheeze outcome; possible effects of maternal demoralization on ability to manage a child's health; and small sample size, preventing control for the effects of viral and other upper respiratory tract infections and other covariates, such as breast-feeding and home endotoxin levels. In addition, the study could not differentiate wheezing attributable to inadequate access to healthcare or compliance with a prescribed medical regimen of anti-inflammatory medications.

"Investigating the effects of chronic vs transient maternal demoralization throughout early childhood emphasizes the importance of assessing health outcomes in children within a multiple exposure perspective," the study authors conclude. "Understanding how maternal demoralization may influence children's health is an important step in developing effective interventions and alleviating the disproportionate burden of asthma and respiratory illness in urban minority populations."

The National Institute of Environmental Health Sciences, US Environmental Protection Agency, Educational Foundation of America; New York Community Trust, John & Wendy Neu Family Foundation, and the Trustees of the Blanchette Hooker Rockefeller Fund supported this study. The study authors have disclosed no relevant financial relationships.

Ann Allergy Asthma Immunol. 2011;107:42-49.


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