Association of Maternal Psychosocial Stress With Increased Risk of Asthma Development in Offspring

Maria C. Magnus; Rosalind J. Wright; Espen Røysamb, Christine L. Parr; Øystein Karlstad; ChristianM. Page; Per Nafstad; Siri E. Håberg; Stephanie J. London; Wenche Nystad


Am J Epidemiol. 2018;187(6):1199-1209. 

In This Article

Abstract and Introduction


Prenatal maternal psychosocial stress might influence the development of childhood asthma. Evaluating paternal psychosocial stress and conducting a sibling comparison could provide further insight into the role of unmeasured confounding. We examined the associations of parental psychosocial stress during and after pregnancy with asthma at age 7 years in the Norwegian Mother and Child Cohort Study (n = 63,626; children born in 2000–2007). Measures of psychosocial stress included lifetime major depressive symptoms, current anxiety/depression symptoms, use of antidepressants, anxiolytics, and/or hypnotics, life satisfaction, relationship satisfaction, work stress, and social support. Childhood asthma was associated with maternal lifetime major depressive symptoms (adjusted relative risk (aRR) = 1.19, 95% confidence interval (CI): 1.09, 1.30), in addition to symptoms of anxiety/depression during pregnancy (aRR = 1.17, 95% CI: 1.06, 1.29) and 6 months after delivery (aRR = 1.17, 95% CI: 1.07, 1.28). Maternal negative life events during pregnancy (aRR = 1.10, 95% CI: 1.06, 1.13) and 6 months after delivery (aRR = 1.14, 95% CI: 1.11, 1.18) were also associated with asthma. These associations were not replicated when evaluated within sibling groups. There were no associations with paternal psychosocial stress. In conclusion, maternal anxiety/depression and negative life events were associated with offspring asthma, but this might be explained by unmeasured maternal background characteristics that remain stable across deliveries.


Prenatal exposure to maternal psychosocial stress is associated with increased risk of childhood asthma.[1–16] Previous studies mostly evaluated single measures or a limited number of measures of psychosocial stress or stress correlates (e.g., psychological functioning), including maternal negative life events,[1,4,7,11,15] depression/anxiety,[3,6,12,14,16] community violence,[2] bereavement,[5,8,13] job strain,[9] and demoralization.[10] These studies also varied in the outcome definition, where some evaluated wheezing symptoms[2,10–12,15] and others evaluated asthma.[1,3–9,13,14] Furthermore, most of these studies relied on maternal reporting of childhood asthma, while only a few used information from national registries/administrative databases.[5,8,13,14]

We wanted to further examine whether the previously reported associations between maternal psychosocial stress and its correlates (hereafter denoted psychosocial stress) and risk of childhood asthma might be explained by unmeasured confounding, by using paternal psychosocial stress as a negative control and by conducting a sibling analysis.[17,18] If similar associations of maternal and paternal psychosocial stress with childhood asthma were observed, this could indicate that the reported association between maternal psychosocial stress and childhood asthma is explained by unmeasured background characteristics linked to psychosocial stress in both parents. A few previous studies examined paternal anxiety/depression while the mother was pregnant in relation to childhood asthma, reporting contradictory findings.[6,14] To the best of our knowledge, no previous study of parental psychosocial stress and childhood asthma used a sibling comparison in order to evaluate the potential role of unmeasured confounding by maternal background characteristics that remain stable between deliveries.

Our aim was therefore to estimate the associations of maternal psychosocial stress during and after pregnancy with childhood asthma. We also evaluated associations with paternal psychosocial stress and explored a sibling analysis to evaluate the role of unmeasured confounding. Because this study was performed in Norway, a country with universal access to health-care services and relatively low levels of social inequality, potential confounding by socioeconomic factors was less likely in comparison with many other locations.