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Ramlal M, van der Meer R, Bendien S. Treatable Traits in Pregnant Women with Asthma. Respiration 2024; 103:217-232. [PMID: 38471469 PMCID: PMC10997272 DOI: 10.1159/000536455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/19/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory disease in pregnancy, affecting approximately 8-10% of pregnant women. Uncontrolled asthma is associated with adverse perinatal outcomes, including low birth weight, preterm birth, and maternal complications such as pre-eclampsia. SUMMARY A current approach to the management of chronic airway diseases is based on targeting treatable traits. The aim of this review was to define treatable traits in pregnant women with asthma based on recent literature and to determine personalized treatment options according to these traits. Traits addressed in this review that may improve asthma control and pregnancy outcomes are fractional exhaled nitric oxide-based asthma monitoring and treatment, medication adherence and inhalation technique, impaired lung function, smoking cessation and comorbidity including psychological conditions (depression and anxiety), obesity, rhinitis, gastroesophageal reflux disease, chronic rhinosinusitis with or without nasal polyps, and sleep apnea. KEY MESSAGES All the treatable traits discussed have the potential to improve asthma control and pregnancy outcomes in pregnant women with asthma. Further research is needed to determine which management approaches are best to improve asthma control during pregnancy, to identify other relevant treatable traits, and to determine whether the treatable trait approach is feasible and beneficial in pregnant women with asthma.
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Affiliation(s)
- Meera Ramlal
- Department of Biomedical Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Renske van der Meer
- Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sarah Bendien
- Department of Pulmonology, Haga Teaching Hospital, The Hague, The Netherlands
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van Gelder MMHJ, van Wijk EJC, Roukema J, Roeleveld N, Verhaak CM, Merkus PJFM. Maternal depressive symptoms during pregnancy and infant wheezing up to 2 years of age. Ann Epidemiol 2023; 88:43-50. [PMID: 37944679 DOI: 10.1016/j.annepidem.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 10/15/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To determine whether maternal depressive symptoms at multiple time points during pregnancy are associated with infant wheezing in the first 2 years of life to assess etiologically relevant time windows. METHODS We included Dutch women participating in the PRIDE Study with delivery in 2013-2019. Maternal depressive symptoms were assessed with the Hospital Anxiety and Depression Scale and Edinburgh Depression Scale at enrollment and in gestational weeks 17 and 34. The International Study of Asthma and Allergies in Childhood questionnaire was used to assess infant wheezing biannually postpartum. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were estimated with modified Poisson regression. RESULTS Among 5294 pregnancies included, maternal depressive symptoms in gestational weeks 15-22 was associated with any wheezing in the first 2 years of life (RR 1.36, 95% CI 1.04-1.78) and with current wheezing at 12 (RR 1.29, 95% CI 1.03-1.61) and 18 months (RR 1.33, 1.04-1.69). Depressive symptoms in gestational weeks 32-35 seemed to be associated with any wheezing reported at two years (RR 1.27, 95% CI 0.96-1.69) and current wheezing at 12 months (RR 1.28, 95% CI 1.02-1.60). Four trajectories of depressive symptoms were identified. Only the trajectory with increasing symptoms throughout pregnancy seemed to be associated with infant wheezing (RR 1.36, 95% CI 0.97-1.89). CONCLUSIONS Maternal depressive symptoms in mid- and late pregnancy may be associated with development of infant wheezing, particularly those with onset in the second half of pregnancy. Research is needed to identify biological pathways and associations with more objective, long-term respiratory morbidity.
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Affiliation(s)
| | - Emma J C van Wijk
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jolt Roukema
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Peter J F M Merkus
- Department of Pediatric Pulmonology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
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Freeman RE, Qi YS, Geller RJ, Cohen AR, Iyer SS, Waynik IY, Sullivan AF, Camargo CA. Parental Mental Health and Childhood Respiratory Outcomes in a Severe Bronchiolitis Cohort. Clin Pediatr (Phila) 2023; 62:1067-1079. [PMID: 36715245 DOI: 10.1177/00099228221150608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Parental mental health conditions appear to contribute to the development of childhood respiratory illness. We investigated the relationship between parental mental health and childhood respiratory illness using data from a 17-center prospective cohort study of infants hospitalized with bronchiolitis between 2011 and 2014 (n = 921). Among 779 (84.6%) participants with self-reported parental mental health history data, 184 (23.6%) had parental history of depression and 155 (19.9%) had anxiety. Multivariable analyses found that both parental history of depression (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.01-1.99) and anxiety (HR 1.28, 95% CI 1.08-1.52) were associated with an increased risk of recurrent wheezing by age 3 years. However, only parental history of anxiety was associated with asthma by age 5 years (odds ratio 1.79, 95% CI 1.25-2.55). Further research on exposure severity, other early life stressors, and effective methods of parental psychosocial support is needed to develop targeted risk factor prevention strategies to reduce the burden of childhood respiratory illness.
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Affiliation(s)
- Rain E Freeman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Population Health Research, School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | - Ying Shelly Qi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruth J Geller
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ari R Cohen
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sujit S Iyer
- Department of Pediatric Emergency Medicine, Dell Children's Medical Center of Central Texas, Austin, TX, USA
| | - Ilana Y Waynik
- Connecticut Children's Medical Center, Hartford, CT, USA
| | - Ashley F Sullivan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Batmaz SB, Birinci G, Akpınar Aslan E. Quality of Life of Children with Allergic Disease: The effect of Depression and Anxiety of Children and Their Mothers. J Asthma 2021; 59:1776-1786. [PMID: 34503366 DOI: 10.1080/02770903.2021.1978480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: In comparison with the general population, several studies have reported higher anxiety and depression rates not only in children with allergic diseases but also in their parents. We aimed to evaluate the mental health of children and their mothers affecting quality of life (QoL) in children with allergic diseases, and to compare anxiety and depression in these patients and their parents with the general population.Methods: One hundred and sixty-eight patients aged 8-18 years diagnosed with an allergic disease who visited our outpatient clinic and a control group of 61 children who did not have any chronic or allergic diseases were included in the study. Patients completed the Pediatric QoL Inventory, Trait Anxiety Inventory for Children, and Children's Depression Inventory, while mothers completed the General Anxiety Disorder-7 (GAD-7) scale and the Patient Health Questionnaire-9 (PHQ-9). Independent samples' t-test was used to compare children's QoL, trait anxiety, and depression scores and mothers' GAD-7 and PHQ-9 scores between the controlled/mild and uncontrolled/moderate-severe groups. The effects of age, gender, disease severity, maternal depression/anxiety, and children's depression/anxiety on QoL were analyzed with multivariate regression analyses.Results: QoL was lower in children with allergic diseases than healthy children, and although the mean QoL score was lower in the group with high disease severity, QoL in children with allergic diseases was not associated with disease severity but inversely related to anxiety/depression and maternal depression.Conclusions: As per the results, QoL is impaired in children with allergic diseases. Both anxiety/depression in the child and maternal depression may adversely affect QoL in these patients.
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Affiliation(s)
- Sehra Birgül Batmaz
- Department of Pediatric Allergy and Clinical Immunology, Tokat State Hospital, Tokat, Turkey
| | | | - Esma Akpınar Aslan
- Department of Psychiatry, School of Medicine, Tokat Gaziosmanpasa University, Tokat, Turkey
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Yilmaz O, Yasar A, Caliskan Polat A, Ay P, Alkin T, Taneli F, Odabasi Cingoz F, Hasdemir PS, Simsek Y, Yuksel H. Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines. Pediatr Pulmonol 2021; 56:1573-1582. [PMID: 33587823 DOI: 10.1002/ppul.25302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/07/2020] [Accepted: 01/22/2021] [Indexed: 11/09/2022]
Abstract
RATIONALE Maternal psychosocial stress might be associated with development of allergic diseases in the offspring. OBJECTIVES To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association. METHODS This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13 and interferon γ. RESULTS We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 ± 274.8 vs. 201.6 ± 299.7, p = .04). CONCLUSIONS In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.
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Affiliation(s)
- Ozge Yilmaz
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Adem Yasar
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Arzu Caliskan Polat
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Pinar Ay
- Department of Public Health, Marmara University Medical Faculty, Istanbul, Turkey
| | - Tunc Alkin
- Department of Psychiatry, Dokuz Eylül University Medical Faculty, Izmir, Turkey
| | - Fatma Taneli
- Department of Biochemistry, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Ferhan Odabasi Cingoz
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Pinar S Hasdemir
- Department of Obstetrics and Gynecology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Yurda Simsek
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
| | - Hasan Yuksel
- Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey
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Margolis R, Bellin MH, Bookman JRM, Collins KS, Bollinger ME, Lewis-Land C, Butz AM. Fostering Effective Asthma Self-Management Transfer in High-Risk Children: Gaps and Opportunities for Family Engagement. J Pediatr Health Care 2019; 33:684-693. [PMID: 31253454 PMCID: PMC6815689 DOI: 10.1016/j.pedhc.2019.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The process of self-management knowledge, behavior, and skill development in children with asthma from families with low income is understudied. METHOD Fifteen mothers of children with uncontrolled asthma participated in semistructured interviews exploring the transfer of asthma self-management responsibilities from parent to child. Team members performed thematic analysis of written transcripts. RESULTS All participants were all the biological mothers and were impoverished, with most (73%) reporting an annual family income of less than $30,000. Their children ranged from 5 to 15 years old, were African American (100%), and had uncontrolled asthma based on national guidelines. Themes showed that child asthma self-management is difficult to achieve, that the transfer of asthma responsibility from mother to child is variable, and that mothers overestimate their child's developmental capacities for independent asthma self-management and have poor understanding of what well-controlled asthma means. DISCUSSION Ongoing assessment and tailored guidance from health care providers are critical to support the pivotal role of mothers in their child's self-management development process.
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Affiliation(s)
- Rachel Margolis
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | - Melissa H. Bellin
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Kathryn S. Collins
- University of Maryland School of Social Work, Division of General Pediatrics and Adolescent Medicine
| | | | - Cassie Lewis-Land
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
| | - Arlene M. Butz
- Johns Hopkins University School of Medicine, Division of General Pediatrics and Adolescent Medicine
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Weinstein SM, Pugach O, Rosales G, Mosnaim GS, Walton SM, Martin MA. Family Chaos and Asthma Control. Pediatrics 2019; 144:peds.2018-2758. [PMID: 31289192 PMCID: PMC6855822 DOI: 10.1542/peds.2018-2758] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Asthma is a highly prevalent childhood chronic disease, with particularly high rates among poor and minority youth. Psychosocial factors have been linked to asthma severity but remain poorly understood. This study examined (1) relationships between parent and child depression and posttraumatic stress disorder (PTSD) symptoms, family functioning, and child asthma control in a sample of urban minority youth with uncontrolled asthma and (2) family functioning as a pathway linking parent depression and asthma outcomes. METHODS Data were drawn from the baseline cohort of a randomized trial testing community interventions for children aged 5 to 16 with uncontrolled asthma (N = 223; mean age = 9.37, SD = 3.02; 85.2% Hispanic). Asthma control was defined by using the Asthma Control Test and Childhood Asthma Control Test, activity limitation, and previous-12-month asthma severity. Psychosocial measures included parent and child depression and PTSD symptoms, family chaos, and parent social support. RESULTS Parent and child depression symptoms, but not PTSD, were associated with worse asthma control (β = -.20 [SE = 0.06] and β = -.12 [SE = -.03]; P < .001). Family chaos corresponded to worse asthma control, even when controlling for parent and child depression (β = -.33; [SE = 0.15]; P < .05), and was a mediator of the parent depression-asthma path. Emotional triggers of asthma also mediated the parent depression-asthma relationship. CONCLUSIONS Findings highlight family chaos as a mechanism underlying the relationship between parent depression and child asthma control. Addressing parent and child depression, family routines, and predictability may optimize asthma outcomes.
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Affiliation(s)
| | | | | | | | - Surrey M. Walton
- Pharmacy Systems Outcomes and Policy, University of Illinois at Chicago, Chicago, Illinois; and
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8
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Brew BK, Lundholm C, Viktorin A, Lichtenstein P, Larsson H, Almqvist C. Longitudinal depression or anxiety in mothers and offspring asthma: a Swedish population-based study. Int J Epidemiol 2019; 47:166-174. [PMID: 29040553 PMCID: PMC5837783 DOI: 10.1093/ije/dyx208] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 12/15/2022] Open
Abstract
Background Previous research has found that maternal stress during pregnancy increases the risk of offspring asthma. However, whether this association is consistent with a causal interpretation has never been tested. The objective is to determine whether there is a critical exposure period for maternal depression or anxiety on offspring asthma or whether cumulative exposure is most important, and to investigate evidence of confounding. Methods The study population included all children born in Sweden from July 2006 to December 2009 (n = 360 526). Information about childhood asthma, maternal depression or anxiety (diagnosis or medication) and covariates was obtained from the Swedish national health registers. The associations between exposure periods (pre-conception, pregnancy, postnatal or current) and childhood asthma were estimated using structured life course approach hypothesis testing. Paternal and cousin analyses were used to test for evidence of confounding from shared genes and environment. Results For childhood asthma, cumulative exposure best described the effect of exposure to maternal depression or anxiety up to a maximum of any two exposure periods [adjusted odds ratio 1.44, 95% confidence interval (CI) 1.38, 1.52]. The hypotheses of a critical period were not supported. The paternal and cousin analyses indicated minimal influence from familial confounding. Conclusions These findings support an association between cumulative exposure to maternal depression or anxiety and asthma development in offspring. This association is unique for maternal depression or anxiety and not due to familial confounding. The clinical implication is that effective psychological management of women with chronic distress may reduce offspring asthma risk.
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Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden. E-mail:
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Alexander Viktorin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Maternal psychological distress during pregnancy and childhood health outcomes: a narrative review. J Dev Orig Health Dis 2018; 10:274-285. [PMID: 30378522 DOI: 10.1017/s2040174418000557] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Maternal psychological distress is common in pregnancy and may influence the risk of adverse outcomes in children. Psychological distress may cause a suboptimal intrauterine environment leading to growth and developmental adaptations of the fetus and child. In this narrative review, we examined the influence of maternal psychological distress during pregnancy on fetal outcomes and child cardiometabolic, respiratory, atopic and neurodevelopment-related health outcomes. We discussed these findings from an epidemiological and life course perspective and provided recommendations for future studies. The literature in the field of maternal psychological distress and child health outcomes is extensive and shows that exposure to stress during pregnancy is associated with multiple adverse child health outcomes. Because maternal psychological distress is an important and potential modifiable factor during pregnancy, it should be a target for prevention strategies in order to optimize fetal and child health. Future studies should use innovative designs and strategies in order to address the issue of causality.
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Magnus MC, Wright RJ, Røysamb E, Parr CL, Karlstad Ø, Page CM, Nafstad P, Håberg SE, London SJ, Nystad W. Association of Maternal Psychosocial Stress With Increased Risk of Asthma Development in Offspring. Am J Epidemiol 2018; 187:1199-1209. [PMID: 29244063 PMCID: PMC5982733 DOI: 10.1093/aje/kwx366] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/22/2017] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Maria C Magnus
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Rosalind J Wright
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Espen Røysamb
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Christine L Parr
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øystein Karlstad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Christian M Page
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Per Nafstad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway
| | - Siri E Håberg
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Wenche Nystad
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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Flanigan C, Sheikh A, DunnGalvin A, Brew BK, Almqvist C, Nwaru BI. Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: A systematic review and meta-analysis. Clin Exp Allergy 2018; 48:403-414. [PMID: 29331049 DOI: 10.1111/cea.13091] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/17/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Prenatal maternal stress may influence offspring's atopic risk through sustained cortisol secretion resulting from activation of the hypothalamic-pituitary axis (HPA), leading to Th2-biased cell differentiation in the foetus. We undertook a systematic review and meta-analysis investigating the relationship between prenatal maternal psychosocial stress and risk of asthma and allergy in the offspring. METHODS We searched 11 electronic databases from 1960 to 2016, searched the grey literature and contacted experts in the field. Type of stress indicator included mood disorders, anxiety, exposure to violence, bereavement and socio-economic problems occurring during pregnancy, both objectively and subjectively measured. We included all possible asthma and IgE-mediated allergy outcomes. We conducted random-effects meta-analyses to synthesize the data. RESULTS We identified 9779 papers of which 30 studies (enrolling >6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, 4 were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema/dermatitis (OR 1.34, 95% CI 1.22-1.47), allergic rhinitis (OR 1.30, 95% CI 1.04-1.62), wheeze (OR 1.34, 95% CI 1.16-1.54) and asthma (OR 1.15, 95% CI 1.04-1.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early-onset and persistent than for late-onset wheeze. Bereavement of a child (HR 1.28, 95% CI 1.10-1.48) or a spouse (HR 1.40, 95% CI 1.03-1.90) increased the risk of offspring asthma. CONCLUSIONS Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester-specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding.
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Affiliation(s)
- C Flanigan
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - A Sheikh
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - A DunnGalvin
- Department of Paediatrics and Child Health, Cork University Hospital, Cork City, Ireland.,University College Cork, Cork City, Ireland.,School of Applied Psychology, University College Cork, Cork City, Ireland
| | - B K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - B I Nwaru
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK.,Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,School of Health Sciences, University of Tampere, Tampere, Finland
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Zhou C, Ibanez G, Miramont V, Steinecker M, Baiz N, Banerjee S, Just J, Annesi-Maesano I, Chastang J. Prenatal maternal depression related to allergic rhinoconjunctivitis in the first 5 years of life in children of the EDEN mother-child cohort study. ALLERGY & RHINOLOGY 2017; 8:132-138. [PMID: 29070270 PMCID: PMC5662538 DOI: 10.2500/ar.2017.8.0213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Backgroud: Evidence about the relationship between prenatal maternal depression and the development of childhood asthma and allergies in early life is scarce. We aimed to examine this relationship by using data set of EDEN mother-child cohort study. A total of 1139 children were followed-up until the age of 5 years. METHODS Prenatal maternal depression was self-reported by using the Centre for Epidemiological Studies-Depression scale (CES-D) questionnaire and was classified into binary variable (maternal depression [CES-D score of ≥16] and no maternal depression [CES-D score of <16]). Asthma and allergies in the first 5 years were assessed by using the questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC). Adjusted odds ratio (aOR) was estimated for the relationship between prenatal maternal depression and early life asthma and allergies by marginal models through the method of generalized estimating equation (GEE) when adjusting for the confounders. RESULTS In our study population, 13.67 % of the mothers had clinical significant depression (the total scores for CES-D ≥16) during pregnancy. For children ages 5 years, the prevalence of wheezing, physician-diagnosed asthma, physician-diagnosed eczema and allergic rhinoconjunctivitis were 46.78, 20.99, 29.17, and 22.54%, respectively. Prenatal maternal depression was associated with ever allergic rhinoconjunctivitis (aOR 1.87 [95% confidence interval {CI}, 1.33-2.62]). No significant relationships were found between prenatal maternal depression and wheezing, physician-diagnosed asthma and physician-diagnosed eczema (aOR 1.12 [95% CI, 0.91-1.39], aOR 1.23 [95% CI, 0.81-1.85] and aOR 1.17 [95% CI, 0.86-1.61], respecitvely). CONCLUSION Prenatal maternal depression was related to ever allergic rhinoconjunctivitis in the first 5 years of life in children of EDEN mother-child cohort study.
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Affiliation(s)
- Cailiang Zhou
- From the Division of Statistics, Measurement and Evaluation of sport, College of Sport Science, Bejing Sport University, Beijing, China
| | - Gladys Ibanez
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Vincent Miramont
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Magali Steinecker
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Nour Baiz
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Soutrik Banerjee
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Jocelyne Just
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Isabella Annesi-Maesano
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
| | - Julie Chastang
- Sorbonne Universités, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Epidemiology of Allergic and Respiratory Disease Department, Paris, France
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13
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Maternal depressive symptoms, maternal asthma, and asthma in school-aged children. Ann Allergy Asthma Immunol 2017; 118:55-60.e1. [PMID: 28007088 DOI: 10.1016/j.anai.2016.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the joint effects of maternal asthma and maternal depression on childhood asthma. OBJECTIVE To examine whether maternal depression and maternal asthma lead to greater risk of childhood asthma than maternal asthma alone. METHODS Cross-sectional studies of children (6-14 years old) in San Juan, Puerto Rico (n = 655) and Sweden (n = 6,887) were conducted. In Puerto Rico, maternal depressive symptoms were defined using the Center for Epidemiologic Studies Depression Scale (CES-D) questionnaire. In Sweden, maternal physician-diagnosed depression was derived from national registries, and maternal depressive symptoms were defined using an abbreviated CES-D questionnaire. Childhood asthma was defined as physician-diagnosed asthma plus current wheeze (in Puerto Rico) or plus medication use (in Sweden). Logistic regression was used for multivariable analysis. RESULTS Compared with Puerto Rican children whose mothers had neither asthma nor depressive symptoms, those whose mothers had asthma but no depressive symptoms had 3.2 times increased odds of asthma (95% confidence interval [CI] = 2.1-4.8) and those whose mothers had asthma and depressive symptoms had 6.5 times increased odds of asthma (95% CI = 3.3-13.0). Similar results were obtained for maternal depression and maternal asthma in the Swedish cohort (odds ratio for maternal asthma without maternal depression = 2.8, 95% CI = 2.1-3.7; odds ratio for maternal asthma and maternal depression = 4.0, 95% CI = 1.7-9.6). Although the estimated effect of maternal asthma on childhood asthma was increased when maternal depressive symptoms (Puerto Rico) or maternal depression (Sweden) was present, there were no statistically significant additive interactions. CONCLUSION Maternal depression can further increase the risk of asthma in children whose mothers have a history of asthma.
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14
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Abstract
OBJECTIVES Exposure to child abuse (CA) is associated with an increased risk of developing asthma and allergies; it is unknown if that risk is present across generations. This study investigated if 2-year-old children born to mothers with a history of CA were at an increased risk of receiving a diagnosis of asthma or allergies. METHODS Data from 1,551 participants were collected as part of the All Our Babies (AOB) study, a prospective pregnancy cohort. During pregnancy, each woman provided information about her own history of CA, and at 24 months postpartum, she provided information about her child's medical diagnoses. Symptoms of maternal depression and anxiety were assessed during pregnancy and at 24 months postpartum. RESULTS Unadjusted models showed that compared to children born to mothers without a history of CA, 2-year-old children born to mothers with a history of CA were more likely to have had a diagnosis of asthma (7.4% vs 4.2%, p = .016) or allergy (15.6% vs 9.2%, p < .001). Maternal symptoms of depression assessed in late pregnancy and symptoms of depression and anxiety at 24 months postpartum were significant mediators of the relationship between maternal CA and 2-year-old asthma diagnosis. Maternal symptoms of depression and anxiety assessed in late pregnancy were also significant mediators of the relationship between maternal CA and 2-year-old allergy diagnosis. CONCLUSIONS The results indicate that maternal exposure to CA is associated with increased risk of asthma and allergy in their 2-year-old children; symptoms of maternal depression and anxiety were identified as pathways linking the variables.
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15
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The effects of early life adversity on the immune system. Psychoneuroendocrinology 2017; 82:140-154. [PMID: 28549270 DOI: 10.1016/j.psyneuen.2017.05.012] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/11/2017] [Accepted: 05/15/2017] [Indexed: 11/23/2022]
Abstract
Early life adversity (ELA) is associated with a higher risk for diseases in adulthood. Although the pathophysiological effects of ELA are varied, there may be a unifying role for the immune system in all of the long-term pathologies such as chronic inflammatory disorders (autoimmune diseases, allergy, and asthma). Recently, significant efforts have been made to elucidate the long-term effects ELA has on immune function, as well as the mechanisms underlying these immune changes. In this review, we focus on data from human studies investigating immune parameters in relation to post-natal adverse experiences. We describe the current understanding of the 'ELA immune phenotype', characterized by inflammation, impairment of the cellular immune system, and immunosenescence. However, at present, data addressing specific immune functions are limited and there is a need for high-quality, well powered, longitudinal studies to unravel cause from effect. Besides the immune system, also the stress system and health behaviors are altered in ELA. We discuss probable underlying mechanisms based on epigenetic programming that could explain the ELA immune phenotype and whether this is a direct effect of immune programming or an indirect consequence of changes in behavior or stress reactivity. Understanding the underlying mechanisms will help define effective strategies to prevent or counteract negative ELA-associated outcomes.
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16
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Alton ME, Zeng Y, Tough SC, Mandhane PJ, Kozyrskyj AL. Postpartum depression, a direct and mediating risk factor for preschool wheeze in girls. Pediatr Pulmonol 2016; 51:349-57. [PMID: 26448278 DOI: 10.1002/ppul.23308] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postpartum depression affects over 1 in 10 child-bearing women. A growing body of evidence links maternal distress during the key developmental stages of infants with poor health outcomes, including wheeze and asthma. OBJECTIVE We sought to investigate whether postpartum depression had an independent association with the development of wheeze in preschool-aged children. A second a priori objective was to ascertain whether postpartum depression functioned as a mediating factor for associations between wheeze, and prenatal distress and nutrition. METHODS Data from the Community Perinatal Care Trial on maternal postpartum depression (Edinburgh Postnatal Depression Scale), the dependent variable, wheeze at age 3, and possible confounding factors were obtained for 791 women and their children in Calgary, Canada. Adjusted gender-specific logistic regression analyses were performed to test the association between postpartum depression and child wheeze, which was independent of maternal distress and vitamin use during pregnancy, pre/postnatal smoking, preterm birth, exclusive breastfeeding duration, daycare attendance, and maternal education. The potential mediating effects of postpartum depression were investigated in a path analysis. RESULTS Wheeze at age 3 was almost 5 times more likely in girls of mothers who experienced postpartum depression. Results from a path analysis suggested that postpartum depression has a direct effect on wheeze (beta-coefficient=0.135, P < 0.05), and also mediates the effects of prenatal distress and vitamin use on wheeze in preschool girls. In boys, only prenatal smoking was a statistically significant predictor of wheeze, mainly through the effects of postnatal smoking. CONCLUSIONS & CLINICAL RELEVANCE Postpartum depression may be a risk factor for preschool wheeze among girls in a low risk population, directly and indirectly through prenatal distress and vitamin use. Interventions which target postpartum depression and promote a healthy pregnancy may also reduce the risk of wheeze in children.
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Affiliation(s)
- Megan E Alton
- Faculty of Medicine, University of Calgary, Calgary, Alberta
| | - Yiye Zeng
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Suzanne C Tough
- Departments of Paediatrics and Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta
| | - Piushkumar J Mandhane
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,School of Public Health, University of Alberta, Edmonton, Alberta
| | - Anita L Kozyrskyj
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta.,School of Public Health, University of Alberta, Edmonton, Alberta
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17
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Andersson NW, Hansen MV, Larsen AD, Hougaard KS, Kolstad HA, Schlünssen V. Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies. Allergy 2016; 71:15-26. [PMID: 26395995 PMCID: PMC5054838 DOI: 10.1111/all.12762] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child. METHODS The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014. RESULTS Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends. CONCLUSION This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
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Affiliation(s)
- N. W. Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
- Sydney Medical School Faculty of Medicine University of Sydney Concord Hospital Sydney NSW Australia
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - M. V. Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - A. D. Larsen
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - K. S. Hougaard
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - H. A. Kolstad
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
| | - V. Schlünssen
- The National Research Centre for the Working Environment Copenhagen Denmark
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
- Section for Environment, Occupation and Health Department of Public Health Danish Ramazzini Centre Aarhus University Aarhus Denmark
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18
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Cheng TS, Chen H, Lee T, Teoh OH, Shek LP, Lee BW, Chee C, Godfrey KM, Gluckman PD, Kwek K, Saw SM, Chong YS, Meaney M, Broekman BFP, Chay OM, Van Bever H, Goh A. An independent association of prenatal depression with wheezing and anxiety with rhinitis in infancy. Pediatr Allergy Immunol 2015; 26:765-71. [PMID: 26235785 DOI: 10.1111/pai.12453] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Different maternal psychological states during pregnancy have been associated with wheeze-rhinitis-eczema symptoms in children. However, previous studies were limited and it was unclear whether the type of prenatal psychological state was associated with a particular symptom. We examined the association of maternal depression and anxiety during pregnancy with wheeze-rhinitis-eczema symptoms in infancy. METHODS In a longitudinal birth cohort (GUSTO) of 1152 mother-child pairs, wheeze-rhinitis-eczema symptoms in the infants during the first year of life were collected by parental report. Maternal depressive and anxiety symptoms were assessed at 26 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and State Trait Anxiety Inventory (STAI). Logistic regression analyses were performed with adjustment for potential confounders. RESULTS An increased risk of wheezing was found in infants of pregnant women with probable depression (EPDS ≥ 15) [odds ratio (OR) = 1.85 (95% confidence interval (CI) 1.10-3.12)], and an increased risk of rhinitis was associated with maternal anxiety [STAI state ≥ 41: OR = 1.42 (95% CI 1.04-1.93); STAI trait ≥ 43: OR = 1.38 (95% CI 1.01-1.88)]. After adjusting for known risk factors for the development of allergic disease, these associations remained significant [EPDS ≥ 15: adjusted OR = 2.09 (95% CI 1.05-4.19); STAI state ≥ 41: adjusted OR = 1.82 (95% CI 1.17-2.82); STAI trait ≥ 43: adjusted OR = 1.70 (95% CI 1.10-2.61)]. However, maternal psychological states were not associated with infantile eczema. CONCLUSION This study suggests that there may be an independent effect of prenatal depression on wheezing and anxiety on rhinitis in infancy.
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Affiliation(s)
- Tuck Seng Cheng
- KK Women's and Children's Hospital, Singapore City, Singapore
| | - Helen Chen
- KK Women's and Children's Hospital, Singapore City, Singapore.,Duke-NUS Graduate Medical School, Singapore City, Singapore
| | - Theresa Lee
- KK Women's and Children's Hospital, Singapore City, Singapore.,Duke-NUS Graduate Medical School, Singapore City, Singapore
| | - Oon Hoe Teoh
- KK Women's and Children's Hospital, Singapore City, Singapore.,Duke-NUS Graduate Medical School, Singapore City, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Lynette P Shek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Bee Wah Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Cornelia Chee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore City, Singapore.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Kenneth Kwek
- KK Women's and Children's Hospital, Singapore City, Singapore
| | - Seang Mei Saw
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore City, Singapore
| | - Yap-Seng Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Michael Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore City, Singapore
| | - Birit F P Broekman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore City, Singapore
| | - Oh Moh Chay
- KK Women's and Children's Hospital, Singapore City, Singapore.,Duke-NUS Graduate Medical School, Singapore City, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Hugo Van Bever
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Anne Goh
- KK Women's and Children's Hospital, Singapore City, Singapore.,Duke-NUS Graduate Medical School, Singapore City, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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19
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van de Loo KFE, van Gelder MMHJ, Roukema J, Roeleveld N, Merkus PJFM, Verhaak CM. Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-analysis. Eur Respir J 2015; 47:133-46. [PMID: 26541526 DOI: 10.1183/13993003.00299-2015] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 08/17/2015] [Indexed: 02/07/2023]
Abstract
The aim of this study was to systematically review and meta-analyse observational studies on prenatal maternal psychological stress and the subsequent development of asthma and wheezing in early childhood.All available published literature from 1960 until November 2013 was systematically searched through electronic databases (PubMed, Embase, PsycInfo and Web of Science). All observational studies assessing associations between any form of prenatal maternal psychological stress and respiratory morbidity in the child were included. Data extraction, quality assessment and meta-analyses were performed.The overall meta-analysis included 10 studies and showed that the prevalence of wheezing, asthma and other respiratory symptoms is higher in children of mothers who were exposed to or experienced some form of psychological stress during pregnancy than in mothers who did not (pooled OR 1.56 (95% CI 1.36-1.80)). Comparable results were observed in subgroup analyses of stress exposure, perceived stress, asthma and wheezing.This study demonstrates that prenatal maternal psychological stress is associated with respiratory morbidity, including asthma and wheezing in the child. Future studies examining the early origins of asthma and wheezing need to account for the impact of prenatal maternal stress.
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Affiliation(s)
- Kim F E van de Loo
- Dept of Medical Psychology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Jolt Roukema
- Dept of Pediatric Pulmonology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Dept for Health Evidence, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Dept of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J F M Merkus
- Dept of Pediatric Pulmonology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands Both authors contributed equally
| | - Christianne M Verhaak
- Dept of Medical Psychology, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands Both authors contributed equally
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20
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Teyhan A, Galobardes B, Henderson J. Child Allergic Symptoms and Well-Being at School: Findings from ALSPAC, a UK Cohort Study. PLoS One 2015; 10:e0135271. [PMID: 26266935 PMCID: PMC4534318 DOI: 10.1371/journal.pone.0135271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 07/20/2015] [Indexed: 11/19/2022] Open
Abstract
Background Eczema and asthma are common conditions in childhood that can influence children’s mental health. Despite this, little is known about how these conditions affect the well-being of children in school. This study examines whether symptoms of eczema or asthma are associated with poorer social and mental well-being in school as reported by children and their teachers at age 8 years. Methods Participants were from the Avon Longitudinal Study of Parents and Children. Measures of child well-being in school were child-reported (n = 6626) and teacher reported (n = 4366): children reported on their enjoyment of school and relationships with peers via a self-complete questionnaire; teachers reported child mental well-being using the Strengths and Difficulties Questionnaire [binary outcomes were high ‘internalizing’ (anxious/depressive) and ‘externalizing’ (oppositional/hyperactive) problems (high was >90th percentile)]. Child rash and wheeze status were maternally reported and symptoms categorised as: ‘none’; ‘early onset transient’ (infancy/preschool only); ‘persistent’ (infancy/preschool and at school age); and ‘late onset’ (school age only). Results Children with persistent (OR 1.29, 95% CI 1.02 to 1.63) and late onset (OR 1.48, 95% CI 1.02 to 2.14) rash were more likely to report being bullied, and children with persistent wheeze to feel left out (OR 1.42, 95% CI 1.10 to 1.84). Late onset rash was associated with high teacher-reported internalising behaviours (OR 1.61, 95% CI 1.02 to 2.54), and persistent rash with high externalising behaviours (OR 1.37, 95% CI 1.02 to 1.84). Child sleep and maternal mental health explained some of the associations with teacher-reported mental well-being. Conclusion Symptoms of eczema or asthma can adversely affect a child’s social and mental well-being at primary school. This suggests interventions, such as additional support or education of peers, should begin at early stages in schooling.
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Affiliation(s)
- Alison Teyhan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Bruna Galobardes
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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21
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Easter G, Sharpe L, Hunt CJ. Systematic Review and Meta-Analysis of Anxious and Depressive Symptoms in Caregivers of Children With Asthma. J Pediatr Psychol 2015; 40:623-32. [PMID: 25829528 DOI: 10.1093/jpepsy/jsv012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 02/02/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide a review of the literature comparing anxious and depressive symptoms in caregivers of children with asthma with caregivers of healthy children. METHOD A systematic search identified 25 studies from 17 articles, reporting outcomes on 4,300 caregivers of children with asthma and 25,064 caregivers of healthy children. RESULTS Overall, anxious (d = 0.50) and depressive symptoms (d = 0.44) were higher in caregivers of children with asthma compared with caregivers of healthy children. Age, site of recruitment, and whether the asthma diagnosis was medically confirmed were included as potential moderators. The relationship between parental psychopathology and asthma was stronger in those with medically confirmed asthma and participants recruited from clinical settings. Other moderators were not significant. CONCLUSIONS Caregivers of children with asthma appear to have greater anxious and depressive symptoms than caregivers of healthy children, but the reasons are unclear. More research that investigates modifiable factors that may moderate this association is urgently needed.
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22
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Giallo R, Bahreinian S, Brown S, Cooklin A, Kingston D, Kozyrskyj A. Maternal depressive symptoms across early childhood and asthma in school children: findings from a Longitudinal Australian Population Based Study. PLoS One 2015; 10:e0121459. [PMID: 25811851 PMCID: PMC4374762 DOI: 10.1371/journal.pone.0121459] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/18/2014] [Indexed: 11/26/2022] Open
Abstract
There is a growing body of evidence attesting to links between early life exposure to stress and childhood asthma. However, available evidence is largely based on small, genetically high risk samples. The aim of this study was to explore the associations between the course of maternal depressive symptoms across early childhood and childhood asthma in a nationally representative longitudinal cohort study of Australian children. Participants were 4164 children and their biological mothers from the Longitudinal Study of Australian Children. Latent class analysis identified three trajectories of maternal depressive symptoms across four biennial waves from the first postnatal year to when children were 6–7 years: minimal symptoms (74.6%), sub-clinical symptoms (20.8%), and persistent and increasing high symptoms (4.6%). Logistic regression analyses revealed that childhood asthma at age 6–7 years was associated with persistent and increasing high depressive symptoms after accounting for known risk factors including smoking during pregnancy and maternal history of asthma (adjusted OR 2.36, 95% CI 1.61–3.45), p.001). Our findings from a nationally representative sample of Australian children provide empirical support for a relationship between maternal depressive symptoms across the early childhood period and childhood asthma. The burden of disease from childhood asthma may be reduced by strengthening efforts to promote maternal mental health in the early years of parenting.
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Affiliation(s)
- Rebecca Giallo
- Murdoch Childrens Research Institute, Parkville, Australia
- * E-mail:
| | | | | | - Amanda Cooklin
- Judith Lumley Centre, La Trobe University, Victoria, Australia
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23
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Marques AH, Bjørke-Monsen AL, Teixeira AL, Silverman MN. Maternal stress, nutrition and physical activity: Impact on immune function, CNS development and psychopathology. Brain Res 2014; 1617:28-46. [PMID: 25451133 DOI: 10.1016/j.brainres.2014.10.051] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 10/20/2014] [Accepted: 10/25/2014] [Indexed: 12/14/2022]
Abstract
Evidence suggests that maternal and fetal immune dysfunction may impact fetal brain development and could play a role in neurodevelopmental disorders, although the definitive pathophysiological mechanisms are still not completely understood. Stress, malnutrition and physical inactivity are three maternal behavioral lifestyle factors that can influence immune and central nervous system (CNS) functions in both the mother and fetus, and may therefore, increase risk for neurodevelopmental/psychiatric disorders. First, we will briefly review some aspects of maternal-fetal immune system interactions and development of immune tolerance. Second, we will discuss the bidirectional communication between the immune system and CNS and the pathways by which immune dysfunction could contribute to neurodevelopmental disorders. Third, we will discuss the effects of prenatal stress and malnutrition (over and undernutrition) on perinatal programming of the CNS and immune system, and how this might influence neurodevelopment. Finally, we will discuss the beneficial impact of physical fitness during pregnancy on the maternal-fetal unit and infant and how regular physical activity and exercise can be an effective buffer against stress- and inflammatory-related disorders. Although regular physical activity has been shown to promote neuroplasticity and an anti-inflammatory state in the adult, there is a paucity of studies evaluating its impact on CNS and immune function during pregnancy. Implementing stress reduction, proper nutrition and ample physical activity during pregnancy and the childbearing period may be an efficient strategy to counteract the impact of maternal stress and malnutrition/obesity on the developing fetus. Such behavioral interventions could have an impact on early development of the CNS and immune system and contribute to the prevention of neurodevelopmental and psychiatric disorders. Further research is needed to elucidate this relationship and the underlying mechanisms of protection. This article is part of a Special Issue entitled SI: Neuroimmunology in Health And Disease.
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Affiliation(s)
- Andrea Horvath Marques
- Obsessive--Compulsive Spectrum Disorders Program, Department & Institute of Psychiatry, University of São Paulo, Medical School, São Paulo, Brazil.
| | | | - Antônio L Teixeira
- School of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marni N Silverman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Teyhan A, Galobardes B, Henderson J. Child allergic symptoms and mental well-being: the role of maternal anxiety and depression. J Pediatr 2014; 165:592-9.e5. [PMID: 24952709 PMCID: PMC4148480 DOI: 10.1016/j.jpeds.2014.05.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/17/2014] [Accepted: 05/12/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether maternal mental health mediates the relationship between eczema or asthma symptoms and mental well-being in children. STUDY DESIGN Analysis of 7250 children from the Avon Longitudinal Study of Parents and Children. Child mental well-being at 8 years was measured by the Strengths and Difficulties Questionnaire. Binary outcomes were high 'internalizing' (anxious/depressive) and 'externalizing' (oppositional/hyperactive) problems (high was >90th percentile). Child rash and wheeze categories were 'none'; 'early onset transient' (infancy/preschool only); 'persistent' (infancy/preschool and at school age); and 'late onset' (school age only). Maternal anxiety and depression were reported during pregnancy and when child was 8 years old. RESULTS Persistent wheezing symptoms were associated with high externalizing (OR 1.74, 95% CI, 1.41-2.15) and internalizing (1.67, 1.35-2.06) problems compared with never wheeze. Maternal anxiety and depression, and disrupted child sleep, attenuated these associations. Persistent rash (externalizing: 1.74, 1.40-2.15; internalizing: 1.42, 1.16-1.74) and late onset rash (externalizing: 1.62, 1.17-2.25; internalizing: 1.46, 1.07-1.99) symptoms were associated with poorer mental well-being compared with no rash at any age. Maternal anxiety and depression, particularly when child was aged 8 years rather than during pregnancy, accounted for the association with internalizing symptoms and partly for externalizing symptoms. Sleep disruption did not mediate the association. CONCLUSIONS Maternal anxiety and depression may mediate the association between child rash and wheeze and child mental well-being.
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Affiliation(s)
- Alison Teyhan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Bruna Galobardes
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Ferro MA, Boyle MH, Alati R, Scott JG, Dingle K. Maternal psychological distress mediates the relationship between asthma and physician visits in a population-based sample of adolescents. J Asthma 2014; 52:170-5. [PMID: 25134785 DOI: 10.3109/02770903.2014.955191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined whether maternal psychological distress mediates the relationship between presence of adolescent asthma and number of physician visits and whether the association between maternal psychological distress and physician visits is moderated by adolescent general health. METHODS Data were obtained from the Mater University Study of Pregnancy and included 4025 adolescents. Path analysis was used to examine mediating and moderating effects. RESULTS Maternal psychological distress was found to partially mediate the relationship between adolescent asthma and number of physician visits, accounting for 25% of the effect of adolescent asthma on physician visits (p = 0.046). There was no evidence to suggest that adolescent general health moderated the association between maternal psychological distress and physician visits (p = 0.093). CONCLUSIONS These findings suggest that maternal psychological distress is associated with increased physician visits, regardless of adolescents' general health. Lowering maternal psychological distress may serve to reduce health care utilization and costs among adolescents with asthma.
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Affiliation(s)
- Mark A Ferro
- Department of Psychiatry & Behavioral Neurosciences, McMaster University , Ontario , Canada
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Prenatal risk factors for depression: a critical review of the evidence and potential mechanisms. J Dev Orig Health Dis 2014; 5:339-50. [DOI: 10.1017/s2040174414000324] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Exposure to adverse experiences in early life increases the risk of depression during adulthood. Recent findings have highlighted that exposure of a fetus to an adverse intrauterine environment may also have implications for later offspring depression. This review considers the status of the evidence for these associations and the potential mechanisms underlying prenatal developmental risks for later depression, addressing the challenging possibility that environmental predisposition to depression may begin before birth.
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27
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O'Connor TG, Moynihan JA, Caserta MT. Annual research review: The neuroinflammation hypothesis for stress and psychopathology in children--developmental psychoneuroimmunology. J Child Psychol Psychiatry 2014; 55:615-31. [PMID: 24372371 PMCID: PMC4029900 DOI: 10.1111/jcpp.12187] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2013] [Indexed: 12/14/2022]
Abstract
Experimental animal and adult human data suggest that stress exposure is associated with alterations in immune system function that may underlie increased susceptibility to disease and behavioral disorders. The implications of these data for child psychology and psychiatry are not yet clear. The current review seeks to distil and translate the relevant animal and adult human work to children to advance a developmental model of psychoneuroimmunology. In addition to reviewing key specific findings, we consider biological/conceptual models and technical aspects of psychoneuroimmunology work in pediatric populations, and outline the rationales and advantages of integrating hypotheses concerning neuroinflammation in developmental studies of psychopathology.
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Zhang H, Wang L. Use of antidepressants during pregnancy: a better choice for some. SHANGHAI ARCHIVES OF PSYCHIATRY 2013; 25:315-6. [PMID: 24991171 PMCID: PMC4054573 DOI: 10.3969/j.issn.1002-0829.2013.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hongxia Zhang
- Huashan Hospital, Fudan University, Shanghai, China
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liwei Wang
- Huashan Hospital, Fudan University, Shanghai, China
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29
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O’Connor TG, Winter MA, Hunn J, Carnahan J, Pressman EK, Glover V, Robertson-Blackmore E, Moynihan JA, Lee FEH, Caserta MT. Prenatal maternal anxiety predicts reduced adaptive immunity in infants. Brain Behav Immun 2013; 32:21-8. [PMID: 23439080 PMCID: PMC3686987 DOI: 10.1016/j.bbi.2013.02.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 01/30/2013] [Accepted: 02/11/2013] [Indexed: 01/29/2023] Open
Abstract
Prenatal anxiety has been linked with altered immune function in offspring in animal studies, but the relevance for human health is unknown. We examined prenatal maternal anxiety as a predictor of adaptive immunity in infants at 2 and 6 months of age as part of a prospective longitudinal study. The humoral immune response to hepatitis B vaccine was assessed at 2 months (n=80) and 6 months (n=76) of age. Prenatal anxiety predicted lower hepatitis B antibody titers at 6 months of age independent of obstetric and socio-demographic covariates; the effects were limited to those infants who had not completed the 3-dose vaccine series (for transformed titer values, r=-.36, p<.05). Cell-mediated immune responses at 2 (n=56) and 6 (n=54) months of age were examined by ELISpot assays for interferon(IFN)-γ, interleukin(IL)-2, and IL-4 responder cell frequencies to three antigens: hepatitis B surface antigen, tetanus toxoid, and phytohaemagglutinin (PHA). Prenatal maternal anxiety was associated with reduced IFN-γ and increased IL-4 responder cell frequencies at 6 months of age, independent of obstetric and socio-demographic covariates. No effect of prenatal anxiety was found on adaptive immunity at 2 months of age. The findings provide the first demonstration in humans that prenatal anxiety alters adaptive immunity in the infant.
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Affiliation(s)
- Thomas G O’Connor
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Marcia A Winter
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Julianne Hunn
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | - Jennifer Carnahan
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, 14642
| | - Eva K Pressman
- Department of Obstetrics, University of Rochester Medical Center, Rochester, NY, 14642
| | - Vivette Glover
- Institute of Reproductive and Developmental Biology, Imperial College London, UK
| | | | - Jan A Moynihan
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, 14642
| | | | - Mary T Caserta
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, 14642
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Marques AH, O'Connor TG, Roth C, Susser E, Bjørke-Monsen AL. The influence of maternal prenatal and early childhood nutrition and maternal prenatal stress on offspring immune system development and neurodevelopmental disorders. Front Neurosci 2013; 7:120. [PMID: 23914151 PMCID: PMC3728489 DOI: 10.3389/fnins.2013.00120] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/25/2013] [Indexed: 12/17/2022] Open
Abstract
The developing immune system and central nervous system in the fetus and child are extremely sensitive to both exogenous and endogenous signals. Early immune system programming, leading to changes that can persist over the life course, has been suggested, and other evidence suggests that immune dysregulation in the early developing brain may play a role in neurodevelopmental disorders such as autism spectrum disorder and schizophrenia. The timing of immune dysregulation with respect to gestational age and neurologic development of the fetus may shape the elicited response. This creates a possible sensitive window of programming or vulnerability. This review will explore the effects of maternal prenatal and infant nutritional status (from conception until early childhood) as well as maternal prenatal stress and anxiety on early programming of immune function, and how this might influence neurodevelopment. We will describe fetal immune system development and maternal-fetal immune interactions to provide a better context for understanding the influence of nutrition and stress on the immune system. Finally, we will discuss the implications for prevention of neurodevelopmental disorders, with a focus on nutrition. Although certain micronutrient supplements have shown to both reduce the risk of neurodevelopmental disorders and enhance fetal immune development, we do not know whether their impact on immune development contributes to the preventive effect on neurodevelopmental disorders. Future studies are needed to elucidate this relationship, which may contribute to a better understanding of preventative mechanisms. Integrating studies of neurodevelopmental disorders and prenatal exposures with the simultaneous evaluation of neural and immune systems will shed light on mechanisms that underlie individual vulnerability or resilience to neurodevelopmental disorders and ultimately contribute to the development of primary preventions and early interventions.
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Affiliation(s)
- Andrea Horvath Marques
- Department of Epidemiology, Mailman School of Public Health, Columbia University New York, NY, USA ; Institute of Human Nutrition, Columbia University New York, NY, USA
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Guxens M, Sonnenschein-van der Voort AMM, Tiemeier H, Hofman A, Sunyer J, de Jongste JC, Jaddoe VWV, Duijts L. Parental psychological distress during pregnancy and wheezing in preschool children: the Generation R Study. J Allergy Clin Immunol 2013; 133:59-67.e1-12. [PMID: 23777854 DOI: 10.1016/j.jaci.2013.04.044] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maternal psychological distress during pregnancy might affect fetal lung development and subsequently predispose children to childhood asthma. OBJECTIVE We sought to assess the associations of maternal psychological distress during pregnancy with early childhood wheezing. METHODS We performed a population-based prospective cohort study among 4848 children. We assessed maternal and paternal psychological distress at the second trimester of gestation and 3 years after delivery and maternal psychological distress at 2 and 6 months after delivery by using the Brief Symptom Inventory questionnaire. Wheezing in the children was annually examined by using questionnaires from 1 to 4 years. Physician-diagnosed ever asthma was reported at 6 years. RESULTS Mothers with psychological distress during pregnancy had increased odds of wheezing in their children from 1 to 4 years of life (overall distress: odds ratio [OR], 1.60 [95% CI, 1.32-1.93]; depression: OR, 1.46 [95% CI, 1.20-1.77]; and anxiety: OR, 1.39 [95% CI, 1.15-1.67]). We observed similar positive associations with the number of wheezing episodes, wheezing patterns, and physician-diagnosed asthma at 6 years. Paternal distress during pregnancy and maternal and paternal distress after delivery did not affect these results and were not associated with childhood wheezing. CONCLUSION Maternal psychological distress during pregnancy is associated with increased odds of wheezing in their children during the first 6 years of life independent of paternal psychological distress during pregnancy and maternal and paternal psychological distress after delivery. These results suggest a possible intrauterine programming effect of maternal psychological distress leading to respiratory morbidity.
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Affiliation(s)
- Mònica Guxens
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Agnes M M Sonnenschein-van der Voort
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Child & Adolescent Psychiatry, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jordi Sunyer
- Center for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Hospital del Mar Research Institute (IMIM), Barcelona, Spain; Pompeu Fabra University, Barcelona, Spain
| | - Johan C de Jongste
- Department of Pediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Department of Pediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Pediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Comparison of the bronchodilating effects of albuterol delivered by valved vs. non-valved spacers in pediatric asthma. Pediatr Allergy Immunol 2012; 23:629-35. [PMID: 23005919 DOI: 10.1111/pai.12008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Inhaled therapy using a metered-dose inhaler (MDI) with attached valved holding chamber has been increasingly recognized as the optimal method for delivering bronchodilators for asthma treatment. However, mainly due to the high cost of these valved holding chambers in many developing countries, the use of non-valved spacers is frequent, despite the scarce evidence that supports their efficacy. The aim of this study was to compare the bronchodilator response to albuterol administered by MDI with and without a valved spacer. METHODS In a randomized, two-period, two-sequence crossover clinical trial, we analyzed 31 stable asthmatic children (6-18 yrs of age) on two consecutive days, who were randomly assigned to receive 100 μg of albuterol MDI through either a locally produced valved spacer or a non-valved spacer. The next day, a crossover treatment was employed through the use of the other spacer. Spirometry was recorded before and after each albuterol administration. RESULTS As we were not able to identify any sequence or carryover effect, we tested for treatment effects in both periods. No significant differences in the absolute change in FEV(1) (0.20 ± 0.17 vs. 0.18 ± 0.16, p = 0.63), FVC (0.07 ± 0.13 vs. 0.07 ± 0.16, p = 0.88), or MMEF (0.49 ± 0.31 vs. 0.43 ± 0.39, p = 0.53) after bronchodilator administration were found between the use of valved and non-valved spacers. CONCLUSIONS In stable asthmatic children, albuterol administered through MDI using a non-valved spacer produces a bronchodilator response similar to that of a spacer with a valve that requires an inhalatory opening pressure (with flows between 2 and 32 l/min) that even toddlers with bronchial obstruction can easily generate.
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Calderon MA, Demoly P, Gerth van Wijk R, Bousquet J, Sheikh A, Frew A, Scadding G, Bachert C, Malling HJ, Valenta R, Bilo B, Nieto A, Akdis C, Just J, Vidal C, Varga EM, Alvarez-Cuesta E, Bohle B, Bufe A, Canonica WG, Cardona V, Dahl R, Didier A, Durham SR, Eng P, Fernandez-Rivas M, Jacobsen L, Jutel M, Kleine-Tebbe J, Klimek L, Lötvall J, Moreno C, Mosges R, Muraro A, Niggemann B, Pajno G, Passalacqua G, Pfaar O, Rak S, Senna G, Senti G, Valovirta E, van Hage M, Virchow JC, Wahn U, Papadopoulos N. EAACI: A European Declaration on Immunotherapy. Designing the future of allergen specific immunotherapy. Clin Transl Allergy 2012; 2:20. [PMID: 23110958 PMCID: PMC3514324 DOI: 10.1186/2045-7022-2-20] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 10/09/2012] [Indexed: 01/03/2023] Open
Abstract
Allergy today is a public health concern of pandemic proportions, affecting more than 150 million people in Europe alone. In view of epidemiological trends, the European Academy of Allergy and Clinical Immunology (EAACI) predicts that within the next few decades, more than half of the European population may at some point in their lives experience some type of allergy. Not only do allergic patients suffer from a debilitating disease, with the potential for major impact on their quality of life, career progression, personal development and lifestyle choices, but they also constitute a significant burden on health economics and macroeconomics due to the days of lost productivity and underperformance. Given that allergy triggers, including urbanization, industrialization, pollution and climate change, are not expected to change in the foreseeable future, it is imperative that steps are taken to develop, strengthen and optimize preventive and treatment strategies. Allergen specific immunotherapy is the only currently available medical intervention that has the potential to affect the natural course of the disease. Years of basic science research, clinical trials, and systematic reviews and meta-analyses have convincingly shown that allergen specific immunotherapy can achieve substantial results for patients, improving the allergic individuals’ quality of life, reducing the long-term costs and burden of allergies, and changing the course of the disease. Allergen specific immunotherapy not only effectively alleviates allergy symptoms, but it has a long-term effect after conclusion of the treatment and can prevent the progression of allergic diseases. Unfortunately, allergen specific immunotherapy has not yet received adequate attention from European institutions, including research funding bodies, even though this could be a most rewarding field in terms of return on investments, translational value and European integration and, a field in which Europe is recognized as a worldwide leader. Evaluation and surveillance of the full cost of allergic diseases is still lacking and further progress is being stifled by the variety of health systems across Europe. This means that the general population remains unaware of the potential use of allergen specific immunotherapy and its potential benefits. We call upon Europe’s policy-makers to coordinate actions and improve individual and public health in allergy by: Promoting awareness of the effectiveness of allergen specific immunotherapy Updating national healthcare policies to support allergen specific immunotherapy Prioritising funding for allergen specific immunotherapy research Monitoring the macroeconomic and health economic parameters of allergy Reinforcing allergy teaching in medical disciplines and specialties The effective implementation of the above policies has the potential for a major positive impact on European health and well-being in the next decade.
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Affiliation(s)
- Moises A Calderon
- Section of Allergy and Clinical Immunology, Imperial College, National Heart and Lung Institute, Dovehouse Street, London, SW3 6LY, UK.
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Abstract
Asthma is a phenotypically heterogeneous disorder of multifactorial origins that affects 300 million people suffering from asthma and more than 250,000 asthma-related deaths each year. Although treatment for asthma has improved, its prevalence continues to increase, particularly in low and middle income countries, or in some ethnic groups in which prevalence was previously low. Observed spatio-temporal variations in the increased prevalence of asthma depend on exposure to environmental factors. Recently, several arguments are also in favor of the involvement of host susceptibility and stress in the observed increase of asthma prevalence. Further investigations are warranted to better understand mechanisms underlying asthma increase or stagnation.
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Affiliation(s)
- Nour Baïz
- Institut National de la Santé et de la Recherche Médicale, UMR S 707, Department of Epidemiology of Allergic and Respiratory Diseases, Paris F-75012, France
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