PURPOSE OF THE STUDY.
The goal of this study was to evaluate the associations of maternal psychological distress during pregnancy with childhood wheezing in the first 6 years of life.
In this study, 4848 children were evaluated from the Generation R Study, a population-based cohort trial from fetal life onward in Rotterdam, the Netherlands. Subjects were born between April 2002 and January 2006.
The Brief Symptom Inventory was used to assess maternal and paternal psychological distress at 20 weeks of gestation and 3 years after delivery. Maternal psychological distress was also assessed at 2 and 6 months after delivery. Information on wheezing was obtained annually at ages 1, 2, 3, and 4 years by using the asthma questionnaire from the International Study on Asthma and Allergy in Childhood, and information on physician-diagnosed (ever) asthma was obtained by using a questionnaire at 6 years.
Of mothers, 7.8% had overall psychological distress during pregnancy. Children had an increased odds ratio (OR) of wheezing overall from 1 to 4 years of life if born to mothers with overall distress (OR: 1.60 [95% confidence interval (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]) during pregnancy. Similar positive associations were observed among children of mothers with a history of asthma and atopy compared with those without such a history and among children of nonsmokers versus smokers. No associations were observed between paternal psychological distress during pregnancy or maternal and paternal psychological distress after delivery and childhood wheezing or physician-diagnosed asthma.
This study found that children of mothers experiencing psychological distress during pregnancy had increased odds of wheezing in the first 6 years of life. This finding was independent of paternal psychological distress or psychological distress in either parent after delivery, suggesting an intrauterine programming effect on fetal lung development and resulting respiratory morbidity.
Few studies have explored the association of maternal psychological distress on childhood wheezing and none previously in a population of this size. As the authors noted, there is a potential for bias given that children included were more often from parents with a higher educational level and less psychological distress during pregnancy than those lost to follow-up. Nevertheless, the mechanisms that may connect maternal psychological distress with childhood wheezing are currently unknown, and the potential of an intrauterine biological mechanism based on the results of this study highlight the need for further research measuring stress markers, changes in the immune system, and possible epigenetic mechanisms that contribute to intrauterine programming for atopic disease outcomes.
- Copyright © 2014 by the American Academy of Pediatrics