Associations between maternal mental health and early child wheezing in a South African birth cohort

MacGinty, Rae; Lesosky, Maia; Barnett, Whitney; Stein, Dan J.; Zar, Heather J.

doi:10.1002/ppul.24008

Cited by 17 publications

(21 citation statements)

References 36 publications

(90 reference statements)

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“…Episodes of wheezing were reported by a caregiver using questions adapted from the International Study of Asthma and Allergies in Childhood or were diagnosed on auscultation by trained study staff at a study visit or during an intercurrent illness. 16 …”

Section: Methodsmentioning

confidence: 99%

Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health

Zar

Nduru

Stadler

et al. 2020

The Lancet Global Health

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Summary Background Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) in children. Early-life RSV LRTI might affect long-term health but there are few data from low-income and middle-income countries. We investigated the epidemiology and effect of early-life RSV LRTI on lung health in a South African birth cohort. Methods We conducted the Drakenstein Child Health Study (DCHS), an ongoing birth cohort longitudinal study in the Western Cape province, South Africa. We enrolled pregnant women aged 18 years or older during their second trimester of pregnancy at two public health clinics. We followed up study children from birth to 2 years. The primary outcome of the study was LRTI and RSV LRTI. LRTI and wheezing episodes were identified through active surveillance; respiratory samples were tested for RSV and other pathogens. Wheezing was longitudinally identified by caregiver report and ascertainment at health facilities. Lung function was measured from 6 weeks to 2 years. We analysed the associations between RSV LRTI and subsequent LRTI, wheezing, and lung function using generalised estimating equations and mixed-effects linear regression. Findings We enrolled 1137 mothers between March 5, 2012, and March 31, 2015. Among their 1143 infants, accruing 2093 child-years of follow-up, there were 851 cases of LRTI (incidence 0·41 episodes per child-year, 95% CI 0·38–0·43). Admission to hospital owing to LRTI occurred in 169 (20%) cases (incidence 0·08 episodes per child-year, 0·07–0·09), with a case-fatality ratio of 0·5%. RSV was detected in 164 (21%) of 785 LRTI events with a specimen available for qPCR, an incidence of 0·08 episodes per child-year (0·07–0·09); highest at age 0–6 months (0·15 episodes per child-year, 0·12–0·19). Children with a first RSV LRTI were three times as likely to develop recurrent LRTI compared with those with non-RSV LRTI (0·32 [0·22–0·48] vs 0·10 [0·07– 0·16] episodes per child-year; p<0·0001), particularly following hospitalised RSV LRTI. RSV LRTI and hospitalisation for all-cause LRTI were independently associated with recurrent wheezing (adjusted incident rate ratio 1·41, 95% CI 1·25–1·59, for RSV LRTI and 1·48, 1·30–1·68, for hospitalisation). LRTI or recurrent LRTI was associated with impaired lung function, but a similar outcome was observed following RSV LRTI or non-RSV LRTI. All-cause LRTI was associated with an average 3% higher respiratory rate (95% CI 0·01–0·06; p=0·013) and lower compliance (–0·1, −0·18 to 0·02) at 2 years compared with no LRTI. Recurrent LRTI was associated with further increased respiratory rate (0·01, 0·001–0·02), resistance (0·77 hPa s L −1 , 0·07–1·47), and lower compliance (–0·6 mL hPa −1 , −0·09 to −0·02) with each additional event. Interpretation RSV LRTI was common in young infants and associated with recurrent LRTI, pa...

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Section: Methodsmentioning

confidence: 99%

Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health

Zar

Nduru

Stadler

et al. 2020

The Lancet Global Health

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“…Indeed, there is increasing evidence for adverse effects of exposure to psychosocial factors in early life on increased risk of both asthma and anxiety disorders in later childhood: several studies have found that maternal anxiety disorders and parenting difficulties were positively associated with anxiety disorders in childhood 11,26,27 , and that maternal prenatal and postnatal psychosocial distress, and parenting difficulties were associated with increased risk of asthma (and allergy-related diseases) in childhood 11,[28][29][30][31] . Most studies investigating the adverse role of parental psychosocial distress on childhood asthma have been conducted in high-income countries, with only one study from sub-Saharan Africa that was conducted in South Africa 32 . It is important to investigate whether psychosocial distress or parenting difficulties are higher among urban dwellers than their rural counterparts in LMICs, and whether this could possibly contribute to the observed increased prevalence of asthma in urban areas.…”

Section: Discussionmentioning

confidence: 99%

Anxiety disorders and asthma among adolescents in urban Uganda: the role of early life exposures

Mpairwe

Mpango

Ssembajjwe

et al. 2020

Preprint

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Background: The reasons for the association between anxiety disorders and asthma are not fully established, and data from Africa is sparse. We investigated whether the association between anxiety disorders and asthma among adolescents may be partly related to shared exposures in early life. Methods: We conducted a case-control study among adolescents (12-17 years) with and without asthma in Wakiso District, an urban area in Uganda. Anxiety disorders were diagnosed by the Youth Inventory-4R (YI-4R), a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) referenced instrument. For this report, we focus on generalized anxiety disorder (GAD), panic disorder and social anxiety disorder. Asthma was doctor-diagnosed by study clinicians. We used questionnaires to collect data on early life exposures. The data were analysed using multiple logistic regression models. Results: We enrolled 162 adolescents. Adolescents with asthma were more likely to have any of three anxiety disorders (44.6%) than adolescents without asthma (21.4%) (adjusted odds ratio (AOR) 2.68, 95% confidence interval (CI) 1.30-5.53, p-value=0.007). The association was strong for GAD (AOR 4.49, 95% CI 1.48-13.56) and panic disorder (AOR 5.43, 95% CI 2.11-14.02), but not for social anxiety disorder (1.46, 95% CI 0.63-3.37). The early life risk factors associated with anxiety disorders among adolescents were similar to asthma risk factors previously published, including urban residence at birth (AOR 3.42 (1.29-9.09)) and during most of the first five years of life (AOR 2.87 (1.07-7.66)), fathers tertiary education (AOR 2.09 (1.00-4.37)), and adolescents history of other allergy-related diseases (AOR 4.64 (1.66-13.00)). Conclusion: We confirm a positive association between anxiety disorders and asthma among adolescents in urban Uganda. The early life risk factors associated with anxiety disorders among adolescents were similar to those for asthma in the same age-group, suggesting shared underlying causes.

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“…Maternal psychosocial risk factors have been found to be associated with wheezing and asthma in early childhood [5–16]. Most studies have been conducted in high income countries (HIC), but recently we reported maternal psychosocial risk factors were associated with wheezing in early childhood in the Drakenstein Child Health Study (DCHS), a South African birth cohort in a LMIC [17]. Postnatal IPV and postnatal maternal psychological distress were found to be associated with recurrent wheezing illness in the first two years of life [17].…”

Section: Introductionmentioning

confidence: 99%

“…Most studies have been conducted in high income countries (HIC), but recently we reported maternal psychosocial risk factors were associated with wheezing in early childhood in the Drakenstein Child Health Study (DCHS), a South African birth cohort in a LMIC [17]. Postnatal IPV and postnatal maternal psychological distress were found to be associated with recurrent wheezing illness in the first two years of life [17]. In addition, antenatal maternal alcohol abuse has been found to be associated with impairments in early infant lung function in the DCHS [18].…”

Section: Introductionmentioning

confidence: 99%

Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

et al. 2019

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ObjectiveTo investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC).Study designPregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors.ResultsThere were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI.ConclusionThe associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.

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Associations between maternal mental health and early child wheezing in a South African birth cohort

Cited by 17 publications

References 36 publications

Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health

Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health

Anxiety disorders and asthma among adolescents in urban Uganda: the role of early life exposures

Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort

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