Perinatal maternal mental health is associated with both infections and wheezing in early childhood

Abstract

Background Wheezing and infections are common during infancy, and the role of early‐life exposures in their development is still under investigation. We examined associations between maternal mental health in pregnancy and after delivery and subsequent offspring wheezing and infections. Methods We studied 2314 mother‐child pairs recruited in the Piccolipiù birth cohort (Italy) from 2011 to 2015. Maternal mental health was assessed in pregnancy and 12 months after delivery via the General Health Questionnaire‐12 (GHQ‐12). GHQ‐12 Likert scores were collapsed into low (below the upper tercile) and high (above). Risk ratios (RR) and 95% confidence intervals (CI) between each combination of scores—during pregnancy and 1 year after delivery—and outcomes were computed by log‐binomial regression models. Results High scores both in pregnancy and after delivery, compared with low scores in both periods, were associated with wheezing (RR: 1.35; 95% CI: 1.08, 1.69), recurrent (≥2 episodes) wheezing (1.35; 0.99, 1.83), any and recurrent (≥4 episodes) upper respiratory infections (1.20; 1.04, 1.41, and 1.45; 1.07, 1.97, respectively), lower respiratory infections (1.31; 1.08, 1.61), and diarrhea (1.49; 1.23, 1.80). High scores either during pregnancy or 1 year after delivery only were less consistently associated with outcomes. Conclusions Maternal mental health problems extending from pregnancy to the first year after delivery are associated with development of both wheezing and infections. As wheezing is mostly triggered by infections, increased infection susceptibility could represent a possible common biologic mechanism. This study confirms the importance of early‐life exposures on childhood health.

The national, longitudinal NASCITA Cohort study: starting population profile

“…This low rate re ects that from an Italian surveillance system on almost 30 000 mothers from 11/20 Italian regions, which found that 21% of mothers took folic acid appropriately. [54] Concerning smoking and alcohol use, the NASCITA data, showing that 6.5% of mothers continued to smoke during pregnancy and that one in ten drank alcohol during pregnancy, also re ected data from the surveillance study, which reported that 6.2% of mothers smoked during pregnancy and 19.7% drank alcohol at least once a month, and from the PiccoliPiù study (9.1% of mothers smoked in pregnancy [44]).…”

“…The maternal level of education is higher in NASCITA compared to national level data (42.5% compared to 31.2% of mothers have a university degree), [43] while the percentage of foreign-born mothers on the other hand, is lower in NASCITA (13.4% vs 21%), with both results likely to be due to language barriers that preclude recruitment and to the more frequent transfers to other areas/paediatricians on the part of families with parents who were born abroad. These differences are also true when NASCITA cohort data are compared with those of the Italian NINFEA [23] and PiccoliPiù [44] cohorts, i.e., the general population characteristics are similar, while the maternal level of education is higher in NASCITA and the percentage of foreign-born parents is lower. The distribution of the newborns' anthropometric measures is also comparable with that of the national data.…”

Associations Between Maternal Distress During Early Life Periods and Offspring Respiratory Infections and Allergic Outcomes

“…Supporting evidence of the link between maternal distress and lower immunity in the offspring is also provided by a number of studies; Rusconi et al reported that higher maternal GHQ scores i.e. poorer mental health during and after pregnancy increased the risk of wheezing as well as respiratory and gastroenteric infections in the offspring at 1–2 years ( 45 ). In another cohort of more than 1.6 million Danish children, maternal stressful events up to 11 months before pregnancy were linked to higher risk of infectious disease hospitalization in the offspring ( 46 ).…”

National, longitudinal NASCITA birth cohort study to investigate the health of Italian children and potential influencing factors

“…The maternal level of education is higher in NASCITA compared with national level data (42.5% compared with 31.2% of mothers have a university degree),45 while the percentage of foreign-born mothers, however, is lower in NASCITA (13.4% vs 21%), with both results likely to be due to language barriers that preclude recruitment and to the more frequent transfers to other areas/paediatricians on the part of families with parents who were born abroad. These differences are also true when NASCITA cohort data are compared with those of the Italian NINFEA27 and PiccoliPiù46 cohorts, that is, the general population characteristics are similar, while the maternal level of education is higher in NASCITA and the percentage of foreign-born parents is lower. The distribution of the newborns’ anthropometric measures is also comparable with that of the national data 47…”