Prenatal Maternal Stress Predicts Childhood Asthma in Girls: Project Ice Storm

Abstract

Little is known about how prenatal maternal stress (PNMS) influences risks of asthma in humans. In this small study, we sought to determine whether disaster-related PNMS would predict asthma risk in children. In June 1998, we assessed severity of objective hardship and subjective distress in women pregnant during the January 1998 Quebec Ice Storm. Lifetime asthma symptoms, diagnoses, and corticosteroid utilization were assessed when the children were 12 years old (N = 68). No effects of objective hardship or timing of the exposure were found. However, we found that, in girls only, higher levels of prenatal maternal subjective distress predicted greater lifetime risk of wheezing (OR = 1.11; 90% CI = 1.01–1.23), doctor-diagnosed asthma (OR = 1.09; 90% CI = 1.00–1.19), and lifetime utilization of corticosteroids (OR = 1.12; 90% CI = 1.01–1.25). Other perinatal and current maternal life events were also associated with asthma outcomes. Findings suggest that stress during pregnancy opens a window for fetal programming of immune functioning. A sex-based approach may be useful to examine how prenatal and postnatal environments combine to program the immune system. This small study needs to be replicated with a larger, more representative sample.

Prenatal Stress, Prematurity, and Asthma

“…Similar to prematurity, factors or exposures that may confound or modify the putative effects of prenatal stress on asthma include socioeconomic status and access to health care [39], in utero environmental tobacco smoke [39], intensity of stressful exposures or perceived maternal stress[36], maternal obesity [33], maternal race or ethnicity[39], air pollution[40], and parental history of asthma or allergies [32, 41]. …”

“…There is conflicting or insufficient evidence of a critical “time window” for detrimental effects of maternal stress during pregnancy [33, 35, 37], an interaction between prenatal stress and the neonate’s sex[36], or the relative independent contributions of pre- and post-natal stress [32, 33, 35] to the pathogenesis of childhood asthma. Because a significant proportion of children who experience wheeze before age 4 years have transient wheeze but no asthma, a key limitation of most (but not all[34]) published studies is the relatively short duration of follow-up after birth, which precludes a confident diagnosis of asthma.…”

Prenatal and postnatal stress and asthma in children: Temporal- and sex-specific associations

“…An analysis using hospital contact data (N>400,000) found that prenatal exposure to maternal bereavement (proxy for maternal prenatal stress) was associated with a faster time to first asthma event between ages 1–4 years and having a documented asthma attack at 7–12 years in boys but not girls(30). A study of 68 children born to mothers exposed prenatally to disaster-related stress (i.e., the 1998 Quebec Ice Storm) showed increased physician-diagnosed asthma in girls but not in boys(31). While these findings suggest differential effects of prenatal stress on asthma development based on fetal sex, the studies were limited by the indirect measurement of prenatal stress and a lack of postnatal stress assessment so that the relative importance of exposure timing could not be examined.…”

Prenatal and postnatal stress and wheeze in Mexican children

“…27 Another small study looking at subjective distress experienced during pregnancy due to the 1998 Quebec ice storm found that only girls had higher odds of lifetime wheezing, doctor diagnosis of asthma and asthma medication use by age 12 years. 28 However, these studies were limited by their inability to examine prenatal and postnatal stress concurrently and adjust for other important confounders.…”