Prenatal stress and childhood asthma risk: taking a broader view

Abstract

@ERSpublicationsCumulative evidence confirms stress in pregnancy is a critical prenatal risk for childhood asthma http://ow.ly/W1CCiWe now know that asthma risk begins in utero during rapid lung morphogenesis, when the developing fetus is particularly vulnerable to toxic insults due to immature immune, neuroendocrine and antioxidant defences. A meta-analysis published in a recent issue of the European Respiratory Journal (ERJ) [1] builds on substantial evidence highlighting psychological stress as a critical toxic exposure that, starting in utero, can permanently alter interrelated systems (i.e. immune, autonomic, neuroendocrine and oxidation systems) believed to programme lung growth and consequent respiratory disorders, including asthma [2].Clinicians have long been challenged by the complexity of "what is asthma" and whether it is of the mind or the body. The concept that emotion plays a role in health is as old as medicine itself. References specifically linking psychological processes to asthma date back at least to the 12th century [3]. At the same time, one can find historical references from ancient Egypt and China on treating asthma by inhaling fumes from herb mixtures heated on bricks, including the shrub Ephedra (ma-huang) from which individuals inhaled beta-agonists [4]. As recently as the first half of the 20th century, Western medicine considered asthma to be psychogenic and treatment primarily involved psychoanalysis and other "talking cures" [5]. As science informed our understanding of the pathophysiological basis of airway inflammation and bronchial hyperresponsiveness, beginning in the 1960s, the psychiatric theory of asthma was largely set aside by the biomedical community, which then recognised asthma as a physical (i.e. inflammatory or allergic) condition [5]. Advances in psychoneuroimmunology shifted the paradigm once again and led scientists to reconsider the role of psychological stress in asthma, including the onset of disease [6].A growing number of prospective epidemiological studies over the past decade have demonstrated significant associations between prenatal maternal stress and early asthma phenotypes in the next generation [7][8][9][10][11]. The magnitude of the association varies across these studies, probably due to differences in populations, study design, the stress measure used, characterisation of the outcome (e.g. wheeze or asthma), timing of exposure and adjusted confounders. In a recent issue of the ERJ, VAN DE LOO et al. [1] presented a well-designed meta-analysis, including 10 moderate to high quality studies (eight prospective cohort studies, one case-control study and one cross-sectional study), substantiating a significant relationship between prenatal stress and childhood asthma. The meta-analysis of both the crude and adjusted odds ratios from the included studies confirmed a significant association between increased prenatal maternal stress and childhood wheeze/asthma. In the adjusted meta-analysis, the overall pooled odds ratio of respiratory disease, includi...

Chronic Illness: Asthma

“…Parenting difficulties in the newborn period also correlate with maternal depression, child emotional problems, and the total psychological risk score. The role of prenatal maternal stress predicting early asthma phenotypes in the next generation has gained heightened significance in the past decade (Lee and Wright 2016;Radhakrishnan et al 2018;van de Loo et al 2016). Even though most asthma begins early in life, with the developing immune system interacting with environmental influences, asthma can have its onset in adolescence in boys but not in girlsin conditions of chronic exposure to stress (high allostatic load (AL)) (Bahreinian et al 2013).…”

“…A single time assessment may fail to detect a specific trimester effect as stressors can be acute, prevail throughout pregnancy, or even be an extension of stressful events predating pregnancy. All in all, there is substantial evidence highlighting psychological stress starting in utero, permanently altering interrelated immune, autonomic, neuroendocrine, and oxidation systems, believed to program lung growth and consequent respiratory disorders, including asthma (Lee and Wright 2016;van de Loo et al 2016).…”

A model of perinatal stress and childhood wheezing: ELSPAC‐CZ cohort

“…In-utero exposure to psychosocial stress has recently been advanced as a potential risk. [2][3][4] In a meta-analysis of 10 studies, perceived stress, depression, anxiety, and adverse life events during pregnancy were significant predictors of paediatric wheeze/asthma. 5 A meta-analysis of 16 studies found a relationship between prenatal maternal stress (negative life events, anxiety/depression, job strain, bereavement) with multiple atopy-related diseases in children.…”

“…There is growing interest in perinatal factors related to wheeze/asthma since better understanding can suggest opportunities for early prevention. In‐utero exposure to psychosocial stress has recently been advanced as a potential risk 2‐4 . In a meta‐analysis of 10 studies, perceived stress, depression, anxiety, and adverse life events during pregnancy were significant predictors of paediatric wheeze/asthma 5 .…”

A Model of Perinatal Stress and Childhood Wheezing: ELSPAC-CZ Cohort

“…There is growing interest in perinatal factors related to wheeze/asthma since better understanding can suggest opportunities for early prevention. In-utero exposure to psychosocial stress has recently been advanced as a potential risk 2 . In a meta-analysis of ten studies, perceived stress, depression, anxiety, and adverse life events during pregnancy were significant predictors of paediatric wheeze/asthma 3 .…”