Relationship between maternal demoralization, wheeze, and immunoglobulin E among inner-city children

Abstract

Background Prior research has linked maternal prenatal and postnatal mental health with the subsequent development of asthma in children. However, this relationship has not been examined in inner-city African Americans and Hispanics, populations at high risk for asthma. Objective To determine the relationship of maternal demoralization with wheeze, specific wheeze phenotypes, and seroatopy among children living in a low-income, urban community. Methods African American and Dominican women aged 18 to 35 years residing in New York City (the Bronx and Northern Manhattan) were recruited during pregnancy (n = 279). Maternal demoralization (ie, psychological distress) was measured both prenatally and postnatally by validated questionnaire. Outcomes included wheeze, transient (birth to 2.5 years of age), late onset (3–5 years), and persistent (birth to 5 years of age), evaluated via questionnaire and total and indoor allergen specific IgE (at birth and ages 2, 3, and 5 years). Logistic regression with generalized estimating equations assessed the association of demoralization with wheeze and atopy. Multinomial regression explored associations between demoralization and specific wheeze phenotypes. Results Prenatal demoralization significantly predicted overall wheeze (adjusted odds ratio OR, 1.66; 95% confidence interval [CI], 1.29 –2.14), transient wheeze (OR, 2.25; 95% CI, 1.34 –3.76), and persistent wheeze (OR, 2.69; 95% CI, 1.52– 4.77). No association was found between demoralization and IgE after adjustment (total IgE: OR, 1.04; 95% CI, 0.74 –1.45; any specific IgE: OR, 0.96; 95% CI, 0.57–1.60). Conclusions In this inner-city cohort, prenatal demoralization was associated with transient and persistent wheeze. Understanding how maternal demoralization influences children’s respiratory health may be important for developing effective interventions among disadvantaged populations.

Prenatal maternal psychological stress and childhood asthma and wheezing: a meta-analysis

“…Only one study provided results of wheezing at multiple ages [35]. Three studies reported results for the different types of wheezing: transient, late onset or persistent [35,37], and single wheeze versus multiple wheeze [38]. Asthma was also assessed at different ages: at 6 [35] or 7.5 years of age [33], and at a mean±SD age of 8.5±3.2 years [34].…”

“…Five (50%) studies assessed wheezing as an outcome measure [30,32,[36][37][38], while one study assessed asthma [27] and three (30%) studies assessed both [33][34][35]. One study assessed respiratory health in general as an outcome measure [31].…”

“…Asthma or wheezing as an outcome measure Subgroup analyses also showed that children of mothers who experienced some form of stress during pregnancy were more often diagnosed with asthma compared with children of mothers who did not experience stress (OR 1.45 (95% CI 1.25-1.68), I 2 =13%, four studies) (online supplementary material S5). In addition, wheezing complaints were more often found among children whose mothers experienced psychological stress during pregnancy compared with mothers who did not (OR 1.87 (95% CI 1.42-2.45), LEFEVRE [36] BEIJERS [31] REYES [37] COOKSON [33] KHASHAN [27] CHU [32] GUXENS [35] WOOD [38] DE MARCO [34] High quality Moderate quality FIGURE 3 Studies included in the overall meta-analysis stratified by study quality. [35].…”

“…Stress exposure was assessed in terms of experience of general life events (for example, any situation of loss or uneasiness) [32][33][34] or difficult life circumstances (such as financial strains) [38] in some studies, and as specific events (such as the loss of a spouse or child) [27] in other studies. Perceived stress was assessed in terms of general stress symptoms (for example, "I feel unhappy") [30,31,35,37,38], anxiety ("I feel tense") [33,36] or depression ("I feel hopeless") [33,36], as well in relation to a specific source of stress, such as pregnancy-specific anxiety or stress ("I worry about the health of the baby") [31,38].…”

“…Studies focused on stress exposure [27,32], perceived stress [30,31,[35][36][37] or both [33,38]. Stress exposure was assessed in terms of experience of general life events (for example, any situation of loss or uneasiness) [32][33][34] or difficult life circumstances (such as financial strains) [38] in some studies, and as specific events (such as the loss of a spouse or child) [27] in other studies.…”