Relationships among Maternal Stress and Depression, Type 2 Responses, and Recurrent Wheezing at Age 3 Years in Low-Income Urban Families

Abstract

Rationale: Maternal depression and prenatal and early life stress may influence childhood wheezing illnesses, potentially through effects on immune development.Objectives: To test the hypothesis that maternal stress and/or depression during pregnancy and early life are associated with recurrent wheezing and aeroallergen sensitivity and altered cytokine responses (enhanced type 2 or reduced virus-induced cytokine responses) from stimulated peripheral blood mononuclear cells at age 3 years.Methods: URECA (Urban Environment and Childhood Asthma) is a birth cohort at high risk for asthma (n = 560) in four inner cities. Maternal stress, depression, and childhood wheezing episodes were assessed by quarterly questionnaires beginning at birth. Logistic and linear regression techniques were used to examine the relation of maternal stress/depression to recurrent wheezing and peripheral blood mononuclear cell cytokine responses at age 3 years.Measurements and Main Results: Overall, 166 (36%) children had recurrent wheeze at age 3 years. Measures of maternal perceived stress at Years 2 and 3 were positively associated with recurrent wheeze (P , 0.05). Maternal depression (any year) was significantly associated with recurrent wheezing (P < 0.01). These associations were also significant when considered in a longitudinal analysis of cumulative stress and depression (P < 0.02). Neither stress nor depression was significantly related to aeroallergen sensitization or antiviral responses. Contrary to our original hypothesis, prenatal and Year 1 stress and depression had significant inverse associations with several type 2 cytokine responses. Conclusions:In urban children at high risk for asthma, maternal perceived stress and depression were significantly associated with recurrent wheezing but not increased atopy or reduced antiviral responses.

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

“…Reyes et al found that antenatal psychological distress predicted recurrent wheeze in early stages of life, in both independent and adjusted models. In addition, Ramratnam et al, and Mathilda Chiu et al, found that antenatal depression was significantly associated with recurrence of child wheeze. As these studies were conducted in HIC, urban, low‐income, and genetically predisposed children, they attributed the associations to biological mechanisms, such as the release of stress hormones, which affect foetal development in utero.…”

“…Antenatal or postnatal maternal psychosocial risk factors have been reported to be associated with development of child wheeze, but there is sparse data from low and middle‐income countries (LMIC). Most research has been conducted in HIC, and predominantly in high‐risk populations.…”

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

“…Putative mechanisms linking stress in pregnancy and childhood wheezing and asthma—independent of an effect on infections—include a dysregulation of maternal and child hypothalamic‐pituitary‐adrenal axes and an immune dysregulation in offspring . However, this mechanism more easily explains an enhanced susceptibility to childhood atopic disorders, including asthma, rather than wheezing in infancy …”

Lessons learned from birth cohort studies conducted in diverse environments

“…3 A number of factors affect early-life immune responses, including season of birth, 5–7 sex, 8 maternal stress, 9 and allergen and microbial exposures (farms, dog, cockroach, and endotoxin) during pregnancy and early life. 7,10 Reduced IFN-γ responses in cord blood and early infancy have been linked to the risk of LRTIs and recurrent wheezing in multiple cohorts.…”