Date Published: June 13, 2018
Publisher: Oxford University Press
Author(s): Maria C Magnus, Rosalind J Wright, Espen Røysamb, Christine L Parr, Øystein Karlstad, Christian M Page, Per Nafstad, Siri E Håberg, Stephanie J London, Wenche Nystad.
Prenatal maternal psychosocial stress might influence the development of childhood asthma. Evaluating paternal psychosocial stress and conducting a sibling comparison could provide further insight into the role of unmeasured confounding. We examined the associations of parental psychosocial stress during and after pregnancy with asthma at age 7 years in the Norwegian Mother and Child Cohort Study (n = 63,626; children born in 2000–2007). Measures of psychosocial stress included lifetime major depressive symptoms, current anxiety/depression symptoms, use of antidepressants, anxiolytics, and/or hypnotics, life satisfaction, relationship satisfaction, work stress, and social support. Childhood asthma was associated with maternal lifetime major depressive symptoms (adjusted relative risk (aRR) = 1.19, 95% confidence interval (CI): 1.09, 1.30), in addition to symptoms of anxiety/depression during pregnancy (aRR = 1.17, 95% CI: 1.06, 1.29) and 6 months after delivery (aRR = 1.17, 95% CI: 1.07, 1.28). Maternal negative life events during pregnancy (aRR = 1.10, 95% CI: 1.06, 1.13) and 6 months after delivery (aRR = 1.14, 95% CI: 1.11, 1.18) were also associated with asthma. These associations were not replicated when evaluated within sibling groups. There were no associations with paternal psychosocial stress. In conclusion, maternal anxiety/depression and negative life events were associated with offspring asthma, but this might be explained by unmeasured maternal background characteristics that remain stable across deliveries.
The distribution of background characteristics among children included in the analyses of maternal and paternal psychosocial stress is given in Table 1. When we compared included and excluded children on the basis of necessary follow-up information, the children included had parents who were older, more educated, and less likely to be smokers and more mothers who were nulliparous (Web Table 2). There was no appreciable difference in the proportions of children with asthma among participants with (4.2%) and without (4.5%) information on measures of maternal psychosocial stress (Web Table 2). Likewise, the proportions of children with asthma among children with (4.1%) and without (4.5%) information on measures of paternal psychosocial stress were very similar (Web Table 2).
Table 1.Distribution of Background Characteristics Among Children Included in an Analysis of Maternal and Paternal Stress and Childhood Asthma, Norwegian Mother and Child Cohort Study, 2000–2007Background CharacteristicMaternal Psychosocial Stress (n = 63,626)Paternal Psychosocial Stress (n = 47,619)No. of Children%No. of Children%Maternal age at delivery, yearsa30.1 (4.5)30.1 (4.4)Maternal parity 028,41344.722,37447.0 122,65035.616,61734.9 29,84915.56,86014.4 ≥32,7144.31,7683.7Maternal education Less than high school4,7957.53,2746.9 High school19,31830.413,85129.1 ≤4 years of college26,26141.320,02142.0 >4 years of college12,99620.410,26721.6 Missing data2560.42060.4Maternal prepregnancy body mass indexb <18.51,8172.91,3402.8 18.5–24.940,45363.630,25963.5 25–29.913,85421.810,39721.8 ≥305,8589.24,4359.3 Missing data1,6442.61,1882.5Maternal smoking during pregnancy None48,18475.736,65477.0 Quit by 18 weeks8,99114.16,66114.0 Smoked after 18 weeks6,1829.74,1128.6 Missing data2690.41920.4Maternal smoking during first 6 months of child’s life No52,12481.939,51783.0 Yes8,87914.06,17413.0 Missing data2,6234.11,9284.1Maternal history of asthma No58,92492.644,02792.5 Yes4,7027.43,5927.5Paternal age, years <252,8514.52,0834.4 25–2914,59222.911,04023.2 30–3425,10139.519,23540.4 ≥3520,95532.915,25932.0 Missing data1270.220Paternal education Less than high school6,77210.64,4419.3 High school25,63140.318,69139.3 ≤4 years of college16,67926.213,08227.5 >4 years of college12,63819.910,08921.2 Missing data1,9063.01,3162.8Paternal body mass index <18.51280.2990.2 18.5–24.927,14942.720,12242.3 25–29.927,56543.320,84643.8 ≥305,8299.24,5609.6 Missing data2,9554.61,9924.2Paternal smoking No45,83072.035,38874.3 Yes17,49027.512,05025.3 Missing data3060.51810.4Paternal history of asthma No43,46268.343,46291.3 Yes4,1576.54,1578.7 Missing data16,00725.200Child’s sex Male32,56251.224,32951.1 Female31,06448.823,29048.9Child’s birth weight, ga3,621 (545)3,613 (543) Missing data310.1220.1Child’s gestational age, weeksa39.5 (1.7)39.5 (1.7) Missing data2440.41880.4Child still breastfeeding at age 6 months No11,55418.28,57418.0 Yes52,07281.839,04582.0a Values are expressed as mean (standard deviation).b Weight (kg)/height (m)2. In this large-scale pregnancy cohort from a country with universal access to health care and relatively modest social inequality, maternal symptoms of anxiety/depression and negative life events, both during pregnancy and during the first 6 months after delivery, were positively associated with asthma in children at age 7 years. Our findings were not explained by unmeasured confounding by background characteristics linked to these measures of psychosocial stress in both parents, since we observed no associations with paternal anxiety/depression. However, we cannot exclude the possibility of unmeasured confounding by maternal background characteristics that remain stable between deliveries based on our sibling analysis. Other measures of maternal psychosocial stress, such as satisfaction with life, relationship satisfaction, or work stress, showed no strong evidence of associations with the risk of childhood asthma. Source: http://doi.org/10.1093/aje/kwx366