Maternal stressful life events during pregnancy and childhood asthma and wheeze

Antenatal depressive and anxiety symptoms in early pregnancy and offspring allergic diseases during toddlerhood

BACKGROUND

While maternal psychological stress during mid-to-late pregnancy has been linked to offspring allergies, the impact of early pregnancy distress remains unclear. This study investigates the association between maternal depressive and anxiety symptoms in early pregnancy and allergic diseases in offspring.

METHODS

Based on a birth cohort of 5263 children, antenatal depressive and anxiety symptoms in early pregnancy were assessed via the Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire, respectively. Allergic outcomes, including asthma, atopic dermatitis (AD), and allergic rhinitis (AR), were evaluated via structured questionnaires. Relative risks (RRs) with 95% confidence intervals (CIs) were estimated via generalized linear models, whereas restricted cubic splines were used to explore linear and non-linear associations between maternal distress and allergic outcomes.

RESULTS

Maternal depressive symptoms in early pregnancy were associated with an increased risk of AD [adjusted RR (95% CI) = 1.15 (1.03-1.29)] and AR [1.52 (1.29-1.79)]. Maternal anxiety symptoms in early pregnancy were associated with increased risks of AD [1.11 (1.02-1.21), mild anxiety] and AR [1.33 (1.04-1.68), moderate to severe anxiety]. Dose‒response analyses revealed graded relationships between distress severity and allergic outcomes. In the joint analysis, comorbid depression and anxiety in early pregnancy were associated with an increased risk of AD [1.15 (1.05-1.26)] and AR [1.42 (1.23-1.63)]. Subgroup analysis revealed a greater risk of asthma for boys born to mothers with mild anxiety [1.95 (1.20-3.15)] but not for girls.

CONCLUSION

Maternal distress in early pregnancy is associated with an increased risk of allergic diseases in offspring during toddlerhood.

Managing childhood asthma with an eye toward environmental, social, and behavioral features

Discussions on asthma management tend to focus on the therapeutic aspects when updates on asthma strategies are released. However, many other components of asthma management are now receiving increased attention, as we seek to make right on health disparities and strive toward health equity. In addition, with the therapeutic aspects of asthma, we now realize that our anti-inflammatory approaches largely address the high T2 component of airway inflammation. However, we know very little about what we can do to control the other inflammatory features that contribute to asthma. Factors, such as environmental exposures, social determinants of health, and risk-taking behaviors may be at the root of asthma persistence, progression, and comorbidities. We will continue to learn methods to identify these issues and draw them into a shared decision-making approach for dialogue with patients and their caregivers. This review provides information and tools to address the nonpharmacologic aspects of asthma management.