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      Mothers' anxiety during pregnancy is associated with asthma in their children

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          Abstract

          Background

          Maternal stress in early life has been associated with the development of asthma in children, although it is unclear whether there are any critical periods of exposure. The association of asthma with prenatal exposure to maternal stress has not been reported.

          Objective

          We tested whether prenatal and postnatal anxiety and/or depression in pregnant women predicted the risk of their offspring developing asthma in childhood.

          Methods

          The Avon Longitudinal Study of Parents and Children is a population-based birth cohort recruited during pregnancy. Data were available on maternal anxiety scores and asthma at age 7½ years in 5810 children. Anxiety was assessed at 18 and 32 weeks of gestation by using the validated Crown-Crisp Experiential Index. Asthma was defined at age 7½ years as doctor-diagnosed asthma with current symptoms or treatment in the previous 12 months. Multivariable logistic regression was used to determine the association of prenatal anxiety with asthma (odds ratio; 95% CI).

          Results

          Independent of postnatal anxiety and adjusted for a number of likely confounders, there was a higher likelihood of asthma at age 7½ years (odds ratio, 1.64; 95% CI, 1.25-2.17) in children of mothers in the highest compared with lowest quartile of anxiety scores at 32 weeks of gestation, with evidence for a dose-response ( P value for trend <0.001).

          Conclusions

          Maternal anxiety symptoms as an indicator of stress during fetal life may program the development of asthma during childhood.

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          Most cited references35

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          Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

          J Cox, J. Holden, R Sagovsky (1987)
          The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
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            ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology.

            J. Golding, M. Pembrey, R. Jones (2001)
            ALSPAC (The Avon Longitudinal Study of Parents and Children, formerly the Avon Longitudinal Study of Pregnancy and Childhood) was specifically designed to determine ways in which the individual's genotype combines with environmental pressures to influence health and development. To date, there are comprehensive data on approximately 10,000 children and their parents, from early pregnancy until the children are aged between 8 and 9. The study aims to continue to collect detailed data on the children as they go through puberty noting, in particular, changes in anthropometry, attitudes and behaviour, fitness and other cardiovascular risk factors, bone mineralisation, allergic symptoms and mental health. The study started early during pregnancy and collected very detailed data from the mother and her partner before the child was born. This not only provided accurate data on concurrent features, especially medication, symptoms, diet and lifestyle, attitudes and behaviour, social and environmental features, but was unbiased by parental knowledge of any problems that the child might develop. From the time of the child's birth many different aspects of the child's environment have been monitored and a wide range of phenotypic data collected. By virtue of being based in one geographic area, linkage to medical and educational records is relatively simple, and hands-on assessments of children and parents using local facilities has the advantage of high quality control. The comprehensiveness of the ALSPAC approach with a total population sample unselected by disease status, and the availability of parental genotypes, provides an adequate sample for statistical analysis and for avoiding spurious results. The study has an open policy in regard to collaboration within strict confidentiality rules.
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              Prenatal exposure to maternal depression, neonatal methylation of human glucocorticoid receptor gene (NR3C1) and infant cortisol stress responses.

              Tim Oberlander, Joanne Weinberg, Michael Papsdorf … (2015)
              In animal models, variations in early maternal care are associated with differences in hypothalamic-pituitary-adrenal(HPA) stress response in the offspring, mediated via changes in the epigenetic regulation of glucocorticoid receptor (GR) gene (Nr3c1) expression. To study this in humans, relationships between prenatal exposure to maternal mood and the methylation status of a CpG-rich region in the promoter and exon 1F of the human GR gene (NR3C1) in newborns and HPA stress reactivity at age three months were examined. Prenatal exposure to increased third trimester maternal depressed/anxious mood was associated with increased methylation of NR3C1 at a predicted NGFI-A binding site. Increased NR3C1 methylation at this site was also associated with increased salivary cortisol stress responses at 3 months, controlling for prenatal SRI exposure, postnatal age and pre and postnatal maternal mood. The methylation status of a CpG-rich region of the NR3C1 gene, including exon 1F, in genomic DNA from cord blood mononuclear cells was quantified by bisulfite pyrosequencing in infants of depressed mothers treated with a serotonin reuptake inhibitor antidepressant (SRI) (n = 33), infants of depressed nontreated mothers (n = 13) and infants of non depressed/non treated mothers (n = 36). To study the functional implications of the newborn methylation status of NR3C1 in newborns, HPA function was assessed at three months using salivary cortisol obtained before and following a non noxious stressor and at a late afternoon basal time. Methylation status of the human NR3C1 gene in newborns is sensitive to prenatal maternal mood and may offer a potential epigenetic process that links antenatal maternal mood and altered HPA stress reactivity during infancy.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Allergy Clin Immunol
                Title: The Journal of Allergy and Clinical Immunology
                Publisher: Mosby
                ISSN (Print): 0091-6749
                ISSN (Electronic): 1097-6825
                Publication date PMC-release: April 2009
                Publication date (Print): April 2009
                Volume: 123
                Issue: 4
                Pages: 847-853.e11
                Affiliations
                [a ]Department of Internal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
                [b ]Department of Social Medicine, University of Bristol, Bristol, United Kingdom
                [c ]Department of Community-Based Medicine, University of Bristol, Bristol, United Kingdom
                Author notes
                [∗ ]Reprint requests: John Henderson, ALSPAC, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom. a.j.henderson@ 123456bris.ac.uk
                Article
                Publisher ID: YMAI7530
                DOI: 10.1016/j.jaci.2009.01.042
                PMC ID: 2726292
                PubMed ID: 19348924
                SO-VID: 40adad5d-f7b7-4044-9b3d-d8d711794c09
                Copyright © © 2009 Mosby, Inc.
                License:

                This document may be redistributed and reused, subject to certain conditions.

                History
                Date received : 14 October 2008
                Date revision received : 9 January 2009
                Date accepted : 12 January 2009
                Categories
                Subject: Asthma and Lower Airway Disease

                ScienceOpen disciplines: Immunology
                Keywords: anxiety,child,prenatal programming,alspac, avon longitudinal study of parents and children,pregnancy,asthma,or, odds ratio,hpa, hypothalamo-pituitary-adrenal
                Data availability:
                ScienceOpen disciplines: Immunology
                Keywords: anxiety, child, prenatal programming, alspac, avon longitudinal study of parents and children, pregnancy, asthma, or, odds ratio, hpa, hypothalamo-pituitary-adrenal

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