Asthma and lower airway disease
Parental psychological distress during pregnancy and wheezing in preschool children: The Generation R Study

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Background

Maternal psychological distress during pregnancy might affect fetal lung development and subsequently predispose children to childhood asthma.

Objective

We sought to assess the associations of maternal psychological distress during pregnancy with early childhood wheezing.

Methods

We performed a population-based prospective cohort study among 4848 children. We assessed maternal and paternal psychological distress at the second trimester of gestation and 3 years after delivery and maternal psychological distress at 2 and 6 months after delivery by using the Brief Symptom Inventory questionnaire. Wheezing in the children was annually examined by using questionnaires from 1 to 4 years. Physician-diagnosed ever asthma was reported at 6 years.

Results

Mothers with psychological distress during pregnancy had increased odds of wheezing in their children from 1 to 4 years of life (overall distress: odds ratio [OR], 1.60 [95% CI, 1.32-1.93]; depression: OR, 1.46 [95% CI, 1.20-1.77]; and anxiety: OR, 1.39 [95% CI, 1.15-1.67]). We observed similar positive associations with the number of wheezing episodes, wheezing patterns, and physician-diagnosed asthma at 6 years. Paternal distress during pregnancy and maternal and paternal distress after delivery did not affect these results and were not associated with childhood wheezing.

Conclusion

Maternal psychological distress during pregnancy is associated with increased odds of wheezing in their children during the first 6 years of life independent of paternal psychological distress during pregnancy and maternal and paternal psychological distress after delivery. These results suggest a possible intrauterine programming effect of maternal psychological distress leading to respiratory morbidity.

Section snippets

Study design and population

This study was embedded in the Generation R Study, a population-based cohort study from fetal life onward in Rotterdam, The Netherlands.12 All children were born between April 2002 and January 2006. Assessments in pregnant women consisted of physical examination, fetal ultrasound, biological sampling, and questionnaires. In total, 8880 mothers were enrolled during pregnancy (see Fig E1 in this article's Online Repository at www.jacionline.org). For this study, 7490 mothers were eligible after

Results

Children included in the present analysis were more frequently from parents with a higher educational level, and their mothers and fathers showed less psychological distress during pregnancy (see Table E3 in this article's Online Repository at www.jacionline.org) compared with those lost to follow-up. No differences on maternal and paternal history of asthma and atopy were found.

Of the study participants, 7.8% mothers had overall psychological distress during pregnancy (Table I). Wheezing

Discussion

Our results suggest that children exposed to maternal psychological distress during pregnancy have increased odds of childhood wheezing until the age of 6 years. The strength of the associations after adjusting for paternal psychological distress during pregnancy and maternal and paternal psychological distress after delivery, the lack of association of paternal psychological distress during pregnancy and maternal and paternal psychological distress after delivery with childhood wheezing, and

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    • Cited by (0)

    The Generation R Study is conducted by the Erasmus Medical Center in close collaboration with the School of Law and Faculty of Social Sciences of the Erasmus University Rotterdam, the Municipal Health Service Rotterdam area, the Rotterdam Homecare Foundation, and the Stichting Trombosedienst and Artsenlaboratorium Rijnmond (STAR). The first phase of the Generation R Study is made possible by financial support from the Erasmus Medical Center, Rotterdam; Erasmus University, Rotterdam; and the Netherlands Organization for Health Research and Development. V. W. V. J. received an additional grant from The Netherlands Organization for Health Research and Development (ZonMw 90700303, 916.10159). L.D. is the recipient of a European Respiratory Society/Marie Curie Joint Research Fellowship, no. MC 1226-2009. The research leading to these results has received funding from the European Respiratory Society and the European Community's Seventh Framework Programme FP7/2007-2013–Marie Curie Actions under grant agreement RESPIRE, PCOFUND-GA-2008-229571 and from the seventh framework programme, project CHICOS (HEALTH-F2-2009-241504). This manuscript was written with the support of the European Child Cohort Network EUCCONET, a Research Networking Programme financed by the European Science Foundation.

    Disclosure of potential conflict of interest: L. Duijts has received a European Respiratory Society/Marie Curie Joint Research Fellowship, no. MC 1226-2009. The research leading to these results has received funding from the European Respiratory Society and the European Community's Seventh Framework Programme FP7/2007-2013–Marie Curie Actions under grant agreement RESPIRE, PCOFUND-GA-2008-229571 and from the seventh framework programme, project CHICOS (HEALTH-F2-2009-241504). The rest of the authors declare that they have no relevant conflicts of interest.

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