Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis

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dc.contributor.author Flanigan, Catherine
dc.contributor.author Sheikh, Aziz
dc.contributor.author Dunn Galvin, Audrey
dc.contributor.author Brew, Bronwyn K.
dc.contributor.author Almqvist, Catarina
dc.contributor.author Nwaru, Bright I.
dc.date.accessioned 2018-01-19T12:24:57Z
dc.date.available 2018-01-19T12:24:57Z
dc.date.issued 2018-01-13
dc.identifier.citation Flanigan, C., Sheikh, A., DunnGalvin, A., Brew, B. K., Almqvist, C. and Nwaru, B. I. (2018) 'Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis', Clinical & Experimental Allergy, 48(4), pp. 403-414. doi:10.1111/cea.13091 en
dc.identifier.volume 48
dc.identifier.issued 4
dc.identifier.startpage 403
dc.identifier.endpage 414
dc.identifier.issn 1365-2222
dc.identifier.uri http://hdl.handle.net/10468/5301
dc.identifier.doi 10.1111/cea.13091
dc.description.abstract Background: Prenatal maternal stress may influence offspring's atopic risk through sustained cortisol secretion resulting from activation of the hypothalamic-pituitary-axis (HPA), leading to Th2-biased cell differentiation in the fetus. We undertook a systematic review and meta-analysis investigating the relationship between prenatal maternal psychosocial stress and risk of asthma and allergy in the offspring. Methods: We searched 11 electronic databases from 1960 to 2016, search the grey literature, and contacted experts in the field. Type of stress indicator included mood disorders, anxiety, exposure to violence, bereavement and socio-economic problems occurring during pregnancy, both objectively or subjectively measured. We included all possible asthma and IgE-mediated allergy outcomes. We conducted random-effects meta-analyses to synthesize the data. Results: We identified 9,779 papers of which 30 studies (enrolling >6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, four were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema/dermatitis (OR 1.34, 95%CI 1.22-1.47), allergic rhinitis (OR 1.30, 95%CI 1.04-1.62), wheeze (OR 1.34, 95%CI 1.16-1.54) and asthma (OR 1.15, 95%CI 1.04-1.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early-onset and persistent than for late-onset wheeze. Bereavement of a child (HR 1.28, 95%CI 1.10-1.48) or a spouse (HR 1.40, 95%CI 1.03-1.90) increased the risk of offspring asthma. Conclusions: Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester-specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding. en
dc.description.sponsorship Tampereen Yliopisto, University of Tampere, Finland (Institute for Advanced Social Research Fellowship; School of Health Sciences); University of Edinburgh (Farr Institute and Asthma UK Centre for Applied Research); Göteborgs Universitet, University of Gothenburg (Wallenberg Centre for Molecular and Translational Medicine); Vetenskapsrådet, Swedish Research Council (through the Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) framework grant no. 340-2013-5867); H2020 Marie Skłodowska-Curie Actions (COFAS Marie Curie Fellowship (grant no 2015-01208)) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Wiley en
dc.rights © 2018, John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Flanigan, C., Sheikh, A., DunnGalvin, A., Brew, B. K., Almqvist, C. and Nwaru, B. I. (2018) 'Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis', Clinical & Experimental Allergy, 48(4), pp. 403-414, doi: 10.1111/cea.13091, which has been published in final form at http://dx.doi.org/10.1111/cea.13091. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. en
dc.subject Adverse life events en
dc.subject Allergy en
dc.subject Asthma en
dc.subject Children en
dc.subject Pregnancy en
dc.subject Psychosocial stress en
dc.title Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Audrey Dunn Galvin, Paediatrics & Child Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: a.dunngalvin@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher. en
dc.check.date 2019-01-13
dc.date.updated 2018-01-19T12:00:51Z
dc.description.version Accepted Version en
dc.internal.rssid 422429616
dc.contributor.funder Tampereen Yliopisto en
dc.contributor.funder University of Edinburgh en
dc.contributor.funder Knut och Alice Wallenbergs Stiftelse en
dc.contributor.funder Göteborgs Universitet en
dc.contributor.funder Vetenskapsrådet en
dc.contributor.funder Forskningsrådet om Hälsa, Arbetsliv och Välfärd en
dc.contributor.funder H2020 Marie Skłodowska-Curie Actions en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Clinical & Experimental Allergy en
dc.internal.copyrightchecked No !!CORA!! en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress a.dunngalvin@ucc.ie en


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