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

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dc.contributor.authorFlanigan, Catherine
dc.contributor.authorSheikh, Aziz
dc.contributor.authorDunn Galvin, Audrey
dc.contributor.authorBrew, Bronwyn K.
dc.contributor.authorAlmqvist, Catarina
dc.contributor.authorNwaru, Bright I.
dc.contributor.funderTampereen Yliopistoen
dc.contributor.funderUniversity of Edinburghen
dc.contributor.funderKnut och Alice Wallenbergs Stiftelseen
dc.contributor.funderGöteborgs Universiteten
dc.contributor.funderVetenskapsrådeten
dc.contributor.funderForskningsrådet om Hälsa, Arbetsliv och Välfärden
dc.contributor.funderH2020 Marie Skłodowska-Curie Actionsen
dc.date.accessioned2018-01-19T12:24:57Z
dc.date.available2018-01-19T12:24:57Z
dc.date.issued2018-01-13
dc.date.updated2018-01-19T12:00:51Z
dc.description.abstractBackground: 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.sponsorshipTampereen 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.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFlanigan, 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.13091en
dc.identifier.doi10.1111/cea.13091
dc.identifier.endpage414
dc.identifier.issn1365-2222
dc.identifier.issued4
dc.identifier.journaltitleClinical & Experimental Allergyen
dc.identifier.startpage403
dc.identifier.urihttps://hdl.handle.net/10468/5301
dc.identifier.volume48
dc.language.isoenen
dc.publisherWileyen
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.subjectAdverse life eventsen
dc.subjectAllergyen
dc.subjectAsthmaen
dc.subjectChildrenen
dc.subjectPregnancyen
dc.subjectPsychosocial stressen
dc.titlePrenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysisen
dc.typeArticle (peer-reviewed)en
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