Rosa Maria José, Just Allan C, Tamayo Y Ortiz Marcela, Schnaas Lourdes, Svensson Katherine, Wright Robert O, Téllez Rojo Martha María, Wright Rosalind J
Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
National Institute of Public Health, Cuernavaca, Mexico.
Ann Allergy Asthma Immunol. 2016 Apr;116(4):306-312.e1. doi: 10.1016/j.anai.2015.12.025. Epub 2016 Jan 25.
Increasing evidence links early-life exposure to psychosocial stress with adverse childhood respiratory outcomes. The influence of exposure timing has not been completely elucidated.
To examine the association between prenatal and postnatal maternal stress and wheeze in 417 children enrolled in a prospective birth cohort in Mexico City.
Maternal negative life event (NLE) scores were ascertained in the second or third trimester of pregnancy and at the 48-month postnatal visit. Children's respiratory outcomes, caregiver report of ever wheeze, and wheeze in the past 12 months were obtained from the International Study of Asthma and Allergies in Childhood survey administered at 48 months. Associations between prenatal and postnatal NLE scores and wheeze were analyzed using a modified Poisson regression approach adjusting for covariates.
In separate models, higher maternal psychosocial stress during pregnancy (relative risk [RR], 1.12; 95% CI, 1.00-1.26) and postnatally (RR, 1.21; 95% CI, 1.08-1.35) were associated with increased risk of wheeze in the past 12 months with an evident exposure-response relationship. There was a significant interaction between postnatal stress and sex in relation to current wheeze. In a sex-stratified model, the association between postnatal stress and risk of wheeze in the past 12 months was stronger in girls (RR, 1.35; 95% CI, 1.13-1.61) than in boys (RR, 1.11; 95% CI, 0.97-1.27) (P for interaction = .04).
Prenatal and postnatal stress in mothers was associated with wheeze in preschool-aged children, and the effect of postnatal stress was stronger in girls. Understanding the temporal- and sex-specific effects of stress may better inform prevention strategies.
越来越多的证据表明，生命早期暴露于心理社会压力与儿童期不良呼吸结局相关。暴露时间的影响尚未完全阐明。
研究墨西哥城一个前瞻性出生队列中417名儿童的产前和产后母亲压力与喘息之间的关联。
在妊娠中期或晚期以及产后48个月访视时确定母亲的负面生活事件（NLE）得分。儿童的呼吸结局、照顾者报告的曾经喘息情况以及过去12个月内的喘息情况，来自于48个月时进行的儿童哮喘和过敏国际研究调查。使用调整协变量的改良泊松回归方法分析产前和产后NLE得分与喘息之间的关联。
在单独的模型中，孕期母亲心理社会压力较高（相对风险[RR]，1.12；95%置信区间[CI]，1.00 - 1.26）和产后（RR，1.21；95% CI，1.08 - 1.35）与过去12个月内喘息风险增加相关，且存在明显的暴露 - 反应关系。产后压力与性别在当前喘息方面存在显著交互作用。在按性别分层的模型中，产后压力与过去12个月内喘息风险的关联在女孩中（RR，1.35；95% CI）比男孩中（RR，1.11；95% CI）更强（交互作用P = 0.04）。
母亲的产前和产后压力与学龄前儿童的喘息相关，且产后压力对女孩的影响更强。了解压力的时间和性别特异性影响可能会更好地为预防策略提供信息。
