Suh Dong In, Chang Hyoung Yoon, Lee Eun, Yang Song I, Hong Soo Jong
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Department of Psychiatry, Ajou University School of Medicine, Suwon, Korea.
Allergy Asthma Immunol Res. 2017 May;9(3):200-211. doi: 10.4168/aair.2017.9.3.200.
Recent studies have suggested a close association between prenatal maternal distress and allergic diseases in the offspring. We selected relevant birth-cohort or national registry studies using a keyword search of the PubMed database and summarized current evidence on the impact of prenatal maternal distress on the development of offspring's allergic diseases. Moreover, we postulated possible pathways linking prenatal distress and allergic diseases based on relevant human and animal studies. Both dysregulated hypothalamic-pituitary-adrenal axis and increased oxidative stress may cause structural (altered brain/lung development) and functional (skewed immune development) changes, which may predispose the fetus to developing allergic diseases during childhood. Although many facts are yet to be discovered, changes in the placental response and epigenetic modification are presumed to mediate the whole process from maternal distress to allergic diseases. Maternal prenatal distress can also interact with other physical or environmental factors, including familial or physical factors, indoor and outdoor pollutants, and early childhood psychological distress. The gut-microbiome-brain axis and the role of the microbiome as an immune modulator should be considered when investigating the stress-allergy relationship and exploring potential intervention modalities. Further research is needed, and particular attention should be given to defining the most vulnerable subjects and critical time periods. To this end, studies exploring relevant biomarkers are warranted, which can enable us to explore adequate intervention strategies.
近期研究表明，产前母亲的心理压力与后代过敏性疾病之间存在密切关联。我们通过对PubMed数据库进行关键词搜索，选取了相关的出生队列或国家登记研究，并总结了当前关于产前母亲心理压力对后代过敏性疾病发展影响的证据。此外，我们根据相关的人体和动物研究，推测了产前心理压力与过敏性疾病之间可能的联系途径。下丘脑-垂体-肾上腺轴失调和氧化应激增加均可能导致结构（大脑/肺部发育改变）和功能（免疫发育失衡）变化，这可能使胎儿在儿童期易患过敏性疾病。尽管仍有许多事实有待发现，但胎盘反应和表观遗传修饰的变化被认为在从母亲心理压力到过敏性疾病的整个过程中起介导作用。母亲产前心理压力还可能与其他身体或环境因素相互作用，包括家族或身体因素、室内和室外污染物以及儿童早期心理压力。在研究压力与过敏的关系以及探索潜在干预方式时，应考虑肠道微生物群-脑轴以及微生物群作为免疫调节剂的作用。需要进一步研究，尤其应关注确定最易受影响的人群和关键时期。为此，有必要开展探索相关生物标志物的研究，这将使我们能够探索适当的干预策略。
