Lee Alison G, Chiu Yueh-Hsiu M, Rosa Maria J, Cohen Sheldon, Coull Brent A, Wright Robert O, Morgan Wayne J, Wright Rosalind J
Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York.
Ann Allergy Asthma Immunol. 2017 Aug;119(2):153-159. doi: 10.1016/j.anai.2017.05.025. Epub 2017 Jun 28.
No prior study has examined associations between prenatal and early-life stress on childhood lung function or identified critical windows of exposure.
To prospectively examine associations between prenatal and early-life stress and childhood lung function.
Stress was indexed by a maternal negative life events (NLEs) score ascertained during pregnancy and between 1 and 2 years post partum. Spirometry was performed when children were a mean (SD) of 6.99 (0.89) years old. Associations of prenatal and early postnatal stress with spirometry z scores were examined in 199 children using linear regression. Effect modification by child sex was explored.
Most mothers were minorities (65% Hispanic, 21% African American), had 12 years or less of education (67%), and did not smoke prenatally (78%). The highest level of prenatal stress (≥5 NLEs) was associated with lower levels of forced expiratory volume in 1 second (FEV) (z score = -0.53, P = .03), forced vital capacity (FVC) (z score = -0.49, P = .04), and forced expiratory flow between 25% and 75% (FEF) (z score = -0.68, P = .01) after covariate adjustment; effects were similar for postnatal stress considered separately. In sex-stratified analyses, high postnatal stress (≥5 NLEs) was associated with lower FEV (z score = -0.76, P = .01), FVC (z score = -0.77, P = .01), and FEF (z score = -0.67, P = .02) in boys but not girls, although the interaction term was not significant (P for interaction >.10).
These are the first prospective data that link perinatal stress with reduced child lung function. High levels of stress in the prenatal and postnatal periods were associated with symmetric reductions in FEV and FVC consistent with impaired lung growth. Given that lung function growth patterns are established by 7 years of age, these findings have lifelong implications.
此前尚无研究探讨产前及生命早期应激与儿童肺功能之间的关联，也未确定关键暴露窗口期。
前瞻性研究产前及生命早期应激与儿童肺功能之间的关联。
应激水平通过孕期及产后1至2年期间确定的母亲负面生活事件（NLEs）得分来衡量。当儿童平均年龄为6.99（0.89）岁时进行肺活量测定。采用线性回归分析了199名儿童的产前及产后早期应激与肺活量测定z得分之间的关联，并探讨了儿童性别对效应的修饰作用。
大多数母亲为少数族裔（65%为西班牙裔，21%为非裔美国人），受教育年限为12年或以下（67%），且产前不吸烟（78%）。经协变量调整后，产前应激最高水平（≥5次负面生活事件）与1秒用力呼气量（FEV）水平较低相关（z得分=-0.53，P=0.03）、用力肺活量（FVC）较低相关（z得分=-0.49，P=0.04）以及25%至75%用力呼气流量（FEF）较低相关（z得分=-0.68，P=0.01）；单独考虑产后应激时效应相似。在按性别分层的分析中，产后应激水平高（≥5次负面生活事件）与男孩的FEV较低相关（z得分=-0.76，P=0.01）、FVC较低相关（z得分=-0.77，P=0.01）以及FEF较低相关（z得分=-0.67，P=0.02），但与女孩无关，尽管交互项不显著（交互作用P>.10）。
这些是将围产期应激与儿童肺功能降低联系起来的首批前瞻性数据。产前和产后的高水平应激与FEV和FVC的对称性降低相关，这与肺生长受损一致。鉴于肺功能生长模式在7岁时就已确立，这些发现具有终身影响。
