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A Model of Perinatal Stress and Childhood Wheezing: ELSPAC-CZ Cohort
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  • Irena Stepanikova,
  • Vojtech Thon,
  • Ondrej Mikes,
  • Jana Klanova
Irena Stepanikova
University of Alabama at Birmingham
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Vojtech Thon
Masaryk University
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Ondrej Mikes
Masaryk University
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Jana Klanova
Masaryk University
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Abstract

Background Prenatal origins of wheezing are not fully understood. This study develops a model of mechanisms linking perinatal stress exposure to wheeze phenotypes in children. Methods Data were obtained from 1,849 mother-child dyads participating in ELSPAC-CZ birth cohort. Wheeze phenotypes assessed between birth and age seven years included “never wheeze”, “early-onset transient (EOT) wheeze,” “early-onset persistent (EOP) wheeze,” and “late-onset (LO) wheeze.” Prenatal and postnatal maternal stress exposures were assessed in mid-pregnancy and six months post-delivery, respectively, using an inventory of 42 life events. Results In adjusted models, children in the highest tercile (high) vs. lowest tercile (low) of prenatal life events had a 44% higher risk of EOT wheeze (relative risk ratio [RRR]=1.44, 95% confidence interval [CI]=1.06-1.95, p=0.02) and 69% higher risk of LO wheeze (RRR=1.69, 95% CI=1.13-2.52, p=0.01). High vs. low exposure to postnatal life events predicted a 74% increase in the risk of EOT wheeze (RRR=1.74, 95% CI=1.27-2.38, p<0.001) and 101% increase for EOP wheeze (RRR=2.01, 95% CI=1.23-3.26, p=0.005). Postnatal life events partially mediated between prenatal life events and any wheeze (high vs. low life events: indirect effect OR=1.13, 95% CI=1.06-1.21, p<0.001). Lower respiratory tract infections and secondary smoke partially mediated between postnatal life events and any wheeze (indirect effects OR=1.06, 95% CI=1.02-1.09, p=0.002 and OR=1.02, 95% CI 1.001-1.05, p=0.035, respectively). Conclusions Exposures to prenatal and postnatal life events are risk factors for development of wheezing. Prenatal stress contributes to wheeze directly and also through postnatal life events and respiratory infections.

Peer review status:IN REVISION

20 Jul 2020Submitted to Pediatric Pulmonology
22 Jul 2020Assigned to Editor
22 Jul 2020Submission Checks Completed
23 Jul 2020Reviewer(s) Assigned
17 Aug 2020Review(s) Completed, Editorial Evaluation Pending
18 Aug 2020Editorial Decision: Revise Major