A Model of Perinatal Stress and Childhood Wheezing: ELSPAC-CZ
Cohort
Irena Stepanikova, Ph.D.,a Vojtech Thon, M.D.,
Ph.D.,b Ondrej Mikes, Ph.D.,b Jana
Klanova, Ph.D.b
a Department of Sociology, University of Alabama at
Birmingham, Birmingham, AL, USA
b RECETOX, Faculty of Science, Masaryk University,
Brno, Czech Republic
Corresponding author:
Irena Stepanikova
Department of Sociology, University of Alabama at Birmingham
1401 University Drive
Birmingham, Alabama, USA
irena@uab.edu
Tel: 650 575 404
Words: Abstract, 244; Body, 3425.
Tables, 3. Figures, 3
Keywords. Gender, depressive symptoms, mental health
Financial support. The ELSPAC-CZ study is funded by the
Ministry of Education, Youth and Sports of the Czech Republic and
European Structural and Investment Funds (CETOCOEN PLUS project:
CZ.02.1.01/0.0/0.0/15_003/0000469 and the RECETOX Research
Infrastructures: LM20150518121. and CZ.02.1.01/0.0/0.0/16_013/0001761).
We also acknowledge the Teaming project: CETOCOEN EXCELLENCE Teaming 2
project supported by Horizon2020 (857560) and the Czech Ministry of
Education, Youth and Sports (CZ.02.1.01/0.0/0.0/18_046/0015975). The
funders of the study had no role in study design, data collection, data
analysis, data interpretation, or writing of the report. The views and
opinions expressed in this paper are those of the authors and do not
reflect the official position of any of the organizations for which the
authors work.
Author contributions. Irena Stepanikova participated in all
aspects of the study, including conceptualization and design, literature
review, data analysis, interpretation, and writing of all sections.
Ondrej Mikes participated in the statistical analyses and writing.
Vojtech Thon participated in conceptualization and interpretation of
results. Jana Klanova participated in acquiring and preparing the data.
Running title . Perinatal stress and childhood wheezing:
ELSPAC-CZ
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.