Maternal stressful life events during pregnancy and childhood asthma and wheeze

Margaret A. Adgent, Erin Buth, Amanda Noroña-Zhou, Adam A. Szpiro, Christine T. Loftus, Paul E. Moore, Rosalind J. Wright, Emily S. Barrett, Kaja Z. LeWinn, Qi Zhao, Ruby Nguyen, Catherine J. Karr, Nicole R. Bush, Kecia N. Carroll

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Studies have linked prenatal maternal psychosocial stress to childhood wheeze/asthma but have rarely investigated factors that may mitigate risks. Objective: To investigate associations between prenatal stress and childhood wheeze/asthma, evaluating factors that may modify stress effects. Methods: Participants included 2056 mother-child dyads from Environmental influences on Child Health Outcomes (ECHO)-PATHWAYS, a consortium of 3 prospective pregnancy cohorts (the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study, The Infant Development and Environment Study, and a subset of the Global Alliance to Prevent Prematurity and Stillbirth study) from 6 cities. Maternal stressful life events experienced during pregnancy (PSLEs) were reported using the Pregnancy Risk Assessment Monitoring System Stressful Life Events questionnaire. Parents reported child wheeze/asthma outcomes at age 4 to 6 years using standardized questionnaires. We defined outcomes as ever asthma, current wheeze, current asthma, and strict asthma. We used modified Poisson regression with robust standard errors (SEs) to estimate risk ratios (RRs) and 95% CI per 1-unit increase in PSLE, adjusting for confounders. We evaluated effect modification by child sex, maternal history of asthma, maternal childhood traumatic life events, neighborhood-level resources, and breastfeeding. Results: Overall, we observed significantly elevated risk for current wheeze with increasing PSLE (RR, 1.09 [95% CI, 1.03-1.14]), but not for other outcomes. We observed significant effect modification by child sex for strict asthma (P interaction = .03), in which risks were elevated in boys (RR, 1.10 [95% CI, 1.02-1.19]) but not in girls. For all other outcomes, risks were significantly elevated in boys and not in girls, although there was no statistically significant evidence of effect modification. We observed no evidence of effect modification by other factors (P interactions > .05). Conclusion: Risk of adverse childhood respiratory outcomes is higher with increasing maternal PSLEs, particularly in boys.

Original languageEnglish (US)
Pages (from-to)594-601.e3
JournalAnnals of Allergy, Asthma and Immunology
Issue number5
StatePublished - May 2024

Bibliographical note

Publisher Copyright:
© 2023 American College of Allergy, Asthma & Immunology

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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