Longitudinal assessment of maternal depression and early childhood asthma and wheeze: Effect modification by child sex

Abstract

Background: Studies report associations between maternal mental health and adverse respiratory outcomes in children; however, the impact of timing and duration of maternal distress remains understudied. We sought to longitudinally examine associations between maternal depression and childhood asthma and wheeze, and explore sex differences.

Methods: Maternal depression (n = 601) was assessed using the Edinburgh Depression Scale questionnaire, dichotomized at a clinically relevant cutoff (>12) (a) during pregnancy, (b) postpartum, and (c) postpartum and subsequent time points postnatally (recurrent depression). Report of wheeze in the past 12 months (current wheeze) and asthma were obtained using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire at 48 and 72 months. Associations were analyzed using a modified Poisson regression adjusted for covariates, and in interaction models.

Results: Both postpartum and recurrent depression were associated with higher risk of current wheeze (relative risk [RR]: 1.87, 95% confidence interval [CI]: 1.21, 2.90; RR: 2.41, 95% CI: 1.53, 3.79) and asthma at 48 months (RR: 2.42, 95% CI: 1.01, 5.84; RR: 2.45, 95% CI: 1.02, 5.84). In interaction analyses, associations were stronger in females. Recurrent depression was associated with a higher risk of current wheeze at 48 months in females (RR: 4.34, 95% CI: 2.02, 9.32) when compared to males (RR: 1.89, 95% CI: 1.05, 3.39).

Conclusions: Postpartum and recurrent depression were associated with a higher risk of wheeze and asthma in children. Understanding the temporal- and sex-specific effects of maternal depression may better inform prevention strategies.

Keywords: asthma; childhood wheeze; maternal depression; postpartum depression; respiratory health.

Figure 1

Sex‐stratified associations between recurrent depression and risk of current wheeze at 48 months. Models adjusted for mother's age and educational level at enrollment, parity, report of a smoker in the home during the second or third trimester, average PM_2.5 exposure during pregnancy, and average PM_2.5 at first year postpartum.

Figure 2

Sex‐stratified associations between postpartum depression and risk of current wheeze at 72 months. Models adjusted for mother's age and educational level at enrollment, parity, report of a smoker in the home during the second or third trimester, average PM_2.5 exposure during pregnancy, and average PM_2.5 at first year postpartum.