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Parental stress as a predictor of wheezing in infancy: a prospective birth-cohort study
Rosalind J Wright1, Sheldon Cohen, Vincent Carey
1Department of Pulmonary and Critical Care Medicine, The Beth Israel Deaconess Medical Center, Boston, MA, USA. rosalind.wright@channing.harvard.edu
Insights
Caregiver stress significantly increases the risk of childhood wheeze, independent of other known factors. This suggests stress may play a direct role in developing respiratory illnesses in infants.
Area of Science:
- Pediatric Respiratory Medicine
- Psychoneuroimmunology
- Environmental Health
Background:
- The link between caregiver stress and childhood wheeze is debated, with potential pathways including behavioral changes or biological impacts on infant development.
- Understanding this relationship is crucial for addressing preventable childhood respiratory illnesses.
Purpose of the Study:
- To investigate the prospective association between caregiver-perceived stress and the development of wheeze in infancy.
- To determine if caregiver stress independently predicts wheeze, controlling for various confounding and mediating factors.
Main Methods:
- A prospective birth-cohort study of 496 genetically predisposed infants.
- Bimonthly assessment of caregiver-perceived stress and child wheeze from 2-3 months of age up to 14 months.
- Statistical analysis controlling for parental asthma, socioeconomic status, birth weight, race/ethnicity, maternal smoking, breastfeeding, allergen exposure, and lower respiratory infections.
Main Results:
- Higher caregiver-perceived stress at 2-3 months was associated with an increased risk of subsequent wheeze in the first 14 months (RR, 1.6).
- This association remained significant after controlling for confounders and mediators (RR, 1.4).
- Caregiver stress prospectively predicted infant wheeze, but not vice versa.
Conclusions:
- Caregiver stress is a significant, independent predictor of early childhood wheeze.
- Findings suggest a direct biological mechanism, beyond behavioral factors, linking stress to infant respiratory issues.
- Addressing caregiver stress may be a viable strategy for reducing the burden of childhood wheeze.
Abstract:
The role of stress in the pathogenesis of childhood wheeze remains controversial. Caretaker stress might influence wheeze through stress-induced behavioral changes in caregivers (e.g., smoking, breast-feeding) or biologic processes impacting infant development (e.g., immune response, susceptibility to lower respiratory infections). The influence of caregiver stress on wheeze in infancy was studied in a genetically predisposed prospective birth-cohort (n = 496). Caregiver-perceived stress and wheeze in the children were ascertained bimonthly from the first 2 to 3 mo of life. Greater levels of caregiver-perceived stress at 2 to 3 mo was associated with increased risk of subsequent repeated wheeze among the children during the first 14 mo of life (RR, 1.6; 95% CI, 1.3 to 1.9). Caregiver-perceived stress remained significant (RR, 1.4; 95% CI, 1.1 to 1.9) when controlling for factors potentially associated with both stress and wheeze (parental asthma, socioeconomic status, birth weight, and race/ethnicity) as well as mediators through which stress might influence wheeze (maternal smoking, breast-feeding, indoor allergen exposures, and lower respiratory infections). Furthermore, caregiver stress prospectively predicted wheeze in the infants, whereas wheeze in the children did not predict subsequent caregiver stress. The effect of caregiver stress on early childhood wheeze was independent of caregiver smoking and breast-feeding behaviors, as well as allergen exposure, birth weight, and lower respiratory infections. These findings suggest a more direct mechanism may be operating between stress and wheeze in early childhood. Stress may contribute significantly to the population burden of preventable childhood respiratory illness.