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Disrupted prenatal maternal cortisol, maternal obesity, and childhood wheeze. Insights into prenatal programming
Rosalind J Wright1, Kate Fisher, Yueh-Hsiu Mathilda Chiu
1Department of Pediatrics and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA. rosalind.wright@mssm.edu
Insights
Prenatal maternal obesity and disrupted cortisol patterns are linked to childhood wheeze. Obese mothers with abnormal cortisol levels had the highest risk of children experiencing recurrent wheezing.
Area of Science:
- Reproductive Medicine
- Pediatric Pulmonology
- Endocrinology
Background:
- Understanding prenatal influences on childhood respiratory health is crucial for developing targeted interventions.
- Childhood wheeze is a common condition with significant public health implications.
- Prenatal factors, including maternal stress and metabolic health, may play a role in programming offspring's respiratory outcomes.
Purpose of the Study:
- To investigate the association between prenatal maternal cortisol profiles, maternal obesity, and the incidence of repeated wheeze in children up to two years of age.
- To explore potential interactions between maternal cortisol levels and obesity in predicting childhood wheeze.
Main Methods:
- Salivary cortisol was measured five times daily over three days during late gestation (29.0 ± 4.9 weeks).
- Mothers were classified as obese (BMI ≥ 30 kg/m²) or nonobese (BMI < 30 kg/m²).
- Logistic regression and linear mixed-effects models analyzed the relationship between cortisol metrics, obesity, and wheeze, adjusting for covariates.
Main Results:
- Maternal obesity (OR, 3.43; 95% CI, 1.26-9.35) and increased mean log cortisol at bedtime (OR, 2.2; 95% CI, 1.09-4.09) were independently associated with wheeze.
- A flatter afternoon cortisol slope (slower decline) was linked to repeated wheeze in children of obese mothers (P = 0.009 for interaction).
- No significant association was found between cortisol trajectories and wheeze in children of nonobese mothers.
Conclusions:
- Prenatal maternal cortisol disruption and obesity are independent risk factors for childhood wheeze.
- The combination of maternal obesity and adverse prenatal cortisol profiles significantly increases the likelihood of recurrent wheezing in offspring.
- These findings highlight the importance of managing maternal metabolic health and stress during pregnancy to reduce the risk of childhood respiratory issues.
Rationale:
Exploring prenatal factors influencing childhood wheeze may inform programming mechanisms.
Objectives:
We examined associations among prenatal maternal cortisol profiles, maternal obesity, and repeated wheeze up to age 2 years (n = 261).
Methods:
Salivary cortisol was collected five times per day over 3 days at 29.0 ± 4.9 weeks gestation. Mothers were categorized as obese (body mass index ≥ 30 kg/m(2)) versus nonobese (body mass index < 30 kg/m(2)). Using logistic regression, we examined the influence of log-transformed cortisol metrics (level at each time point, morning rise, diurnal and afternoon slopes) and obesity on wheeze adjusting for covariates. Linear mixed models were implemented to examine associations between cortisol trajectories and wheezing. Interactions between maternal cortisol and obesity were considered.
Measurements And Main Results:
Mothers were primarily minority (56.5% Hispanic, 24.1% African American), 61% had less than or equal to 12 years of education, 34% were obese, and 8.4% of children had repeated wheeze. An interquartile range increase in mean log cortisol at bedtime (odds ratio, 2.2; 95% confidence interval, 1.09-4.09) and maternal obesity (odds ratio, 3.43; 95% confidence interval, 1.26-9.35) were independently associated with wheeze. Linear mixed models revealed an association between a flatter afternoon slope (slower decline in log cortisol per hour) and repeated wheeze in children of obese mothers (children with [-0.017 change] and without [-0.061 change] wheeze [P = 0.009 for time × wheeze interaction]), but not in children of nonobese mothers (with [-0.050 change] and without [-0.061 change] wheeze [P = 0.51]).
Conclusions:
Maternal prenatal cortisol disruption and obesity were independently associated with children's wheeze. Obese women with adverse cortisol profiles were most likely to have children with repeated wheeze.
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