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Maternal mental illness and child atopy: a UK population-based, primary care cohort study
Cemre Su Osam1, Holly Hope1, Darren M Ashcroft2
1Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.
Insights
Maternal mental illness increases childhood atopy risk, particularly asthma and allergic rhinitis. Addiction disorders showed a reduced risk for eczema and food allergies in offspring. Early intervention is crucial.
Area of Science:
- Epidemiology
- Public Health
- Pediatrics
Background:
- Rising rates of maternal mental illness globally.
- Limited understanding of its impact on childhood atopy.
- Need for research on the offspring's health outcomes.
Purpose of the Study:
- To investigate the association between maternal mental illness and the risk of atopy in children.
- To analyze how different types of maternal mental illness affect specific atopic conditions.
Main Methods:
- Retrospective cohort study utilizing a large UK primary care database.
- Inclusion of 590,778 children born between 1993 and 2017.
- Time-varying exposure assessment for various maternal mental illnesses and Cox regression analysis for atopy incidence.
Main Results:
- Children exposed to common maternal mental illnesses (depression, anxiety) had a higher risk of asthma and allergic rhinitis.
- Hospital admission for asthma was also elevated in offspring of mothers with common mental illnesses.
- Exposure to maternal addiction disorders was linked to a reduced risk of eczema and food allergies.
Conclusions:
- The type of maternal mental illness significantly influences the risk of childhood atopy.
- Findings highlight the need for integrated care and early preventive services for mothers with mental health conditions.
- Implications for general practitioners and policymakers to support vulnerable women and address the etiology of atopy.
Background:
The number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy.
Aim:
To investigate the association between maternal mental illness and risk of atopy among offspring.
Design And Setting:
Retrospective cohort study using a UK primary care database (674 general practices).
Method:
In total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region).
Results:
Children exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93).
Conclusion:
The finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier.
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