Parental psychological distress during pregnancy and the risk of childhood lower lung function and asthma: a population-based prospective cohort study

Background Although maternal psychological distress during pregnancy is associated with increased risks of respiratory morbidity in preschool children, it is unknown whether this association persists into later childhood. Objective To examine the association between parental psychological distress during pregnancy and lung function and asthma in children of school age. Methods This study of 4231 children was embedded in a population-based prospective cohort. Parental psychological distress was assessed by the Brief Symptom Inventory during and 3 years after pregnancy, and in mothers also at 2 and 6 months after pregnancy. At age 10 years, lung function was obtained by spirometry and asthma by questionnaire. Results The prevalence of asthma was 5.9%. Maternal overall psychological distress during pregnancy was associated with a lower forced vital capacity (FVC) (z-score difference −0.10 (95% CI −0.20 to –0.01) per 1-unit increase), maternal depressive symptoms during pregnancy with a lower forced expiratory volume in the first second (FEV1) and FVC (−0.13 (95% CI −0.24 to –0.01) and −0.13 (95% CI −0.24 to –0.02) when using clinical cut-offs) in their children. All maternal psychological distress measures during pregnancy were associated with an increased risk of asthma (range OR: 1.46 (95% CI 1.12 to 1.90) to 1.91 (95% CI 1.26 to 2.91)). Additional adjustment for paternal psychological distress during pregnancy and parental psychological distress after pregnancy did not materially change the associations. Paternal psychological distress during pregnancy was not associated with childhood respiratory morbidity. Conclusion Maternal, but not paternal, psychological distress during pregnancy is associated with an increased risk of asthma and partly lower lung function in children. This suggests intrauterine programming for the risk of later-life respiratory disease.

. Percentage change for associations of paternal psychological distress during pregnancy with lung function and asthma at age 10 years, adjusted for paternal psychological distress at 36 months after pregnancy.

Supplemental text
Covariates Information on maternal characteristics included age (years), parity (nulliparous; multiparous), ethnicity (European; non-European), educational level (low-middle; high), smoking during pregnancy (yes; no), body mass index at enrolment (kg/m 2 ), history of asthma and atopy (yes; no), and pet keeping (yes; no), and were obtained from multiple questionnaires during pregnancy.
Information on paternal characteristics included age (years), ethnicity (European; non-European), educational level (low-middle; high), smoking before pregnancy (yes; no), body mass index at enrolment (kg/m 2 ), and history of asthma and atopy (yes; no), and were obtained by a questionnaire during pregnancy. Information on child's sex (female; male), gestational age at birth (weeks), and birthweight (grams) were obtained from midwife and hospital records. Information on child's ethnicity (European; non-European) was based on questionnaires during pregnancy, and information on breastfeeding (yes; no) and daycare attendance (yes; no) were obtained by questionnaires in the first year of life. The main models were adjusted for maternal age, parity, educational level, smoking during pregnancy, body mass index at enrolment, history of asthma or atopy and pet keeping, and child's sex, gestational age at birth, birthweight, ethnicity, breastfeeding and daycare attendance.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)  Supplementary Table S3. Association of patterns of parental psychological distress with lung function and asthma at age 10 years.
Values are Z-scores or odds ratios (OR) with 95% confidence interval (95% CI) from linear or logistic regression models, respectively. Parental psychological distress is treated as continuous variables (per 1-unit increase) or dichotomous variables based on clinical cut-offs (no; yes, where 'no' was the reference category). Postnatal distress reflect psychological distress at either 2, 6 or 36 months after pregnancy. Forced Expiratory Flow in 1 second (FEV1), Forced Vital Capacity (FVC), Forced Expiratory Flow after exhaling 95% of FVC (FEF75). The models were adjusted for maternal age, parity, education level, smoking during pregnancy, body mass index at enrolment, history of asthma or atopy and pet keeping, and child's   Values are Z-scores or odds ratios (OR) with 95% confidence interval (95% CI) from linear or logistic regression models, respectively. Maternal psychological distress is treated as continuous variables (per 1-unit increase) or dichotomous variables based on clinical cut-offs (no; yes, where 'no' was the reference category). Forced Expiratory Flow in 1 second (FEV1), Forced Vital Capacity (FVC), Forced Expiratory Flow after exhaling 95% of FVC (FEF75). The models were adjusted for 1 smoking during pregnancy, body mass index at enrolment and history of asthma or atopy, 2 maternal age, parity, education level and pet keeping, and child's sex and ethnicity, and 3 child's gestational age at birth, birthweight, breastfeeding and daycare attendance. *p-value <0.05, **p-value <0.01.  Supplementary Table S5. Associations of paternal psychological distress during pregnancy with lung function and asthma at age of 10 years adjusted for paternal psychological distress at 36 months after pregnancy.

Depressive symptoms
Values are Z-scores or odds ratios (OR) with 95% confidence interval (95% CI) from linear or logistic regression models, respectively. Maternal psychological distress are treated as continuous variables (per 1-unit increase) or dichotomous variables based on clinical cut-offs (no; yes, where 'no' was the reference category). Forced Expiratory Flow in 1 second (FEV1), Forced Vital Capacity (FVC), Forced Expiratory Flow after exhaling 95% of FVC (FEF75). The models were adjusted for maternal age, parity, education level, smoking during pregnancy, body mass index at enrolment, history of asthma or atopy and pet keeping, and child's sex, gestational age at birth, birthweight, ethnicity, breastfeeding and daycare attendance, and paternal psychological distress 36 months after pregnancy. At 36 months after pregnancy, not all subscales were measured, and therefor overall psychological distress could not be included at this time point. * p-value <0.05  Values are percentage change (95% CI) between the main model, and the model additionally adjusted for paternal psychological distress at 36 months after pregnancy. Paternal psychological distress is treated as continuous variables (per 1-unit increase) or dichotomous variables based on clinical cut-offs (no; yes, where 'no' was the reference category). Forced Expiratory Flow in 1 second (FEV1), Forced Vital Capacity (FVC), Forced Expiratory Flow after exhaling 95% of FVC (FEF75). The main models were adjusted for maternal age, parity, education level, smoking during pregnancy, body mass index at enrolment, history of asthma or atopy and pet keeping, and child's sex, gestational age at birth, birthweight, ethnicity, breastfeeding and daycare attendance. Additionally, models were adjusted for paternal psychological distress at 36 months after pregnancy. At 36 months after pregnancy, not all subscales were measured, and therefor overall psychological distress could not be included at this time point.   Figure S1. Flowchart of participants included for analysis.
Prenatally included children with participation at age 10 years n = 7,393 Children of mothers with information on maternal psychological distress during pregnancy available n = 5,244 Singleton live births n = 7,208 Children with information on lung function or asthma available n = 4,231