The influence of prenatal mental health service use on the incidence of childhood asthma: a population-based cohort study

ABSTRACT

Objectives: We aimed to determine whether maternal mental health service use during pregnancy, a potential proxy measure of prenatal maternal stress, is associated with the development of asthma in a large population-based sample of children. We hypothesized that children born to mothers with mental health service use during pregnancy would have a higher incidence of childhood asthma. Study Design: Health administrative data from Ontario, Canada (population >13 million) was used to identify pairs of mothers linked with their children born between April 1, 2001 to March 31, 2002. Descriptive statistics were used to compare the cumulative incidence of asthma by age 12 years in children whose mothers did or did not have prenatal mental health service use. Multivariable logistic regression was used to estimate the association between prenatal maternal mental health service use and childhood asthma incidence, after adjusting for the child's sex, residency (rural vs. urban), socioeconomic status, comorbid health conditions, low birthweight, and maternal history of asthma. Results: In a population-based sample of 122,333 children, those born to mothers with mental health service use during pregnancy had increased odds of developing asthma (odds ratio: 1.16, 95% confidence intervals: 1.12, 1.20, p < 0.001). Conclusions: Prenatal maternal mental health service use is an independent risk factor for the development of asthma in childhood. This supports growing evidence for the importance of in utero exposure to maternal stress factors in asthma pathogenesis. This study highlights a potential strategy for the primary prevention of childhood asthma, namely improved recognition and management of mental health issues and stress in pregnant mothers.

KEYWORDS:

• Anxiety
• depression
• epidemiology
• health services use
• pediatrics
• pregnancy

Author contributions

DR participated in study design and conceptualization, interpretation of analysis, drafting of the manuscript and final approval. SS participated in study design, statistical analysis, manuscript revision and final approval. TT participated in study design and conceptualization, interpretation of analysis, manuscript revision, and final approval.

Conflict of interest

The authors have no conflicts of interest to declare. The study sponsors did not have any role in study design, data collection or analysis, manuscript preparation or decision to submit this manuscript for publication. No honorarium, grant or other form of payment was given to any author to produce this manuscript.

Additional information

Funding

This study was funded by grants from the Department of Pediatrics, Western University, London, Ontario Canada and by the Academic Medical Association of Southwestern Ontario, Canada. This study was further supported by the Institute for Clinical Evaluative Sciences (ICES) Western site. ICES is a nonprofit organization funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and information compiled and provided by The Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions and statements expressed herein are those of the author, and not necessarily those of CIHI.