Children Born to Mothers With Stress, Mental Health Conditions During Pregnancy at Higher AD Risk

Children born to mothers with stress or mental health conditions during pregnancy had a higher risk of atopic dermatitis (AD), according to a study published in Clinical and Translational Allergy.¹

The researchers explained that the latest available data show that AD prevalence has continuously increased in young children and low-income countries. Multiple aspects are involved in AD pathogenesis, including environmental hazards, immune dysfunction, and genetic factors. Conversely, the etiological factors of AD are still being explored and remain unknown.

Factors that may increase AD risk in children are maternal anxiety, depression, or work stress during pregnancy, but all these mechanisms are based on speculation and not fully understood. Emerging studies have also suggested the impact of paternal life experiences on the health of offspring. Consequently, the researchers aimed to summarize the current evidence exploring AD risk in children who are exposed to maternal/paternal stress during pregnancy or after delivery.

Mother and infant | Image Credit: Anatta_Tan - stock.adobe.com

To do so, they selected observational studies published in English that investigated the association between stress experienced by parents or children before AD onset and AD; participants were children below the age of 18 and their parents. The researchers searched for related studies published up to May 1, 2023, using online databases, like PubMed and EMBASE. They extracted data from eligible studies, including study design, country, sample size, and outcome parameters. Conversely, they excluded reviews, case reports, cross-sectional studies, and abstracts.

From their literature search, the researchers found 22 studies that they included in the final analysis, more than 80% of which were published after 2013. Of these studies, 20 were prospective cohort studies, 1 was a retrospective cohort study, and the other was a case-control study. The overall study population consisted of individuals from various countries, including the US, China, and Australia.

Within each study, maternal stress during pregnancy was the most assessed type of stress, followed by maternal anxiety, depression, and stressful life events. The age of AD outcomes varied between studies, but it occurred in most patients before they turned 6.

The studies used various questionnaires to analyze stress and mental health conditions, including the Screening Scale of the Trier Inventory of Chronic Stress (SSCS-TICS) and the Hospital Anxiety and Depression Scale (HADS). Similarly, the methods used for assessing AD differed across studies, ranging from physician diagnoses to paternal or self-report questionnaires.

Of the 22 studies, only 2 explored the relationship between paternal stress and AD. Elbert et al found no significant association between paternal psychiatric symptoms during pregnancy or at 36 months post-delivery with AD.² However, Hamann et al observed that paternal depression during pregnancy was associated with an increase in a child’s AD diagnosis (OR, 1.16; 95% CI, 1.06-1.26).³

Additionally, 13 studies included in the meta-analysis examined the impact of maternal stress/distress on AD risk in children.¹ The researchers found that infants born to mothers with stress during pregnancy and after delivery (OR, 1.29; 95% CI, 1.09-1.51; I² = 89%), or distress during pregnancy (OR, 1.26; 95% CI, 1.13-1.41; I² = 9%), had a higher AD risk.

Also, 8 studies assessed the association between AD and maternal anxiety, 1 of which reported that postnatal maternal anxiety increases the risk of AD. The pooled ORs of the remaining 7 studies for the association between prenatal maternal anxiety during pregnancy and AD was 1.40 (95% CI, 1.24-1.59).

In addition, the researchers analyzed 6 studies that investigated prenatal depression and 4 examining postnatal depression. They found that only maternal depression during pregnancy was significantly associated with an increased risk of AD in offspring (OR, 1.21; 95% CI, 1.09-1.33; I² = 0%; P < .01). Conversely, no significant relationship was observed between maternal postnatal depression and AD (OR, 1.07; 95% CI, 0.86-1.33; I² = 91%).

Lastly, 4 studies examined adverse life events, which the researchers defined as “traumatic and stressful experiences encountered by a child or their mother;" examples include divorce, the death of a family member, and emotional abuse. Through their analysis, they discovered that maternal exposure to adverse life events during pregnancy and after delivery was associated with increased AD risk in their offspring (OR, 2.00; 95% CI, 1.46-2.76; I² = 46%).

The researchers acknowledged their study’s limitations, one being that AD outcomes were determined using various measures across studies; this could potentially lead to bias due to the misclassification of patients with AD. Also, the study was limited to articles published in English and excluded abstracts, which may introduce unforeseen and immeasurable bias into the meta-estimates. Based on these limitations, the researchers suggested areas for further research.

“Importantly, rigorously designed studies are required to corroborate the link between maternal stress and AD in children,” the authors wrote. “These studies should aim to gather insights about the impact of stress during specific trimesters of pregnancy, postnatal stress, and paternal stress, and to identify potential prevention strategies.”

References

1. Ai Y, Huang J, Zhu TT. Early exposure to maternal stress and risk for atopic dermatitis in children: A systematic review and meta-analysis. Clin Transl Allergy. 2024;14(3):e12346. doi:10.1002/clt2.12346

2. Elbert NJ, Duijts L, den Dekker HT, et al. Maternal psychiatric symptoms during pregnancy and risk of childhood atopic diseases. Clin Exp Allergy. 2017;47(4):509‐519. doi:10.1111/cea.12889

3. Hamann CR, Egeberg A, Silverberg JI, Gislason G, Skov L, Thyssen J. Exploring the association between parental psychiatric disease and childhood atopic dermatitis: a matched case‐control study. J Eur Acad Dermatol Venereol. 2019;33(4):725‐734. doi:10.1111/jdv.15321