STRERSS DURING ANTENATAL AND EARLY CHILDHOOD PERIOD MAY CAUSE ASTHMA,DR.D.K.JHA,M.D
Asthma is the most common chronic disease in children.
Its incidence is increasing even in the era of advanced investigation facilities and treatment modalities’.
Most school days of children are lost due to asthma morbidities.
Interaction between host and environment is necessary for the manifestations of disease in genetically susceptibles.
Stress is one of the aggravating factor for asthma flare ups.
It has long been assumed that the stress has a causative role in asthma and now a definite link has been found.
The exact mechanism for the causation of asthma by stress is still unclear.
There is more concerns by Researchers and clinicians about the developments during intrauterine life and during the first 2 years of life.
Stress during pregnancy affects the immune system,neuroendocrine system and antioxidant system.
The result is recurrent respiratory tract infections and recurrent wheezing and asthma in children born to such mothers having depression and anxiety during pregnancy.
Smejda and colleagues studied on 370 pairs of mother and child to know the correlation between maternal stress ,atopic dermatitis,asthma and recurrent respiratory infections.Those mothers were included who experienced stress for at least 1 month during pregnancy. The study was a part of Polish mother and child cohort,a large multicentre prospective cohort study established in 2007..The lead researcher was Katarzyna Smejda MD from the department of Pediatrics and Allergy ,Medical university of Lodz in Poland.The whole cohort comprises 1700 pairs of mother and child followed from pregnancy upto 2 years of age of the child. The ongoing cohort study is focussed on the child at the age of 7 years.
- One of the theories explaining the effects of maternal stress on respiratory health of children born to these mothers states that that ,there is increased levels of stress hormones particularly cortisol in mother who are in stress.
- The cortisol crosses the placenta and binds to the endogenous and exogenous cortisol receptors of the fetuses and thus disturbs the hypothalmic-pituitory-adrenal axis.It also makes imbalance in the autonomic nervous system and immune system.The result is ,these children born of these mothers become susceptible to asthma and recurrent respiratory infections during early childhood.
Thakur and colleagues studied the effect of social discrimination on development of asthma in children aged 8-21 years.African American children who were discriminated socially had 78% more chance of developing asthma as compared to nondiscriminated(OR, 1.78; 95% CI,1.33-2.39). Children who felt discriminated socially also had poor asthma control even after good adherence to correct technique of asthma controller medication as compared to nondiscriminated choldren.(OR, 1.97; 95% CI, 1.42-2.76)
In conclusion,stress free environment during pregnancy and childhood is essential for a good respiratory health of children.
REFERENCES:
- Rosa MJ, Lee AG, Wright RJ. Evidence establishing a link between prenatal and early-life stress and asthma development. Curr Opin Allergy Clin Immunol. 2018;18(2):148-158.
- Busse WW, Kiecolt-Glaser JK, Coe C, Martin RJ, Weiss ST, Parker SR. NHLBI workshop summary: stress and asthma. Am J Respir Crit Care Med. 1995;151(1):249-252.
- Smejda K, Polanska K, Merecz-Kot D, et al. Maternal stress during pregnancy and allergic diseases in children during the first year of life. Respir Care. 2018;63(1):70-76.
- Thakur N, Barcelo NE, Borrell LN, et al. Perceived discrimination associated with asthma and related outcomes in minority youth: the GALA II and SAGE II studies. Chest. 2017;151(4):804-812.