Maternal Stress Linked to Atopic Dermatitis Risk in Children

According to the experts, the most recent data available indicates that the frequency of AD has been steadily rising among low-income nations and young children. The pathophysiology of AD is multifaceted and involves genetic factors, immunological dysfunction, and environmental risks. On the other hand, the causes of AD are still a mystery and are being investigated.

Maternal anxiety, depression, or work stress during pregnancy are risk factors for AD in children; however, the mechanisms behind these effects are unclear and based primarily on conjecture. Recent research has also hinted at the influence of fathers’ life experiences on their children’s health. As a result, the researchers set out to compile the available data regarding the risk of AD in infants exposed to stress from their parents either during or after pregnancy.

To do this, they chose observational studies that were published in English and looked into the relationship between stress that parents or kids went through before the onset of AD and AD; the studies included kids under the age of eighteen and their parents. The researchers used internet sources including PubMed and EMBASE to look for relevant papers published up until May 1, 2023. They took information from studies that qualified, such as study design, nation, sample size, and outcome factors. On the other hand, they did not include reviews, abstracts, cross-sectional studies, or case reports.

Over eighty percent of the 22 papers that the researchers considered in the final analysis were published after 2013, according to their search of the literature. Twenty of these studies were prospective cohort studies, one was a case-control study, and one was a retrospective cohort research. The study population comprised individuals from diverse countries such as the United States, China, and Australia.

mother anxiety, depression, and stressful life events were the next most frequently assessed types of stress in each study, after mother stress during pregnancy. While the age at which AD effects manifested varied throughout studies, most patients experienced it before turning six.

The Hospital Anxiety and Depression Scale (HADS) and the Screening Scale of the Trier Inventory of Chronic Stress (SSCS-TICS) were two of the questionnaires utilized in the studies to assess stress and mental health issues. Similar variations were seen in the techniques employed to evaluate AD, which ranged from self-report questionnaires to parental or medical diagnoses.

Just two of the 22 research looked at the connection between AD and parental stress. Elbert et al. discovered no evidence of a connection between AD and paternal psychiatric problems at 36 months after birth or during pregnancy.2. On the other hand, Hamann et al. found that a child’s diagnosis of AD increased with a father’s depression during pregnancy (OR, 1.16; 95% CI, 1.06-1.26).3.

Thirteen more studies that were part of the meta-analysis looked at the effect of mother stress or anxiety on the risk of AD in offspring.1. The study’s findings showed that mothers who experienced stress before, during, or after giving birth (OR, 1.29; 95% CI, 1.09-1.51; I2 = 89%) or discomfort during pregnancy (OR, 1.26; 95% CI, 1.13-1.41; I2 = 9%) were more likely to have AD in their offspring.

Additionally, eight studies examined the relationship between AD and mother worry; one of those studies found a link between postnatal maternal anxiety and an increased risk of AD. For the relationship between prenatal mother anxiety during pregnancy and AD, the pooled ORs of the remaining 7 trials were 1.40 (95% CI, 1.24-1.59).

The researchers also examined four papers that looked at postnatal depression and six that looked at prenatal depression. They discovered that the only factor substantially linked to a higher risk of AD in offspring was mother depression during pregnancy (OR, 1.21; 95% CI, 1.09-1.33; I2 = 0%; P <.01). On the other hand, there was no discernible link found between AD and mother postnatal depression (OR, 1.07; 95% CI, 0.86-1.33; I2 = 91%)

Finally, four research papers looked at negative life events, which the researchers described as “traumatic and stressful experiences encountered by a child or their mother.” Examples of such experiences include emotional abuse, divorce, and the loss of a family member. Based on their data, they found that a mother’s exposure to stressful events both before and after giving birth raised the chance of AD in her offspring (OR, 2.00; 95% CI, 1.46-2.76; I2 = 46%).

The researchers noted some limitations in their study, including the possibility of bias due to incorrect patient classification because different measures were used in different trials to identify AD results. Furthermore, abstracts and papers published in English were not included in the analysis, which could have introduced unanticipated and unquantifiable bias into the meta-estimates. The researchers recommended areas for additional study based on these constraints.

“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.”

For more information: Early exposure to maternal stress and risk for atopic dermatitis in children: A systematic review and meta-analysis, Clinical and Translational Allergy, https://onlinelibrary.wiley.com/doi/10.1002/clt2.12346