Sex-dependent effects of maternal interpersonal trauma and children’s asthma risk: A life-course perspective Kelly J. Brunst, PhD 1 ; Michelle Bosquet-Enlow, PhD 2 ; Brent A. Coull, PhD 3 ; Sheldon Cohen, PhD 4 ; Rosalind J. Wright, MD MPH 1, 5 1 Kravis Children’s Hospital, Department of Pediatrics, Icahn School of Medicine at Mount Sinai 2 Department of Psychiatry, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA, 3 Departments of Environmental Health and Biostatistics, Harvard School of Public Health, Boston, MA, USA, 4 Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA, 5 Mindich Child Health & Development Institute, Icahn School of Medicine at Mount Sinai Lower income, ethnic minorities are more likely to experience lifetime adversities, including interpersonal trauma 1 Evidence suggests prenatal stress is associated with adverse fetal and childhood outcomes 2 Maternal interpersonal trauma (IPT) has been linked to elevated cord blood IgE and repeated wheeze 3 Research highlights the critical role of sex differences in stress- related and respiratory disorders 4-6 In an urban, ethnically mixed prenatal cohort we: Examined the impact of maternal IPT on childhood asthma Determined whether this association varied by sex Asthma Coalition for Community, Environment and Social Stress Prenatal cohort Designed to examine the independent and interactive effects of early-life psychosocial stress and physical toxins on urban childhood respiratory health Recruitment Mother-child pairs recruited from prenatal clinics/health centers and Women, Infants, and Children (WIC) programs in Boston, Massachusetts (N=955) Mid-late pregnancy (28.4 ± 7.9 weeks gestation) Inclusion Criteria English or Spanish speaking mothers ≥ 18 years of age Singleton pregnancies   Analyses include 857 mother-child pairs with asthma and IPT data Interpersonal Trauma (IPT) via Revised Conflict Tactic Scale (CTS-R) Measured at enrollment Exposure to trauma defined as Early (childhood/adolescence), Late (adulthood/index pregnancy), Chronic (early and late), or unexposed 3 During each life-stage if mother answered yes to any of the following items they were considered exposed: Push, grab, or shove you? Kick, bite, or punch you? Hit you with something that hurt your body? Choke or burn you? Force you to have sexual activities? Physically attack you in some other way? Asthma Maternal-reported physician-diagnosed asthma prior to age 7 years Statistical Analyses Logistic regression, sex-stratified Possible confounders: Maternal education, race, child’s sex Mediating variables: Smoking during pregnancy, environmental tobacco smoke exposure (ETS), maternal atopy, current negative life events (NLEs) 2-way interaction between child sex and IPT by adding product term (sex * IPT) in the model References: 1. Holman EA, et al. Traumatic life events in primary care patients: a study in an ethnically diverse sample. Archive of Family Medicine. 2000;9(9): ; 2. Kingston D: The effects of prenatal and postpartum maternal psychological distress on child development: a systematic review. The Centre for Child, Family and Community Research: Edmonton, Alberta; ; 3. Sternthal MJ et al. Maternal interpersonal trauma and cord blood IgE levels in an inner-city cohort: a life-course perspective. J Allergy Clin Immunol Nov;124(5): ; 4 Duchesne A, et al.. Sex differences in corticolimbic dopamine and serotonin systems in the rat and the effect of postnatal handling. Prog Neuropsychopharmacol Biol Psychiatry. 2009;14(2):251–261.. ; 5 Huang Y, et al.. Pre-gestational stress alters stress- response of pubertal offspring rat in sexually dimorphic and hemispherically asymmetric manner. BMC Neurosci Jul 8;14:67. ; 6 Belgrave DC, et al. Trajectories of Lung Function during Childhood. Am J Respir Crit Care Med May 1;189(9): INTRODUCTION   Mothers lifetime interpersonal trauma (chronic IPT) is associated with increased risk for childhood asthma in their offspring   This relationship appears to be stronger in boys   Future research is needed to elucidate underlying pathways involving potential mediating variables (e.g., risk factors on the path to asthma development) such as ETS exposure, maternal atopy, and child’s birth weight as well as gender-specific effects Acknowledgements: ACCESS Project supported by NIEHS R01ES and NHLBI U01HL and R01HL Table 1. Demographic Characteristics for ACCESS (n=857) Covariatesn% < HS diploma (n=811)52865 Male43951 Smoking during pregnancy(n=828)12515 Household ETS (n=816)12315 Race (n=837) White769 Black25030 Hispanic45855 Other536 Maternal atopy (n=804)29937 Outcome Asthma13416 Primary Exposure Early IPT21525 Late IPT556 Chronic IPT11413 Table 2. Relationship between maternal IPT and childhood asthma* Model ParameteraOR95% CI Unexposedref Early IPT Late IPT Chronic IPT *Model was adjusted for maternal education, race, and child’s sex P int =0.05 P int =0.06 Figure 1. Effects of chronic maternal IPT exposure and childhood asthma in the total group and stratified by sex Overall Girls Boys OBJECTIVES STUDY POPULATION METHODS RESULTS RESULTS (Cont.) CONCLUSIONS Models adjusted for maternal education and race ( child’s sex in overall model) Models adjusted for maternal education, race, mediating variables and current non- traumatic NLEs ( child’s sex in overall model) P int : P-value for the interaction between sex * IPT in the total group