1. Daniela Porta, Francesco Forastiere Rome, October 15th - 16th, 2012 POTENTIALS OF BIRTH COHORT STUDIES Maternal depression and stress in relation to childhood asthma

2. BACKGROUND It is well established that developmental processes are influenced by environmental factors in utero Pregnancy and birth cohorts are the best study design to evaluate the impact of early exposures prospectively and at multiple time points during the development of a child.

3. BACKGROUND Collaboration across large regions is needed to obtain the full potential information from single cohorts www.birthcohorts.net ENRIECO CHICOS establish collaboration among birth cohorts ESCAPE MEDALL collaborative projects focused on specific diseases or exposures

4. GASPII Gene and Environment: Prospective Study on Infancy in Italy 708 children and mothers enrolled at birth in 2 hospitals of Rome in 2003-2004 Cord blood and maternal blood (serum and DNA) Outcomes at study: Asthma and allergies Neurodevelopment Obesity Injuries Follow-up6, 15 months 4, 7, years 8 years ongoing (MEDALL) GASPII participated in all the EU projects mentioned before

5. Stress, through its influence on immune function, has been proposed to play an important role in infection susceptibility and allergy Immunodevelopment is regulated in utero, so maternal stress in the prenatal period may alter neonatal immunity and asthma risk BACKGROUND Maternal stress and asthma

6. Childhood asthma was associated with continued maternal distress disorders beginning at birth

7. Association between maternal anxiety symptoms during pregnancy and asthma in childhood.

8. Exposure-response relationship between greater prenatal and postnatal maternal stress, when considered independently, and increased odds of early childhood repeated wheeze

9. Children with higher maternal stress in both developmental periods were most likely to have recurrent wheeze

10. BACKGROUND Maternal stress and asthma Strengths: - prospective study - heterogeneous population - confounders control - mediators control - robust findings Limits: - maternal reported outcome - unmeasured confounding FURTHER STUDIES ARE REQUIRED

11. OBJECTIVES To study the role of maternal depression and stress, in different period of children’s life, on the onset of wheezing and asthma. To evaluate which factors are mediators of the relationship.

12. DAG SES/education Mode of delivery Breast-feeding Number of siblings Atopic history Depression Asthma/ wheezing Maternal smoking/ETS Air pollution Maternal age Maternal BMI Partner Job Family/social support Child Sleeping/eating difficulties Maternal problems in pregnancy Ethnicity Day-care Child sex Birth weight ?

13. METHODS Exposures EPDS (Edinburgh Postnatal Depression Scale) - at delivery (I – II – III trimester of pregnancy) - at 6 months (1 st months after pregnancy) - at 15 months (last week) - at 4 years (last week) Socioeconomic status - occupation - education - area level variable Health problems in pregnancy, personal history, job, number of siblings, family and social support, presence and support of a partner Other possible stressors related to children - sleep or eating difficulties - health problems

14. METHODS Outcomes Wheezing (mother-reported) - at 6 months - at 15 months - at 4 years - at 7 years - at 8 years Asthma (doctor diagnosed and/or mother-reported) - at 6 months - at 15 months - at 4 years - at 7 years - at 8 years (clinical measurements)

15. RESULTS EPDS Description of EPDS scoring (depression) by period of testing

16. RESULTS EPDS Percentage of mothers with EPDS score>10 by period of testing

17. DISCUSSION Limits Not a priori hypotheses have been set Maternal report of outcomes Strenghts EPDS – standardized depression index repeated measures Several adjustment/mediator variables Challenges Mediation analysis

18. FUTURE CHALLENGES Piccoli+ - Ongoing Italian cohort (about 3000 newborns) Turin Trieste Florence Rome - Other kind of stress or depression scale (GHQ 12, p-scale) Collaborations with other birth cohorts are hoped - joined analysis - design of new instruments for future assessment of the exposure

19. METHODS Covariates At birth - maternal age - maternal education - ethnicity - parental atopic history - maternal pre-pregnancy BMI - smoking during pregnancy - exposure to air pollution - child sex and birth-weight - modality of delivery At follow-up (6 and 15 months, 4 years) - breast-feedings - passive tobacco smoke - day-care attendance - number of siblings