Stress in pregnancy linked to children's asthma risk

NEW YORK - Stress during pregnancy brought on by events like divorce, job loss or death of a loved one appears to be linked to an increased risk of asthma and eczema among children.

These findings, Dr. Petra Arck told Reuters Health in an email, could "allow clinicians to evaluate future asthma risk in unborn children using a simple life event assessment questionnaire."

Arck, of University Medical Center Hamburg-Eppendorf in Germany, and her colleagues note that although there are strong genetic components to asthma and related conditions, these alone do not help explain the unprecedented increase in such diseases in recent years.

Over the same period as that increase, they add, stress levels have been on the rise. But there hasn't been much evidence to connect stress in pregnancy to asthma and eczema.

To investigate further, the researchers examined data from 1,587 children and their mothers who took part in an Australian pregnancy study. The original purpose of the study was to determine the effects of intensive fetal monitoring on pregnancy outcomes.

Mothers-to-be were asked about recent stressful life events halfway through their pregnancy and again toward the end of pregnancy. Their children were evaluated for asthma, eczema and other allergy-related conditions at age six and 14.

Complete data were available for 994 children and their mothers.

The researchers calculated that the likelihood of having asthma or eczema as a teenager was substantially higher among children of mothers who experienced stressful life events during the second half of their pregnancies.

Specifically, kids were about twice as likely to have asthma as 14-year-olds if their mothers had been through a single stressful life event, once other factors known to influence asthma were taken into account. Risks were similar when mothers had experienced multiple life stressors.

When the researchers looked closer, they found that pattern only held among children whose mothers did not have asthma themselves.

There was no link between stressful events in pregnancy and a child's chance of having asthma or eczema at age six, according to findings published in the Journal of Allergy and Clinical Immunology.

The authors note that they did not have information on how mothers-to-be coped with stressful life events or the types of social support they had available.

And they point out that factors other than stress in pregnancy might have been responsible for the increased risk of disease in certain children.

One researcher not involved in the study said it was well designed and addressed an important topic, but urged caution when interpreting the findings.

Alet H. Wijga, from the National Institute for Public Health and the Environment in Bilthoven, the Netherlands, echoed the warning that stress, itself, may not have been what caused kids' asthma and eczema.

"Life events like money problems, job loss and residential move associated with separation or divorce during pregnancy may well have lasting impact on the socio-economic position of the mother and her child and may, for example, be associated with unfavorable indoor and outdoor exposures throughout the child's life course up to adolescence," Wijga told Reuters Health in an email.

"I do think the study provides evidence for an association between prenatal adverse life events and the risk for allergic disease in childhood," Wijga said. The challenge in the future will be to sort out the possible effects of stress during pregnancy from a child's environment growing up, the researcher added. — Reuters

source: gmanetwork.com

Saliva reveals asthmatic kids’ smoke exposure

NEW YORK - Asthmatic children who are exposed to cigarette smoke are more likely to make repeat trips to the hospital for breathing problems. But researchers say asking parents about kids' smoke exposure may not yield the most reliable information.

In a recent study, saliva revealed exposure to tobacco smoke in roughly 80 percent of children brought to the hospital for asthma or breathing problems. But only about a third of parents said their children came in contact with smoke.

What's more, finding evidence of nicotine, a chemical in tobacco, in children's saliva was a better predictor of whether they would need to come back to the hospital, compared to the information parents gave to doctors.

"We think saliva is a good and potentially useful test for assessing an important trigger for asthma," Dr. Robert Kahn, the study's senior author, told Reuters Health.

Previous research has found that being exposed to tobacco can lead to airway problems and poor asthma control among children, Kahn and his colleagues write in the journal Pediatrics.

By figuring out which children are being exposed to tobacco, doctors may be able to step in and identify and possibly eliminate the exposure, said Kahn, a pediatrician at Cincinnati Children's Hospital Medical Center in Ohio.

For example, if a parent is still smoking cigarettes and exposing the child to smoke, doctors can offer the parent smoking cessation tools while the child is hospitalized.

For the new study, the researchers assessed data from 619 children admitted to Cincinnati Children's Hospital Medical Center for asthma or other breathing problems between August 2010 and October 2011. The children were between one and 16 years old.

During the children's first couple of days in the hospital, researchers asked their parents if the children had any exposure to tobacco—either at home, in the car or in another place the children slept. Nurses also collected blood and saliva samples from the children.

About 35 percent of parents reported their children having some tobacco exposure.

However, about 56 percent of the children's blood samples and about 80 percent of their saliva samples tested positive for cotinine, a component of nicotine that's a marker for tobacco exposure.

The difference in the results of the saliva and blood tests and the parents' reports doesn't necessarily mean the parents lied about their children's exposure to smoke.

It could also be that the researchers and doctors didn't ask enough or the right questions or that the parents didn't know their children were being exposed to smoke.

"Sometimes a parent's response to a simple question may not reflect the nuances of life," Dr. James Kreindler said.

He was not involved with the new study but is an attending pulmonologist at The Children's Hospital of Philadelphia in Pennsylvania.

One in six children in the study had to be readmitted to the hospital within a year.

Parents' reports of smoke exposure weren't tied to the likelihood of children returning to the hospital. But Kahn and his colleagues did find that children were more likely to be readmitted if their saliva or blood tested positive for cotinine.

The researchers write that saliva is an attractive testing option, because it's not hard or invasive to get a sample. It also appeared to be a more sensitive test than blood.

But Kreindler cautioned that the new results don't mean children should get tested for cotinine in the hospital.

"The test they are using to determine cotinine levels is a very sophisticated test—not one that would be available to every community hospital," he said. And the treatment for asthma wouldn't necessarily change based on whether a child was exposed to tobacco, he noted.

Kreindler said a cost analysis would also be needed to look at the expense of testing.

According to Kahn, a cost analysis would most likely follow a trial of whether smoking cessation after positive saliva tests decreased hospital readmissions among children.

"The take-home message should always be that exposure to secondhand smoke for both adults and children is a significant health risk factor—particularly for children with asthma and respiratory disorders," Kreindler said. "They should not be exposed to secondhand smoke under any circumstance." —Reuters

source: gmanetwork.com