Traumatic loss, adult separation anxiety and childhood asthma

Prenatal Stress and Risk of Asthma Hospitalization in the Offspring: A Swedish Population-Based Study

  1. Ali S. Khashan, PhD,
  2. Susanne Wicks, PhD,
  3. Christina Dalman, MD, PhD,
  4. Tine B. Henriksen, PhD,
  5. Jiong Li, PhD,
  6. Preben B. Mortensen, DMSc and
  7. Louise C. Kenny, MRCOG, PhD

+ Author Affiliations

  1. From the Anu Research Centre (A.S.K., L.C.K.), Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; Division of Public Health Epidemiology (S.W., C.D.), Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; and Perinatal Epidemiology Research Unit (T.B.H.), Department of Paediatrics, Aarhus University Hospital, Skejby; and The Danish Epidemiology Science Centre (J.L.), Department of Epidemiology, Institute of Public Health, and National Centre for Register-based Research (P.B.M.), University of Aarhus, Denmark.
  1. Address correspondence and reprint requests to Ali S. Khashan, PhD, Anu Research Center, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland. E-mail:


Objective Recent research suggested that maternal stress and anxiety increase the risk of asthma and eczema in the offspring. In this study, we aimed to study whether maternal exposure to death of a spouse or a child is associated with risk of asthma hospitalization in the offspring using a very large population-based cohort.

Methods In a cohort of 3.2 million births in Sweden between January 1, 1973, and December 31, 2004, mothers were considered exposed if their spouse or child died up to 6 months before or during pregnancy. Offspring were followed up from birth to their death, migration, first hospitalization with asthma, or December 31, 2006, whichever came first; hospital admissions were identified by linkage of several national Swedish registers. Log-linear Poisson regression was used for data analysis.

Results Overall, the risk of offspring asthma was increased with any prenatal exposure to bereavement in any exposure period (adjusted relative risk [RR] = 1.20 [95% confidence interval {CI} = 1.03?1.39]). The risk was higher when the exposure period was restricted to pregnancy only (adjusted RR = 1.43 [95% CI = 1.06?1.92]). Furthermore, the risk of asthma was increased in relation to death of a spouse during pregnancy (adjusted RR = 1.59 [95% CI = 1.10?2.30]).

Conclusions These findings suggest that prenatal exposure to severe life events increases the risk of hospitalization for asthma in the offspring. Fetal programming may be a plausible explanation for the association.

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