Anxiety During Pregnancy Linked to Childhood Asthma: An Interview With MedPage Today Executive Editor Peggy Peck

(www.livelywomen.com) — When I received word of new findings presented at the European Respiratory Society suggesting that women with high levels of anxiety during pregnancy were more likely to have asthmatic children, I had to know more. Executive Editor of medical news service MedPage Today Peggy Peck was kind enough to answer my questions. (FYI: The italicized section after the jump is the main takeaway, or what you should know as a pregnant woman or soon-to-be pregnant woman.)

Kristen, LivelyWomen.com: Where were these data announced, and what are the differences between research reported at a medical meeting and a published study?

Peggy Peck, MedPage Today: The data were reported at the European Respiratory Society meeting, a scientific meeting that was attended by pulmonologists and other clinicians who treat patients with respiratory illnesses, as well as epidemiologists and basic science researchers in the field of respiratory medicine.

When a study is reported at a meeting such as this, the data are first submitted in abstract format–that abstract usually just describes the methodology of the study and the research question that is being asked, but it may contain a very sketchy account of the findings. Abstracts are usually submitted to program committees months and months before the meeting and while thousands of abstracts are submitted only a small percentage are actually selected for presentation at the meeting–usually less than half of the abstract submissions are accepted and sometimes the acceptance rage is as low as 20%-33%.

Accepted abstracts are presented either as posters or oral presentations. Oral presentations allow a lead investigator about 10 to 15 minutes to present the study, including background, methodology, description of the study population, and the findings. Those data are most often presented as slides. This story was based on an oral presentation.

While it is good for a researcher to have his or her findings accepted for presentation at a scientific meeting (this counts as publication in a CV), data reported this way are not given the same weight as data published in a peer-reviewed journal. The reason for this two-tier approach is that studies published in journals need to not only pass muster with the journal editors but must also pass review by at least two and sometimes three or four outside reviewers, each of whom is considered an expert in the same field as the study investigators. Studies that don’t pass review are rejected outright or sometimes sent back to authors for extensive rewriting, usually to answer questions that reviewers say are essential for full understanding of the findings.

Kristen: Who were the lead researchers and what institution are they associated with?

Peggy Peck: The lead research was Raquel Granell, M.Sc., a doctoral candidate at the University of Bristol in the U.K. She worked on the research with a team of University of Bristol scientists.

Kristen: What are the main findings?

Peggy Peck: The main finding was that anxiety during pregnancy appeared to increase the risk of asthma developing in offspring. Moreover, the relationship between a mother’s anxiety or stress level and asthma in her child was strongest for women who reported high levels of anxiety around their due dates.

Kristen: What are the implications of these findings?

Peggy Peck: This is one of those cases when it appears that there may be some science to back up what many people might consider common sense–it’s better to stay calm and stress free when pregnant than it is to become overly anxious or nervous because anxiety has some physiologic effects that can impact the fetus. For example, the adrenal gland responds to stress by turning up cortisol, which is a good thing when we need to make quick getaway or perform some super human feat of strength, but maybe not so good when we’re carrying around an almost full term fetus. In this study the children of women who reported maternal stress had disrupted cortisol secretion as late as age 10.

One important implication of the study is that it appears to lay to rest the theory that anxious women were more likely to have children with asthma because “they were looking for it”, i.e. it’s all in mom’s mind. These findings may put that canard to rest.

Kristen: Were there any limitations to the study?

Peggy Peck: There are many limitations to this study because even though the researchers collected data prospectively and there were a large number of women who participated–5,810–this was an observational study, not a randomized controlled trial. Logically, of course, one can’t really do a placebo controlled trial of maternal stress–one could not ethically submit some pregnant women to unusual stress, while soothing others–the fact is that the best evidence comes from randomized controlled trials. When this study was presented an outside expert said the findings proved an association, but there is a difference between association and causality. We can not say for certain that stress in the mom caused asthma in the child.

Kristen: What are some ways women can reduce stress and anxiety during pregnancy?

Peggy Peck: Exercise is a great stress reducer, yet unfortunately many women cut down on exercise during pregnancy. While pregnancy is probably not the time to take up competitive weight-lifting or marathon running, aerobic exercise–spinning for instance or vigorous walking–can, in most cases, be continued throughout the pregnancy. Yoga has also been shown to be useful in reducing stress and many centers offer classes specifically designed for pregnant women.

Simple things like taking time every day to relax and “put your feet up” can also be helpful.

It is, however, probably impossible to avoid stress during pregnancy and normal worries–will be the baby be all right? Will I ever wear jeans again? Does everyone have this much heartburn? Will this baby ever be born?–won’t turn the baby into an asthmatic. Women who think they are having unusual levels of anxiety should discuss their concerns with their physician or midwife.

Kristen: Are women in any one demographic group more susceptible to giving birth to asthmatic babies?

Peggy Peck: It’s estimated that about 155 million people worldwide have asthma and most of them probably have a relative with asthma because there are dozens of genes that have been linked to asthma. The problem is that the real risk has not yet been quantified so experts estimate the heritability rate for asthma in a very wide range: 36%-79%.

So for that reason it is not a matter of identifying a particular ethnic group or geographic region in which women would be more or less at risk. We just don’t have enough reliable information to answer that question.

Kristen: Does pregnancy-related stress influence asthma during infancy, asthma that develops later in life, or both? Please explain

Peggy Peck: This study only investigated asthma developing during childhood–they investigated a time point, age 7.

Kristen: Please describe the study participants and study design.

Peggy Peck: The women were all enrolled in an ongoing cohort study–the Avon Longitudinal Study of Parents and Children. They all gave birth from April 1, 1991 though December 31, 1992. The women live in England, so most — but not all — of the women are white.

Contents Copyright © 2008 Kristen King

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