The effects of maternal asthma during pregnancy on child cognitive and behavioral development: A systematic review

Whalen, Olivia M.; Karayanidis, Frini; Murphy, Vanessa E.; Lane, Alison E.; Mallise, Carly A.; Campbell, Linda E.

doi:10.1080/02770903.2018.1437174

Cited by 21 publications

(10 citation statements)

References 30 publications

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“…A potential confounder of the association between maternal antiasthmatic medication use and subsequent offspring development is the maternal history of asthma during pregnancy . We found no evidence of confounding by a maternal history of prepregnancy asthma, consistent with those of several studies . Furthermore, we examined the effect modification by sex; the results suggested no sex differences regarding the association between in utero antiasthmatic medication exposure and offspring development.…”

Section: Discussionsupporting

confidence: 89%

Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

Nagata,

Masumoto,

Nishigori

et al. 2023

JAMA Netw Open

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ImportanceCorticosteroids and β2-adrenergic agonists are commonly used during pregnancy to treat asthma. However, offspring neurodevelopmental outcomes following in utero exposure to these medications remain unclear.ObjectiveTo investigate the association between timing of in utero exposure to corticosteroids and β2-adrenergic agonists and offspring neurodevelopmental milestones during the first 3 years of life.Design, Setting, and ParticipantsThis cohort study obtained data from the Japan Environment and Children’s Study, an ongoing birth cohort study conducted in collaboration with 15 Regional Centers across Japan. Participants were mother-offspring pairs who were recruited between January 1, 2011, and March 31, 2014. Data were analyzed between January and February 2023.ExposureCorticosteroids and β2-adrenergic agonists were the exposure of interest. Timing of corticosteroid and β2-adrenergic agonist exposure included early pregnancy (weeks 0-12), mid- to late pregnancy (weeks &gt;12), and both stages of pregnancy.Main Outcomes and MeasuresOffspring neurodevelopmental milestones (communication, gross motor, fine motor, problem-solving, and personal-social skills) were assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition, at 6, 12, 18, 24, 30, and 36 months.ResultsIn total, 91 460 mother-offspring pairs were analyzed. Among mothers, the mean (SD) age at delivery was 31.20 (5.05) years. Among offspring, 46 596 (50.9%) were males and 44 864 (49.1%) were females, of whom 66.4% had a gestational age of 39 to 41 weeks. During early, mid- to late, and both stages of pregnancy, 401 (0.4%), 935 (1.0%), and 568 (0.6%) offspring, respectively, were exposed to corticosteroids, whereas 170 (0.2%), 394 (0.4%), and 184 (0.2%), respectively, were exposed to β2-adrenergic agonists. No association of corticosteroid exposure during early, mid- to late, and both stages of pregnancy with all 5 neurodevelopmental milestones was found. Similarly, no association between β2-adrenergic agonist use during early pregnancy and all 5 neurodevelopmental milestones was observed. An association was found between β2-adrenergic agonist exposure during mid- to late pregnancy and delayed personal-social skills (adjusted odds ratio, 1.48; 95% CI, 1.01-2.32; P = .045).Conclusions and RelevanceResults of this study found no association between in utero corticosteroid and β2-adrenergic agonist exposure and offspring neurodevelopmental outcomes, regardless of the timing of exposure. Despite the limitations and low power of the study, the findings suggest that corticosteroids and β2-adrenergic agonists are safe for pregnant individuals with asthma and the neurodevelopment of their offspring.

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Section: Discussionsupporting

confidence: 89%

Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

Nagata,

Masumoto,

Nishigori

et al. 2023

JAMA Netw Open

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“…Changes in infant gut microbiome secondary to maternal immune status may result in changes to infant temperament and sensory features, which could be a potential explanation for our finding of high proportions of distractibility and arrhythmia. A recent systematic review (Whalen et al, 2019) highlights the importance of optimal asthma management during pregnancy, and the potential effect this has on child development. Thus, our findings, along with the previous literature, support the need to further investigate the role of maternal asthma in infant behavioural outcomes.…”

Section: Limitations and Directions For Future Researchmentioning

confidence: 99%

“…Both temperament and sensory processing can be assessed reliably in infancy, offering an opportunity to explore early bidirectional links between early developmental vulnerabilities and immune function (Engel-Yeger et al, 2014;O'Connor et al, 2017). Infants born to mothers with asthma have been reported to be at-risk for poorer behavioural outcomes (for review, see Whalen et al, 2019), which may be associated with temperament and sensory differences (Ben-Sasson et al, 2013;Mallise et al, 2020). Exploring differences in temperament and sensory processing of infants born to mothers with asthma during the first year of life may allow for the early identification of those at high-risk of poorer developmental and behavioural outcomes in later childhood.…”

Section: Introductionmentioning

confidence: 99%

Early Sensory and Temperament Features in Infants Born to Mothers With Asthma: A Cross-Sectional Study

et al. 2021

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Maternal asthma in pregnancy is associated with an increased risk of adverse perinatal outcomes. Adverse perinatal outcomes may result in poorer infant developmental outcomes, such as temperament and sensory difficulties. This study aimed to (1) assess differences in temperament and sensory features between infants born to mothers with and without asthma and (2) investigate differences in these infant behaviours as a function of maternal asthma severity and asthma control. Mothers completed the Carey Temperament Scales and the Sensory Profile 2 at either 6 weeks, 6 months, or 12 months postpartum. Overall, we observed no significant differences between infants born to mothers with and without asthma in their temperament or sensory features; scores in both domains fell within the normative range. More infants in the asthma group, however, were reported to be highly distractible. When compared with normative data, infants in both groups were reported to have poor predictability of biological functions and fewer infants engaged in low levels of sensory behaviours. Some infants were observed to experience difficulties with hyper-reactivity within several domains. Maternal asthma severity and control during pregnancy were not linked to significant differences between infant temperament and sensory features. The present findings indicate that infants born to mothers with asthma are not at an increased risk overall for temperament or sensory difficulties, compared to control infants. However, a subset of infants across both groups may be at risk for attention or sensory hyper-reactivity difficulties. Further research into the developmental outcomes of infants born to mothers with asthma is warranted.

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“…Less is known about short-term placental and fetal manifestations of MIA when the immunogen is targeted to the lungs, as in respiratory infections and maternal airway inflammation [14][15][16][17][18][19][20] , which are common during pregnancy: 49.6% of control mothers in the National Birth Defects Prevention Study reported respiratory infections during pregnancy 21,22 .…”

Section: Introductionmentioning

confidence: 99%

Pulmonary maternal immune activation does not extend through the placenta but leads to fetal metabolic adaptation

Hansen

Krautz

Rago

et al. 2023

Preprint

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Maternal immune system activation (MIA) during pregnancy can disrupt the fetal environment, causing postnatal susceptibility to disorders. How the placenta and the fetus respond to acute MIA over time is unknown. Here, we characterized the response to acute maternal pulmonary inflammation across time in maternal and fetal organs using multi-omics. Unlike maternal organs which mounted strong innate immune responses, the placenta upregulated tissue-integrity genes, likely to prevent fetal exposure to infections, and downregulated growth-associated genes. Subsequently, the placenta upregulated biosynthesis and endoplasmic reticulum stress genes in order to return to homeostasis. These responses likely protected the fetus, since we observed no immune response in fetal liver. Instead, likely due to nutrient depletion, the fetal liver displayed metabolic adaptations, including increases in lipids containing docosahexaenoic acid, crucial for fetal brain development. Our study shows, for the first time, the integrated temporal response to pulmonary MIA across maternal and fetal organs.

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The effects of maternal asthma during pregnancy on child cognitive and behavioral development: A systematic review

Cited by 21 publications

References 30 publications

Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

Early Sensory and Temperament Features in Infants Born to Mothers With Asthma: A Cross-Sectional Study

Pulmonary maternal immune activation does not extend through the placenta but leads to fetal metabolic adaptation

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