Eczema in fetus and neonates rise with maternal stress

Stress factors mothers experience before, during and soon after pregnancy can increase eczema risk in their children, according to a systematic review published Feb. 25, 2018 in The International Journal of Environmental Research and Public Health.

Stress factors that might increase eczema risk in mothers’ children include prenatal or postpartum depression, prenatal anxiety, maternal stress during pregnancy, adverse life events, distress or perceived stress before pregnancy, and job strain during pregnancy.

Researchers in China, the U.S. and Canada did a literature search, yielding 11 studies looking at the association between stressors leading to maternal stress and the odds of their infants developing eczema during childhood. While eight of the studies showed the increase in eczema risk in children whose mothers experienced maternal stress was statistically significant, some studies also found contradictory results - notably, when researchers examined the association between a mother’s depression and childhood eczema risk.

Eczema prevalence is increasing worldwide and is estimated to impact 20 percent of children younger than five years, according to the review. Researchers have identified a number of factors linked to the increased risk of eczema in children. Those include, in the last decade, suggesting a potential correlation between mothers’ stress and eczema development in their children.

Stress, induced from a stimulus such as a traumatic life event, activates the hypothalamic pituitary adrenal axis and produces cortisol. Studies have shown maternal cortisol can cross the placenta, reaching the fetus and leading to detrimental effects, including impaired brain development and low birthweight.

Maternal stress also has been linked to immune function deregulation in offspring. That could result in inflammation, which is associated with eczema occurrence. The authors point to a study, which found maternal stress leads to cytokine production, which contributes to allergy development.

“In other words, immune dysregulation may serve as a link between stress in mothers and increased risk of their children having eczema,” the authors write.

When they looked specifically at aspects of maternal stress, the researchers uncovered four studies on mothers’ depression and children’s eczema risk. While three of those found a significant positive correlation between depression and eczema, one found little to no positive association. The authors point out that this could have something to do with the ethnic groups studied. For example, while studies done in European countries didn’t find an association between depression and childhood eczema risk, those done in Asian countries did, indeed, find an association.

The association between the skin disease and maternal stress was clearer in other areas. For example, both studies looking at adverse life events and eczema found mothers who experienced these events during pregnancy were more likely to have children who developed eczema during childhood.

When the researchers examined other stress factors, such as perceived stress, they found mothers’ perceived stress seemed to have a more significant positive association with childhood eczema risk as children grew older.

Three studies reported odds ratio temporal changes at various time points, highlighting whether the extent of the reported positive association between the stressors mothers experience and how that impacts their children’s eczema risk might change as children grow older.

But it remains unclear, the authors write, how childhood eczema risk might be altered as the child ages.

These findings generally suggest the need to help ensure mothers’ exposure to stress is minimal, according to the authors. Possible interventions include educating pregnant women about stress reduction techniques. And given the finding of an association between job strain experienced by mothers and childhood eczema, the authors suggest women should be encouraged to take mandatory paid maternity leaves during pregnancy, and pregnant women should avoid working overtime or long hours to make ends meet.

REFERENCES

Chan CWH, Law BMH, Liu YH, Ambrocio ARB, Au N, Jiang M, Chow KM. “The Association between Maternal Stress and Childhood Eczema: A Systematic Review,” The International Journal of Environmental Research and Public Health. February 2018;15(3). DOI:10.3390/ijerph15030395