{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T23:19:52Z","timestamp":1791328792666,"version":"4.3.1"},"reference-count":59,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2018,2,8]],"date-time":"2018-02-08T00:00:00Z","timestamp":1518048000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Prenatal maternal stress may influence offspring's atopic risk through sustained cortisol secretion resulting from activation of the hypothalamic\u2010pituitary axis (\n                      <jats:styled-content style=\"fixed-case\">HPA<\/jats:styled-content>\n                      ), leading to Th2\u2010biased cell differentiation in the foetus. We undertook a systematic review and meta\u2010analysis investigating the relationship between prenatal maternal psychosocial stress and risk of asthma and allergy in the offspring.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched 11 electronic databases from 1960 to 2016, searched the grey literature and contacted experts in the field. Type of stress indicator included mood disorders, anxiety, exposure to violence, bereavement and socio\u2010economic problems occurring during pregnancy, both objectively and subjectively measured. We included all possible asthma and IgE\u2010mediated allergy outcomes. We conducted random\u2010effects meta\u2010analyses to synthesize the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 9779 papers of which 30 studies (enrolling &gt;6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, 4 were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema\/dermatitis (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      1.34, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.22\u20101.47), allergic rhinitis (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      1.30, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.04\u20101.62), wheeze (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      1.34, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.16\u20101.54) and asthma (\n                      <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>\n                      1.15, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.04\u20101.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early\u2010onset and persistent than for late\u2010onset wheeze. Bereavement of a child (\n                      <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n                      1.28, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.10\u20101.48) or a spouse (\n                      <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n                      1.40, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      1.03\u20101.90) increased the risk of offspring asthma.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester\u2010specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cea.13091","type":"journal-article","created":{"date-parts":[[2018,1,13]],"date-time":"2018-01-13T08:48:24Z","timestamp":1515833304000},"page":"403-414","source":"Crossref","is-referenced-by-count":150,"title":["Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"48","author":[{"given":"C.","family":"Flanigan","sequence":"first","affiliation":[{"name":"Asthma UK Centre for Applied Research Centre for Medical Informatics Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Asthma UK Centre for Applied Research Centre for Medical Informatics Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"DunnGalvin","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Cork University Hospital Cork City Ireland"},{"name":"University College Cork Cork City Ireland"},{"name":"School of Applied Psychology University College Cork Cork City Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9885-8261","authenticated-orcid":false,"given":"B. 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