Associations between maternal mental health and early child wheezing in a South African birth cohort

Background: Wheezing in early childhood is common and has been identified in high-income countries (HIC) as associated with maternal antenatal or postnatal psychosocial risk factors. However, the association between maternal mental health and childhood wheezing has not been well studied in low and middle-income countries (LMIC), such as South Africa. Methods: A total of 1137 pregnant women over 18 year old, between 20 and 28 weeks’ gestation, and attending either of two catchment area clinics were enrolled in a South African parent study, the Drakenstein Child Health Study (DCHS). Psychosocial risk factors including maternal depression, psychological distress, early adversity, and intimate partner violence (IPV), were measured antenatally and postnatally by validated questionnaires. Two outcomes were evaluated: Presence of wheeze (at least one episode of child wheeze during the first 2 years of life); and recurrent wheeze (two or more episodes of wheezing in a 12-month period). Logistic regression was used to investigate the association between antenatal or postnatal psychosocial risk factors and child wheeze, adjusting for clinical and socio-demographic covariates. Results: Postnatal psychological distress and IPV were associated with both presence of wheeze (adjusted OR = 2.09, 95%CI: 1.16-3.77 and 1.63, 95%CI: 1.13-2.34, respectively), and recurrent child wheeze (adjusted OR = 2.26, 95%CI: 1.06-4.81 and 2.20, 95%CI: 1.35-3.61, respectively). Conclusion: Maternal postnatal psychological distress and IPV were associated with wheezing in early childhood. Thus, screening and treatment programs to address maternal psychosocial risk factors may be potential strategies to reduce the burden of childhood wheeze in LMICs.