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J Asthma. 2018 Apr 25:1-9. doi: 10.1080/02770903.2018.1466313. [Epub ahead of print]

The influence of prenatal mental health service use on the incidence of childhood asthma: a population-based cohort study.

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a Department of Pediatrics , Children's Hospital of Eastern Ontario , Ottawa , Ontario , Canada.
b Department of Pediatrics , University of Ottawa , Ottawa , Ontario , Canada.
c Department of Pediatrics , Institute for Clinical Evaluative Sciences , Ontario , Canada.
d Department of Pediatrics , Hospital for Sick Children, Child Health Evaluative Sciences , Toronto , Ontario , Canada.
e Department of Pediatrics , Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada.



We aimed to determine whether maternal mental health service use during pregnancy, a potential proxy measure of prenatal maternal stress, is associated with the development of asthma in a large population-based sample of children. We hypothesized that children born to mothers with mental health service use during pregnancy would have a higher incidence of childhood asthma.


Health administrative data from Ontario, Canada (population >13 million) was used to identify pairs of mothers linked with their children born between April 1, 2001 to March 31, 2002. Descriptive statistics were used to compare the cumulative incidence of asthma by age 12 years in children whose mothers did or did not have prenatal mental health service use. Multivariable logistic regression was used to estimate the association between prenatal maternal mental health service use and childhood asthma incidence, after adjusting for the child's sex, residency (rural vs. urban), socioeconomic status, comorbid health conditions, low birthweight, and maternal history of asthma.


In a population-based sample of 122,333 children, those born to mothers with mental health service use during pregnancy had increased odds of developing asthma (odds ratio: 1.16, 95% confidence intervals: 1.12, 1.20, p < 0.001).


Prenatal maternal mental health service use is an independent risk factor for the development of asthma in childhood. This supports growing evidence for the importance of in utero exposure to maternal stress factors in asthma pathogenesis. This study highlights a potential strategy for the primary prevention of childhood asthma, namely improved recognition and management of mental health issues and stress in pregnant mothers.


Anxiety; depression; epidemiology; health services use; pediatrics; pregnancy

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