title: Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies.
abstract: BACKGROUND
  A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child.
  
  
  METHODS
  The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014.
  
  
  RESULTS
  Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends.
  
  
  CONCLUSIONS
  This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
authors.affiliation: Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.|Sydney Medical School, Faculty of Medicine, University of Sydney, Concord Hospital, Sydney, NSW, Australia.|Department of Organic Psychiatric Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Aarhus, Denmark.
authors.forename: N W
authors.initials: NW
authors.lastname: Andersson
authors.affiliation: Department of Organic Psychiatric Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Aarhus, Denmark.
authors.forename: M V
authors.initials: MV
authors.lastname: Hansen
authors.affiliation: The National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: A D
authors.initials: AD
authors.lastname: Larsen
authors.affiliation: The National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: K S
authors.initials: KS
authors.lastname: Hougaard
authors.affiliation: Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H A
authors.initials: HA
authors.lastname: Kolstad
authors.affiliation: The National Research Centre for the Working Environment, Copenhagen, Denmark.|Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.|Section for Environment, Occupation and Health, Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.
authors.forename: V
authors.initials: V
authors.lastname: Schlünssen
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000453:epidemiology* / Q000209:etiology*; D007223:Infant; D018811:Maternal Exposure / Q000009:adverse effects*; D016017:Odds Ratio; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D013312:Stress, Physiological; D013315:Stress, Psychological
keywords: asthma; atopic disorders; child allergy; prenatal maternal stress; systematic review