Maternal psychosocial risk factors and lower respiratory tract infection (LRTI) during infancy in a South African birth cohort.

Dan J Stein,Aneesa Vanker,Maia Lesosky,Rae Macginty,Maria Christine Magnus,Heather J Zar,Polite M Nduru,Whitney Barnett

doi:10.1371/journal.pone.0226144

Abstract

ObjectiveTo investigate the association between maternal antenatal and/or postnatal psychosocial risk factors (including depression, psychological distress, alcohol abuse and intimate partner violence (IPV) and infant lower respiratory tract infection (LRTI) in a low- and middle-income-country (LMIC).Study designPregnant women (n = 1137) enrolled in a South African birth cohort study, the Drakenstein Child Health Study (DCHS) were longitudinally assessed for psychosocial risk factors including depression, psychological distress, alcohol abuse and/or intimate partner violence (IPV). Infants were followed from birth until one year of age for the development of LRTI by active surveillance. Two outcomes were evaluated: any LRTI, and severe and/or hospitalised LRTI. Logistic regression was used to identify associations between individual maternal psychosocial risk factors and LRTI outcomes. Analyses stratified by age were also performed to determine which age groups related to infant LRTI were linked with maternal psychosocial risk factors.ResultsThere were 606 LRTI episodes in 369 infants in the first year (crude incidence rate = 0.53 episodes per person-year, 95%CI: 0.50; 0.56); 31% (n = 186) of episodes were severe or hospitalised events. Maternal psychosocial risk factors were associated with LRTI and severe LRTI, particularly postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal IPV. Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months of age, and postnatal maternal IPV was associated with early LRTI and severe forms of LRTI.ConclusionThe associations between maternal psychosocial risk factors and infant LRTI highlight the potential value of screening for maternal psychosocial risk factors in clinical settings and developing targeted interventions. Such interventions may not only improve maternal well-being, but also help reduce the burden of infant LRTI in LMIC settings.

Highlights

Lower respiratory tract infections (LRTI), pneumonia, is the leading cause of death in children beyond the neonatal period, and a major cause of morbidity
Maternal psychosocial risk factors were associated with lower respiratory tract infection (LRTI) and severe LRTI, postnatal and long-term maternal psychological distress, antenatal maternal alcohol consumption, and postnatal maternal intimate partner violence (IPV)
Age stratified analyses found that antenatal maternal alcohol consumption was associated with early infant LRTI, while antenatal maternal depression was linked with infant severe LRTI between 3 and 6 months

Summary

Introduction

Lower respiratory tract infections (LRTI), pneumonia, is the leading cause of death in children beyond the neonatal period, and a major cause of morbidity. There has been growing interest in the association of maternal psychosocial risk factors, such as perinatal depression, psychological distress, substance use, and intimate partner violence (IPV), with childhood respiratory illness, including LRTI. Maternal psychosocial risk factors have been found to be associated with wheezing and asthma in early childhood [5,6,7,8,9,10,11,12,13,14,15,16]. Most studies have been conducted in high income countries (HIC), but recently we reported maternal psychosocial risk factors were associated with wheezing in early childhood in the Drakenstein Child Health Study (DCHS), a South African birth cohort in a LMIC [17]. Antenatal maternal alcohol abuse has been found to be associated with impairments in early infant lung function in the DCHS [18]

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Conclusion