Promoting child respiratory health through novel psychosocial targets: An investigation of a maternal mental health intervention
Summary
Respiratory problems during childhood, including reduced lung function and asthma symptoms, present a threat to healthy child development. There is increasing evidence linking prenatal and early childhood adversity, such as poverty, violence, or maternal depression, to multiple respiratory health problems over the lifecourse. However, almost the entirety of this research has been conducted in high income settings, while the majority of the disease burden of respiratory health problems in childhood and beyond is in low resource settings, especially low-and-middle income countries (LMICs). In this study, we propose expanding on a birth cohort with a randomized controlled trial of a maternal depression intervention to generate important evidence on how childhood adversity impacts child respiratory health. Specifically, we will study how multiple adverse experiences during pregnancy, infancy, early childhood, and middle childhood affect respiratory health in early adolescence in a low resource setting. In addition, we will test whether a maternal depression intervention is an avenue for improving child respiratory function. We will achieve this by adding a wave of data collection to the Bachpan study, a birth cohort of roughly 900 mother-child dyads in rural Pakistan (R01HD075875, PI: Maselko). Led by a strong and multi-disciplinary team, the Bachpan study is a birth cohort with a nested cluster randomized controlled trial (cRCT) of a maternal depression intervention. Building on our teams successful track record in implementing the Bachpan cohort study, this proposal will fund the collection of an additional module focused on lung function and respiratory symptoms when children are 11 years old. The resulting unique dataset enables us to test several key hypotheses about the impact of common adversities, specifically poverty, violence, and maternal depression, spanning multiple development periods from pregnancy through middle childhood, on respiratory health at age 11. Additionally, hair-derived markers of child hypothalamic-pituitary-adrenal (HPA) axis activity are available for a subset of the children from multiple time points, facilitating an analysis of potential physiological pathways through which adversities may shape respiratory health. This innovative study will allow us to capitalize on an existing study infrastructure, cRCT design, and extensive longitudinal dataset to: (1) gain a holistic understanding of how childhood adversity and physiological regulation during varying developmental windows (prenatal, infancy, early childhood, middle childhood) relate to child respiratory function at age 8, and (2) test whether targeting maternal mental health may have benefits for child respiratory health.