Promoting child respiratory health through novel psychosocial targets: An investigation of a maternal mental health intervention - ABSTRACT 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. Childhood adversity may be a promising target for prevention of respiratory problems, but has never been the focus of a randomized control trial. In addition, there is a dearth of longitudinal evidence on how childhood adversity impacts respiratory health from low resource settings, such as low-and-middle income countries (LMICs), where the majority of the disease burden lies. In this study, we propose leveraging an ongoing 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 test whether a maternal depression intervention is an avenue for improving child respiratory function. In addition, we will study how multiple adverse experiences from pregnancy through middle childhood affect respiratory health in early adolescence in a low resource setting. We will achieve this by expanding on the Bachpan study, a birth cohort of roughly 825 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 team’s successful track record in implementing the Bachpan cohort study from pregnancy through child age 8, this proposal will fund an additional data collection wave focused on lung function and respiratory symptoms at child age 11. The resulting unique dataset enables us to test several key hypotheses about the impact of common adversities (poverty, violence, and maternal depression) spanning multiple development periods (pregnancy, infancy, early childhood, middle childhood) on respiratory health at age 11, as well as the potential role of a psychosocial maternal depression intervention. 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 and cost-effective study will allow us to capitalize on an existing study infrastructure, cRCT design, and extensive longitudinal dataset to: (1) test whether targeting maternal mental health may have benefits for child respiratory health, and (2) 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 11.
