Obstetric complications in patients with depression - A population-based case-control study

CMG, Psychiatry branch, Cagliari, via Costantinopoli 42, 09129, Cagliari, Italy.
Journal of Affective Disorders (Impact Factor: 3.38). 01/2001; 61(1-2):101-6. DOI: 10.1016/S0165-0327(99)00185-8
Source: PubMed


To examine whether sufferers of affective disorders are more likely to be subject to obstetric complications than normal healthy people.
Data based on prospectively recorded birth case-notes for patients with a diagnosis of depression (or related disorders) with early onset were compared to those of normal healthy controls, individually matched by gender, time and parity of birth, maternal age and marital status.
Forty-one case-controls pairs born between 1964 and 1978 were compared. No differences between cases and controls in gestational age or birthweight were significant, though depressive patients on average weighed 200 g less than controls at birth. Patients were more likely than controls to be small for their gestational age (22 vs. 1: chi(2)=4.34, P=0.03). They were significantly more likely than controls to have suffered at least one obstetric complication: 35 (85%) vs. 25 (60%), chi(2)=5.03, P=0.02; or more than one (two on average, as opposed to one on average among controls). No obstetric complication was seen significantly more among cases than controls, apart from bleeding during gestation, which was observed for four cases and no controls. The prevalence of complications with a clear brain damaging potential did not differ significantly between cases and controls: 11 (26%) vs. 8 (19%).
A developmental deficit, as indicated by lower birthweight and gestational age, may contribute to the risk of depressive breakdowns and affective disorders in later life. Severe, brain damaging obstetric complications are unlikely to be a significant risk factor for affective disorders, though some early onset cases may be accounted for by prenatal brain lesions. Limitations: Sample size limits statistical power for isolation of a rare, single risk factor.

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    • "It is interesting to note that psychiatric disorders appear to be strongly associated in neuorodevelopmental changes. Even in psychiatric disorders such as MDD, anorexia nervosa, and schizophrenia , in which symptoms typically emerge in adolescence or young adulthood, epidemiological studies have shown the increased risks of these disorders in offspring with low birth weight (Abel et al., 2010; Cnattingius et al., 1999; Mick et al., 2002; Costello et al., 2007), obstetric complication [anorexia nervosa (Favaro et al., 2006) and schizophrenia (Geddes and Lawrie, 1995), but not for MDD (Bain et al., 2000; Preti et al., 2000)], and exposure to prenatal environmental factors such as stress (Ronald et al., 2011; van Os and Selten, 1998; Rodriguez and Bohlin, 2005; Khashan et al., 2008; Malaspina et al., 2008), famine (Brown et al., 1995b, 2000; Susser et al., 1996), and virus infection (Favaro et al., 2011; Mednick et al., 1988; Brown et al., 1995a; Brown, 2006; Machon et al., 1997). Thus, prenatal period may be the critical time window for environmental adaptation incorporated into evolution, which in turn may originate psychiatric conditions that bring benefits for survival of organisms in severe environmental conditions. "
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    ABSTRACT: Adverse antenatal maternal environments during pregnancy influence fetal development that consequently increases a risk of mental health problems including psychiatric disorders in offspring. Therefore, behavioral and brain alterations caused by adverse prenatal environmental conditions are generally considered as deficits. In this article, we propose a novel hypothesis, along with summarizing a body of literatures supporting it, that fetal neurodevelopmental alterations, particularly synaptic network changes occurring in the prefrontal cortex, associated with adverse prenatal environmental conditions may be adaptation to cope with expected severe postnatal environments, and therefore, psychiatric disorders may be able to be understood as adaptive strategies against severe environmental conditions through evolution. It is hoped that the hypothesis presented in this article stimulate and open a new venue on research toward understanding of biological mechanisms and therapeutic treatments of psychiatric disorders.
    Journal of Physiology-Paris 04/2013; 107(6). DOI:10.1016/j.jphysparis.2013.04.007 · 1.90 Impact Factor
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    • "Neurobiological defi cits may not only be due to genetic transmission, but also a consequence of prenatal, perinatal or postnatal brain damage. Impaired neurodevelopment during fetal life and obstetric complications may increase susceptibility to depression (Gale and Martyn 2004; Preti et al. 2000). To our knowledge, the present study is the fi rst comparison of patients with predominantly melancholic depression and healthy control subjects with regard to retrospectively recalled childhood trauma, parental rearing styles, birth risk factors, and familial psychiatric disorders with healthy controls. "
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    ABSTRACT: Objective: Only few studies have compared the frequency of traumatic life events during childhood in inpatients with depression with a healthy control group. Methods: Consecutively admitted inpatients with depression (n = 79), most of whom belonged to the melancholic subtype (n = 73; 92.4%), and healthy controls (n = 110) were investigated using a comprehensive retrospective interview with 203 questions regarding childhood traumatic life events, parental attitudes, family history of psychiatric disorders and birth risk factors. Results: Depressed patients had significantly more severe traumatic events (mean score 1.33; SD 1.4) than control subjects (0.85; SD 1.2) on a 0-10 point "severe trauma scale". 70.9% (n = 56) of the depressed patients, but only 48.2% (n = 53) of the controls reported at least one severe traumatic event. When looking at single events, only few differences were found between patients and controls. Compared to controls, patients described significantly higher rates of psychiatric disorders in their families, in particular depression. Parental rearing styles were rated as more unfavorable in the patient group. In a logistic regression model, of all possible etiological factors examined, only a family history of psychiatric disorders showed a significant influence (OR = 3.6). Conclusions: Melancholic depression seems to be less associated with traumatic events than other psychiatric disorders.
    International Journal of Psychiatry in Clinical Practice 10/2012; 17(1). DOI:10.3109/13651501.2012.735244 · 1.39 Impact Factor
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    • "Torrey, & Yolken, 2008; Cannon, Jones, & Murray, 2002; Hultman, Sparen, Takei, Murray, & Cnattingius, 1999; Verdoux et al., 1997), autism (Gardener, Spiegelman, & Buka, 2009; Hultman, Sparén, & Cnattingius, 2002), attention-deficit/hyperactivity symptoms (Hultman, Sparen, Takei, Murray, & Cnattingius, 2007), depression (Preti, Cardascia, & Stein, 2000), and anorexia nervosa (Cnattingius et al., 1999). However, little is known about the potential role of perinatal risk factors in the development of personality disorders. "
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    ABSTRACT: Although perinatal factors are associated with the development of several psychiatric disorders, it is unknown whether these factors are linked with personality disorder. Cases of personality disorder were drawn from a national registry of all forensic psychiatric evaluations (n = 150). Two control groups were used: (1) A sample of forensic evaluations without any psychiatric disorder (n = 97) allowing for a nested case-control investigation; and (2) A population-based sample matched by age and gender with no history of psychiatric hospitalization (n = 1498). Prematurity (<37 weeks of completed gestation) was significantly associated with a diagnosis of personality disorder, both in the nested and the population-based case-control comparisons with adjusted odds ratios (OR) for this risk factor ranging from 2 to 4. Asphyxia (adjusted OR = 2.4, 95% CI: 1.4-4.1) and complicated delivery (adjusted OR = 1.5, 1.0-2.1) were associated with personality disorder in the population-based study, and the former remained significant in multivariate models. Overall, perinatal complications were found to be associated with a later diagnosis of personality disorder in this selected sample. As with other psychiatric disorders where such associations have been demonstrated, changes during the perinatal period may lead to abnormal brain development and function.
    Journal of personality disorders 10/2012; 26(5):737-50. DOI:10.1521/pedi.2012.26.5.737 · 3.08 Impact Factor
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