IMPORTANCE Gestational influenza has been associated previously with schizophrenia in offspring, but the relationship between this exposure and bipolar disorder (BD) is unclear. The identification of gestational influenza as a risk factor for BD may have potential for preventive approaches. OBJECTIVE To test the hypothesis that maternal influenza during pregnancy is related to BD among offspring. DESIGN Nested case-control study of a population-based birth cohort from the Child Health and Development Study (CHDS). From January 1, 1959, through December 31, 1966, the CHDS recruited nearly all pregnant women receiving obstetric care from the Kaiser Permanente Medical Care Plan, Northern California Region (KPNC). Data on treated maternal influenza from the CHDS were used. Potential cases with BD from the cohort were identified by database linkages of identifiers among the CHDS, Kaiser Permanente database, and a large county health care database; by a mailed questionnaire to the CHDS cohort with subsequent interviews; and from an earlier psychiatric follow-up study on this birth cohort. SETTING The CHDS, Kaiser Permanente, and county health care databases. PARTICIPANTS Cases of BD (n = 92) confirmed by structured research interviews and consensus diagnosis among the 214 subjects (48% of those ascertained) who participated and control subjects (n = 722) matched on date of birth, sex, and membership in KPNC or residence in Alameda County. EXPOSURES Influenza. MAIN OUTCOME AND MEASURES Bipolar I or II disorder, BD not otherwise specified, or BD with psychotic features. RESULTS We found a significant, nearly 4-fold increase in the risk of BD (odds ratio, 3.82 [95% CI, 1.58-9.24; P = .003]) after exposure to maternal influenza at any time during pregnancy. The findings were not confounded by maternal age, race, educational level, gestational age at birth, and maternal psychiatric disorders. CONCLUSIONS AND RELEVANCE Maternal influenza may be a risk factor for BD. Although replication is required, the findings suggest that prevention of maternal influenza during pregnancy may reduce the risk of BD.
"Thus, the other ideal model would be an animal model that is created by gene-environment interaction, in which a genetic model of a common polymorphism is exposed to an environmental risk factor interacting with the polymorphism. Among environmental factors, perinatal infection (Parboosing et al., 2013), maternal smoking during pregnancy (Talati et al., 2013), and perinatal complications are established risk factors for bipolar disorder, but also apply to schizophrenia (Schmitt et al., 2014). Childhood maltreatment also is a common risk factor for depression and bipolar disorder (Daruy-Filho et al., 2011) as well as other mental disorders, such as personality and anxiety disorders. "
"Environmental conditions during early life may amplify individual vulnerability to psychiatric disease later in life, especially in those with a genetic susceptibility to a specific disease (Bale et al., 2010; Gluckman et al., 2008; Rutter, 2005). Multiple studies have reported an association between bipolar disorder and stressful early life events such as gestational hunger (Brown et al., 2000), gestational influenza (Machon et al., 1997; Parboosing et al., 2013), childhood abuse (Daglas et al., 2014; Etain et al., 2008; Gilman et al., 2014) and early parental loss (Mortensen et al., 2003). Early life events that may induce circadian dysfunction are of particular interest since bipolar disorder involves the disruption of many biological rhythms affecting the 24 h sleepewake cycle, energy and alertness (Giglio et al., 2009; McClung, 2013; Murray and Harvey, 2010; Wirz-Justice, 2006). "
[Show abstract][Hide abstract] ABSTRACT: Pregnant women infected with influenza virus are more likely to experience severe complications when compared with their non-pregnant peers. Yet influenza vaccine uptake is low among pregnant women. The purpose of this study was to assess the prevalence of seasonal influenza vaccine uptake among pregnant women in Hong Kong and to identify predictors of vaccine uptake.
Using a multi-center cross-sectional design, we recruited 2822 new mothers during their immediate postpartum stay from all eight public obstetric hospitals in Hong Kong. We assessed antenatal maternal influenza vaccination status as well as health beliefs and perceptions toward influenza and influenza vaccination. Bivariable and multivariable logistic regression was used to identify the predictors of vaccination uptake.
Only 49 (1.7%; 95% CI 1.3-2.3%) participants were vaccinated during their pregnancy. Fear that the vaccine would cause harm to the fetus or themselves were the most common reasons for not being vaccinated. Being aware of the vaccination recommendations (OR=2.69; 95% CI 1.06, 6.82), being advised by a health-care provider (OR=6.30; 95% CI 3.19, 12.46), history of vaccination (OR=2.47; 95% CI 1.25, 4.91), perceived susceptibility to influenza infection (OR=3.67; 95% CI 1.64, 8.22), and perceived benefits of influenza vaccination (OR=9.98; 95% CI 3.79, 26.24) were all independently associated with vaccination. Perceived barriers to vaccination (OR=0.17; 95% CI 0.07, 0.40) were strongly associated with failure to vaccinate.
Low seasonal influenza vaccination uptake among Hong Kong pregnant women was related to a number of factors, all of which are amenable to interventions. Vaccination promotion strategies need to focus on encouraging health-care providers to discuss vaccination with their pregnant clients and in providing pregnant women with accurate and unbiased information about the risks of influenza infection and the benefits of vaccination.
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