Article

Gestational Influenza and Bipolar Disorder in Adult Offspring

JAMA Psychiatry (Impact Factor: 12.01). 05/2013; 70(7):1-8. DOI: 10.1001/jamapsychiatry.2013.896
Source: PubMed

ABSTRACT

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.

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    • "Influenza was not associated with an increased risk of bipolar disorder in a Finnish cohort study of offspring exposed during pregnancy to the Asia flu epidemic of 1957 (Machon et al., 1997). Two subsequent studies, using the same American cohort (Northern California Birth Cohort), came to opposite results: one study found a 4-fold increase in the risk of BD after exposure during pregnancy and the risk increased to 6-fold for exposure during the 3 rd trimester (Parboosing et al., 2013); in the second study prenatal flu exposure, ascertained by serological examination, significantly increased the risk of BD with psychotic symptoms but not BD in general (Canetta et al., 2014). "
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    • "Maternal infectious or inflammatory insults during pregnancy have been repeatedly implicated in the etiology of developmental neuropsychiatric disorders, including schizophrenia (Brown and Derkits, 2010; Canetta et al., 2014b), autism (Atladóttir et al., 2012; Brown et al., 2014), and bipolar disorder (Canetta et al., 2014a; Parboosing et al., 2013). Preclinical support for these epidemiological associations has been obtained by various translational rodent models demonstrating multiple brain and behavioral abnormalities following prenatal exposure to infection and/or immune activation (reviewed in Boksa (2010), Harvey and Boksa (2012), Meyer (2014), Meyer and Feldon (2010)). "
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    • "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. "
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