Gestational Influenza and Bipolar Disorder in Adult Offspring
Gestational Influenza and Bipolar Disorder in Adult Offspring
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DOI：
10.1001/jamapsychiatry.2013.896
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发表时间：
2013-07-01
期刊：
影响因子：
25.8
通讯作者：
Brown, Alan S.
中科院分区：
文献类型：
--
作者：
Parboosing, Raveen;Bao, Yuanyuan;Brown, Alan S.
妊娠期流感的重要性以前曾与子代精神分裂症有关，但这种暴露与双相情感障碍(BD)之间的关系尚不清楚。将孕期流感确定为BD的危险因素可能具有预防措施的潜力。目的验证孕期流感与子代BD相关的假设。设计一项来自儿童健康与发展研究(CHDS)的基于人群的出生队列嵌套病例对照研究。从1959年1月1日到1966年12月31日，CHDS招募了几乎所有从北加州地区凯撒永久医疗计划(KPNC)接受产科护理的孕妇。使用了CHDS提供的治疗过的母体流感数据。通过CHDS、Kaiser Permanente数据库和大型县卫生保健数据库之间的识别符的数据库链接，通过向CHDS队列邮寄问卷并随后进行访谈，确定队列中潜在的BD病例；收集CHDS、Kaiser Permanente和县卫生保健数据库。在214名参与研究的受试者(48%)和722名对照受试者(n=722)中，通过结构化的研究访谈和共识诊断确认了BD病例(n=92)。结果我们发现BD的风险显著增加，几乎增加了4倍。3.82[95%可信区间，1.58~9.24；P=.003])在怀孕期间的任何时间暴露于母亲流感之后。母亲的年龄、种族、教育程度、出生时的胎龄和母亲的精神障碍没有混淆这一发现。结论母亲流感可能是BD的危险因素。尽管复制是必要的，但研究结果表明，孕期预防母亲流感可能会降低患BD的风险。
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.