Maternal Bacterial Infection During Pregnancy and Offspring Risk of Psychotic Disorders

American Journal of Psychiatry
09 Oct, 2019 ,

Younga H. Lee et al tested their hypothesis that maternal bacterial infection during pregnancy enhances offspring risk of psychotic disorders in adulthood, and that the severity of infectious exposure and offspring gender influence the magnitude of this association. They performed analysis of prospectively collected data of 15,421 pregnancies among women recruited between 1959 and 1966 at two study sites through the Collaborative Perinatal Project. Findings suggest a strong association of maternal bacterial infection during pregnancy with an elevated risk for psychotic disorders in offspring and that infection severity and offspring gender determines the association. Males vs females had a significantly higher tendency to develop psychosis after maternal exposure to any bacterial infection during pregnancy. These findings, if replicated, emphasize making public health and clinical efforts that focus on limiting and managing bacterial infection in pregnant women.

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Abstract

Objective:

Previous studies suggest that prenatal immune challenges may elevate the risk of schizophrenia and related psychoses in offspring, yet there has been limited research focused on maternal bacterial infection. The authors hypothesized that maternal bacterial infection during pregnancy increases offspring risk of psychotic disorders in adulthood, and that the magnitude of this association varies as a function of severity of infectious exposure and offspring sex.

Methods:

The authors analyzed prospectively collected data from 15,421 pregnancies among women enrolled between 1959 and 1966 at two study sites through the Collaborative Perinatal Project. The sample included 116 offspring with confirmed psychotic disorders. The authors estimated associations between maternal bacterial infection during pregnancy and psychosis risk over the subsequent 40 years, stratified by offspring sex and presence of reported parental mental illness, with adjustment for covariates.

Results:

Maternal bacterial infection during pregnancy was strongly associated with psychosis in offspring (adjusted odds ratio=1.8, 95% CI=1.2–2.7) and varied by severity of infection and offspring sex. The effect of multisystemic bacterial infection (adjusted odds ratio=2.9, 95% CI=1.3–5.9) was nearly twice that of less severe localized bacterial infection (adjusted odds ratio=1.6, 95% CI=1.1–2.3). Males were significantly more likely than females to develop psychosis after maternal exposure to any bacterial infection during pregnancy.

Conclusions:

The study findings suggest that maternal bacterial infection during pregnancy is associated with an elevated risk for psychotic disorders in offspring and that the association varies by infection severity and offspring sex. These findings call for additional investigation and, if the findings are replicated, public health and clinical efforts that focus on preventing and managing bacterial infection in pregnant women.