PapersPrenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control studyPrenatal and perinatal risk factors for early onset schizophrenia, affective psychosis, and reactive psychosis
BMJ 1999; 318 doi: https://doi.org/10.1136/bmj.318.7181.421 (Published 13 February 1999) Cite this as: BMJ 1999;318:421
Footnotes
- Accepted 9 November 1998
Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study
- Christina M Hultman, research fellow (christina.hultman{at}ullpsyk.uu.se)a,
- Pär Sparén, research fellowb,
- Noriyoshi Takei, associate professorc,
- Robin M Murray, associate professord,
- Sven Cnattingius, associate professore
- aDepartment of Neuroscience, Psychiatry, Ulleråker, University of Uppsala, S-750 17 Uppsala 17, Sweden
- bStockholm Centre on Health of Societies in Transition, Huddinge, Sweden
- cDepartment of Psychiatry and Neurology, Hamamtsu University School of Medicine, Hamamtsu, Japan
- dDepartment of Psychological Medicine, Institute of Psychiatry, London
- eDepartment of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
- Correspondence to: Christina M Hultman
Abstract
Objective: To examine prenatal and perinatal risk factors for subsequent development of schizophrenia and affective and reactive psychosis.
Design: Three population based, case-control studies conducted within a Sweden-wide cohort of all children born during 1973-9.This was done by linking individual data from the Swedish birth register, which represents 99% of all births in Sweden, to the Swedish inpatient register.
Subjects: Patients listed in inpatient register as having been first admitted to hospital aged 15-21years with a main diagnosis of schizophrenia (n=167), affective psychosis (n=198), or reactive psychosis (n=292). For each case, five controls were selected.
Main outcome measures: Risks of schizophrenia and affective and reactive psychosis in relation to pregnancy and perinatal characteristics.
Results: Schizophrenia was positively associated with multiparity (odds ratio 2.0), maternal bleeding during pregnancy (odds ratio 3.5), and birth in late winter (odds ratio 1.4). Affective psychosis was associated with uterine atony (odds ratio 2.2) and late winter birth (odds ratio 1.5). Reactive psychosis was related to multiparity (odds ratio 2.1). An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2), who were number four or more in birth order (odds ratio 3.6), and whose mothers had had bleeding during late pregnancy (odds ratio 4.0).
Conclusions: A few specific pregnancy and perinatal factors were associated with the subsequent development of psychotic disorder, particularly schizophrenia, in early adult life. The association of small size for gestational age and bleeding during pregnancy with increased risk of early onset schizophrenia among males could reflect placental insufficiency.
Prenatal and perinatal risk factors for early onset schizophrenia, affective psychosis, and reactive psychosis
- John Geddes, senior clinical research fellow
- aDepartment of Neuroscience, Psychiatry, Ulleråker, University of Uppsala, S-750 17 Uppsala 17, Sweden
- bStockholm Centre on Health of Societies in Transition, Huddinge, Sweden
- cDepartment of Psychiatry and Neurology, Hamamtsu University School of Medicine, Hamamtsu, Japan
- dDepartment of Psychological Medicine, Institute of Psychiatry, London
- eDepartment of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden
- University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX