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Schizophrenia After Prenatal Famine: Further Evidence

Schizophrenia After Prenatal Famine: Further Evidence Abstract Background: Suggestive findings of an earlier study that prenatal nutritional deficiency was a determinant of schizophrenia prompted us to undertake a second test of the hypothesis using more precise data on both exposure and outcome. Methods: Among persons born in the cities of western Netherlands during 1944 through 1946, we compared the risk for schizophrenia in those exposed and unexposed during early gestation to the Dutch Hunger Winter of 1944/1945. The frequency of hospitalized patients with schizophrenia at age 24 to 48 years in the exposed and unexposed birth cohorts was ascertained from a national psychiatric registry. Results: The most exposed birth cohort, conceived at the height of the famine, showed a twofold and statistically significant increase in the risk for schizophrenia (relative risk [RR] = 2.0; 95% confidence interval [CI] = 1.2 to 3.4; P<.01) in both men (RR = 1.9; 95% CI = 1.0 to 3.7; P=.05) and women (RR = 2.2; 95% CI = 1.0 to 4.7; P=.04). Among all birth cohorts of 1944 through 1946, the risk for schizophrenia clearly peaked in this exposed cohort. Conclusion: Prenatal nutritional deficiency may play a role in the origin of some cases of schizophrenia. References 1. Susser E, Lin SP. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944-1945 . Arch Gen Psychiatry . 1992;49:983-988.Crossref 2. Jones P. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944-1945 . Arch Gen Psychiatry . 1994;51:333. Letter.Crossref 3. Brown S, Susser E, Butler P, Richardson Andrews R, Kaufmann C, Gorman J. Neurobiological plausibility of prenatal nutritional deprivation as a risk factor for schizophrenia . J Nerv Ment Dis . In press. 4. Carpenter WT Jr, Buchanan RW. Medical progress schizophrenia . N Engl J Med . 1994;330: (10) :681-690.Crossref 5. Weinberger DR. Implications of normal brain development for the pathogenesis of schizophrenia . Arch Gen Psychiatry . 1987;44:660-669.Crossref 6. Murray RM. Is schizophrenia a neurodevelopmental disorder . BMJ . 1987;295:681-682.Crossref 7. Waddington JL. Schizophrenia: developmental neuroscience and pathobiology . Lancet . 1993;341:531-538.Crossref 8. Bloom FE. Advancing a neurodevelopmental origin for schizophrenia . Arch Gen Psychiatry . 1993;50:224-227.Crossref 9. Suddath RL, Christison GW. Torrey EF, Casanova MF, Weinberger DR. Anatomical abnormalities in the brain of monozygotic twins discordant for schizophrenia . N Engl J Med . 1990;322:789-794.Crossref 10. Andreasen NC, Arndt S, Swayze V II, Cizadlo T, Flaum M, O'Leary D, Erhardt JC, Yuh WT. Thalamic abnormalities in schizophrenia visualized through magnetic resonance image averaging . Science . 1994;266:294-298.Crossref 11. Fish B, Marcus J, Hans SL, Auerbach JG, Purdue S. Infants at risk for schizophrenia . Arch Gen Psychiatry . 1992;49:221-235.Crossref 12. Done DJ, Crow TJ, Johnstone EV, Sacker A. Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11 . BMJ . 1994;309:699-703.Crossref 13. Jones P, Rodgers B, Murray R, Marmot M. Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort . Lancet . 1994;344:1398-1402.Crossref 14. Medical Research Council Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study . Lancet . 1991;338:131-137.Crossref 15. Rosso PR. Prenatal nutrition and brain growth . In: van Gelder NM, Butterworth RF, Drujan BD, eds. (Mal)nutrition and the Infant Brain . New York, NY: Wiley-Liss Inc; 1990;25-40. 16. DeLong GR. Effects of nutrition on brain development in humans . Am J Clin Nutr(Suppl) . 1993;57:286-290. 17. Stein Z, Susser M, Saenger G, Marolla F, eds. Famine and Human Development: The Dutch Hunger Winter of 1944-45 . New York, NY: Oxford University Press; 1975. 18. Stein Z, Susser M, Saenger G, Marolla F. Nutrition and mental performance . Science . 1973;178:708-713.Crossref 19. Burger GCE, Drummond JC, Sandstead HR, eds. Malnutriton and Starvation in Western Netherlands: September 1944-July 1945 . Hague, the Netherlands: General State Printing Office; 1948. 20. Ravelli GP, Stein ZA, Susser MW. Obesity in young men after exposure in utero and early infancy . N Engl J Med . 1976;295:349-353.Crossref 21. Jablensky A, Sartorious N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A. Schizophrenia: manifestations, incidence and course in different cultures: a World Helath Organization Ten Country Study . Psychol Med Monogr Suppl . 1992;20. 22. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1938. 23. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1948. 24. World Health Organization. Mental Disorders: Glossary and Guide to Their Classification in Accordance With the Ninth Revision of the International Classification of Diseases . Geneva, Switzerland: World Health Organization; 1978. 25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Washington, DC: American Psychiatric Association; 1994. 26. Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons; 1981. 27. Brown AS, Susser ES, Lin SP, Neugebauer R, Gorman J. Increased risk of affective disorders in males after second trimester prenatal exposure to the Dutch Hunger Winter of 1944-45 . Br J Psychiatry . 1995:166;606-606.Crossref 28. Crow TJ. Integrated viral genes as potential pathogens in the functional psychoses . J Psychiatr Res . 1987;21:479-485.Crossref 29. Huttenen M, Niskanen P. Prenatal loss of father and psychiatric disorders . Arch Gen Psychiatry . 1978;35:429-431.Crossref 30. Czeisel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation . N Engl J Med . 1992;327:1832-1835.Crossref 31. Elwood JM, Little J, Elwood JH. Epidemiology and Control of Neural Tube Defects . New York, NY: Oxford University Press; 1992. 32. Susser E, Susser M. Genetic epidemiology of psychiatric disorders: examples from schizophrenia . In: Michels R, ed. Psychiatry . Philadelphia, Pa: JB Lippincott Co; 1993. 33. Mednick SA, Machon RA, Huttunen MO, Bonett D. Adult schizophrenia following prenatal exposure to an influenza epidemic . Arch Gen Psychiatry . 1988;45:189-192.Crossref 34. O'Callaghan E, Sham P, Takei N, Glover G, Murray RM. Schizophrenia after prenatal exposure to 1957 A2 influenza epidemic . Lancet . 1991;337:1248-1250.Crossref 35. Mills JL, McPartlin JM, Kirke PN, Lee YJ, Conley MR, Weir DG, Scott JM. Homocysteine metabolism in pregnancies complicated by neural-tube defects . Lancet . 1995;345:149-151.Crossref 36. Susser M. The logic in ecological, I . Am J Publ Health . 1994;84:825-829.Crossref 37. Morgane PJ, Austin-LaFrance R, Bronzino J, Tonkiss J, Diaz-Cintra S, Cintra L, Kemper T, Galler JR. Prenatal malnutrition and development of the brain . Neurosci Biobehav Rev . 1993;17:91-128.Crossref 38. Butler PD, Susser ES, Brown AS, Kaufmann CA, Gorman JM. Prenatal nutritional deprivation as a risk factor in schizophrenia: preclinical evidence . Neuropsychopharmacology . 1994;11:227-235.Crossref 39. Done DJ, Johnstone EC, Frith CD, Golding J, Shepherd PM, Crow TJ. Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British Perinatal Mortality Survey Sample . BMJ . 1991;302:1576-1580.Crossref 40. Wiersma D, Giel R, DeJong A, Slooff CJ. Social class and schizophrenia in a Dutch cohort . Psychol Med . 1983;13:141-150.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1996.01830010027005
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Abstract

Abstract Background: Suggestive findings of an earlier study that prenatal nutritional deficiency was a determinant of schizophrenia prompted us to undertake a second test of the hypothesis using more precise data on both exposure and outcome. Methods: Among persons born in the cities of western Netherlands during 1944 through 1946, we compared the risk for schizophrenia in those exposed and unexposed during early gestation to the Dutch Hunger Winter of 1944/1945. The frequency of hospitalized patients with schizophrenia at age 24 to 48 years in the exposed and unexposed birth cohorts was ascertained from a national psychiatric registry. Results: The most exposed birth cohort, conceived at the height of the famine, showed a twofold and statistically significant increase in the risk for schizophrenia (relative risk [RR] = 2.0; 95% confidence interval [CI] = 1.2 to 3.4; P<.01) in both men (RR = 1.9; 95% CI = 1.0 to 3.7; P=.05) and women (RR = 2.2; 95% CI = 1.0 to 4.7; P=.04). Among all birth cohorts of 1944 through 1946, the risk for schizophrenia clearly peaked in this exposed cohort. Conclusion: Prenatal nutritional deficiency may play a role in the origin of some cases of schizophrenia. References 1. Susser E, Lin SP. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944-1945 . Arch Gen Psychiatry . 1992;49:983-988.Crossref 2. Jones P. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944-1945 . Arch Gen Psychiatry . 1994;51:333. Letter.Crossref 3. Brown S, Susser E, Butler P, Richardson Andrews R, Kaufmann C, Gorman J. Neurobiological plausibility of prenatal nutritional deprivation as a risk factor for schizophrenia . J Nerv Ment Dis . In press. 4. Carpenter WT Jr, Buchanan RW. Medical progress schizophrenia . N Engl J Med . 1994;330: (10) :681-690.Crossref 5. Weinberger DR. Implications of normal brain development for the pathogenesis of schizophrenia . Arch Gen Psychiatry . 1987;44:660-669.Crossref 6. Murray RM. Is schizophrenia a neurodevelopmental disorder . BMJ . 1987;295:681-682.Crossref 7. Waddington JL. Schizophrenia: developmental neuroscience and pathobiology . Lancet . 1993;341:531-538.Crossref 8. Bloom FE. Advancing a neurodevelopmental origin for schizophrenia . Arch Gen Psychiatry . 1993;50:224-227.Crossref 9. Suddath RL, Christison GW. Torrey EF, Casanova MF, Weinberger DR. Anatomical abnormalities in the brain of monozygotic twins discordant for schizophrenia . N Engl J Med . 1990;322:789-794.Crossref 10. Andreasen NC, Arndt S, Swayze V II, Cizadlo T, Flaum M, O'Leary D, Erhardt JC, Yuh WT. Thalamic abnormalities in schizophrenia visualized through magnetic resonance image averaging . Science . 1994;266:294-298.Crossref 11. Fish B, Marcus J, Hans SL, Auerbach JG, Purdue S. Infants at risk for schizophrenia . Arch Gen Psychiatry . 1992;49:221-235.Crossref 12. Done DJ, Crow TJ, Johnstone EV, Sacker A. Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11 . BMJ . 1994;309:699-703.Crossref 13. Jones P, Rodgers B, Murray R, Marmot M. Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort . Lancet . 1994;344:1398-1402.Crossref 14. Medical Research Council Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council Vitamin Study . Lancet . 1991;338:131-137.Crossref 15. Rosso PR. Prenatal nutrition and brain growth . In: van Gelder NM, Butterworth RF, Drujan BD, eds. (Mal)nutrition and the Infant Brain . New York, NY: Wiley-Liss Inc; 1990;25-40. 16. DeLong GR. Effects of nutrition on brain development in humans . Am J Clin Nutr(Suppl) . 1993;57:286-290. 17. Stein Z, Susser M, Saenger G, Marolla F, eds. Famine and Human Development: The Dutch Hunger Winter of 1944-45 . New York, NY: Oxford University Press; 1975. 18. Stein Z, Susser M, Saenger G, Marolla F. Nutrition and mental performance . Science . 1973;178:708-713.Crossref 19. Burger GCE, Drummond JC, Sandstead HR, eds. Malnutriton and Starvation in Western Netherlands: September 1944-July 1945 . Hague, the Netherlands: General State Printing Office; 1948. 20. Ravelli GP, Stein ZA, Susser MW. Obesity in young men after exposure in utero and early infancy . N Engl J Med . 1976;295:349-353.Crossref 21. Jablensky A, Sartorious N, Ernberg G, Anker M, Korten A, Cooper JE, Day R, Bertelsen A. Schizophrenia: manifestations, incidence and course in different cultures: a World Helath Organization Ten Country Study . Psychol Med Monogr Suppl . 1992;20. 22. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1938. 23. World Health Organization. Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death . Geneva, Switzerland: World Health Organization; 1948. 24. World Health Organization. Mental Disorders: Glossary and Guide to Their Classification in Accordance With the Ninth Revision of the International Classification of Diseases . Geneva, Switzerland: World Health Organization; 1978. 25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders . 4th ed. Washington, DC: American Psychiatric Association; 1994. 26. Fleiss JL. Statistical Methods for Rates and Proportions . 2nd ed. New York, NY: John Wiley & Sons; 1981. 27. Brown AS, Susser ES, Lin SP, Neugebauer R, Gorman J. Increased risk of affective disorders in males after second trimester prenatal exposure to the Dutch Hunger Winter of 1944-45 . Br J Psychiatry . 1995:166;606-606.Crossref 28. Crow TJ. Integrated viral genes as potential pathogens in the functional psychoses . J Psychiatr Res . 1987;21:479-485.Crossref 29. Huttenen M, Niskanen P. Prenatal loss of father and psychiatric disorders . Arch Gen Psychiatry . 1978;35:429-431.Crossref 30. Czeisel AE, Dudas I. Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation . N Engl J Med . 1992;327:1832-1835.Crossref 31. Elwood JM, Little J, Elwood JH. Epidemiology and Control of Neural Tube Defects . New York, NY: Oxford University Press; 1992. 32. Susser E, Susser M. Genetic epidemiology of psychiatric disorders: examples from schizophrenia . In: Michels R, ed. Psychiatry . Philadelphia, Pa: JB Lippincott Co; 1993. 33. Mednick SA, Machon RA, Huttunen MO, Bonett D. Adult schizophrenia following prenatal exposure to an influenza epidemic . Arch Gen Psychiatry . 1988;45:189-192.Crossref 34. O'Callaghan E, Sham P, Takei N, Glover G, Murray RM. Schizophrenia after prenatal exposure to 1957 A2 influenza epidemic . Lancet . 1991;337:1248-1250.Crossref 35. Mills JL, McPartlin JM, Kirke PN, Lee YJ, Conley MR, Weir DG, Scott JM. Homocysteine metabolism in pregnancies complicated by neural-tube defects . Lancet . 1995;345:149-151.Crossref 36. Susser M. The logic in ecological, I . Am J Publ Health . 1994;84:825-829.Crossref 37. Morgane PJ, Austin-LaFrance R, Bronzino J, Tonkiss J, Diaz-Cintra S, Cintra L, Kemper T, Galler JR. Prenatal malnutrition and development of the brain . Neurosci Biobehav Rev . 1993;17:91-128.Crossref 38. Butler PD, Susser ES, Brown AS, Kaufmann CA, Gorman JM. Prenatal nutritional deprivation as a risk factor in schizophrenia: preclinical evidence . Neuropsychopharmacology . 1994;11:227-235.Crossref 39. Done DJ, Johnstone EC, Frith CD, Golding J, Shepherd PM, Crow TJ. Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British Perinatal Mortality Survey Sample . BMJ . 1991;302:1576-1580.Crossref 40. Wiersma D, Giel R, DeJong A, Slooff CJ. Social class and schizophrenia in a Dutch cohort . Psychol Med . 1983;13:141-150.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jan 1, 1996

References