News Release

Exposure to influenza during pregnancy may increase risk of schizophrenia in offspring

New study indicates that exposure to influenza during pregnancy may increase the risk of schizophrenia in offspring years later

Peer-Reviewed Publication

Columbia University Irving Medical Center

Researchers reveal the first serologic evidence that prenatal exposure to influenza plays a role in the development of the neuropsychiatric disorder in offspring

NEW YORK, NY (August 2, 2004)– A new study published today in the JAMA publication, Archives of General Psychiatry, indicates that prenatal exposure to influenza may increase the risk for development of schizophrenia years later. The study, which evaluated archived sera from pregnant women who participated in a large birth cohort called the Child Health and Development Study (CHDS) from 1959–1966, was conducted by researchers at the New York State Psychiatric Institute and the Mailman School of Public Health at Columbia University, in collaboration with the Kaiser Permanente Medical Care Plan, Northern California Region and the Public Health Institute, Berkeley, California.

Today's findings are part of a larger team study known as the Prenatal Determinants of Schizophrenia (PDS), which examines prenatal infection, nutrition, chemical exposure, paternal age, and a range of other prenatal factors that influence schizophrenia risk.

The study has shown for the first time that serologically documented prenatal exposure to influenza is associated with schizophrenia. The risk of schizophrenia was increased threefold when influenza occurred during the first half of pregnancy; however when influenza occurred during the second half of pregnancy, no increased risk was observed.

"It is an exciting time for research that combines serologic documentation of infectious diseases during pregnancy, long-term follow-up, and careful assessments for schizophrenia and other disease outcomes," said Alan Brown, MD, lead author and associate professor of clinical psychiatry and epidemiology at the New York State Psychiatric Institute and Mailman School of Public Health. "Because the individuals whom we are studying have only recently passed through the age of risk for schizophrenia, it has become possible only in the last few years to analyze archived prenatal serum specimens in order to address the question of whether schizophrenia is related to prenatal risk factors such as viruses, as well as nutritional factors and toxins, during pregnancy." The 40-year study of the CHDS was made possible by ongoing support from the National Institute of Child Health and Development.

"These findings represent the strongest evidence thus far that prenatal exposure to influenza plays a role in schizophrenia," said Ezra Susser, MD, DrPH, senior investigator of the PDS study, chair of the Department of Epidemiology at the Mailman School of Public Health and head of Epidemiology of Brain Disorders at the New York State Psychiatric Institute. "Although the findings may ultimately have implications for prevention, we strongly caution against making any public health policy recommendations until these links have been confirmed through further study."

The PDS, initiated by Dr. Susser together with Dr. Brown and Dr. Catherine Schaefer of Kaiser Permanente Division of Research, included a nested case-control study of the CHDS birth cohort, which was recruited from 1959-1967, and was followed up for psychiatric disorders 30-38 years later. During that time period, the CHDS, under the direction of Jacob Yerushalmy, University of California, Berkeley, recruited nearly every pregnant woman who received obstetric care from Kaiser Permanente in Alameda County, California. All of the children born were automatically enrolled in Kaiser Permanente. The PDS study cohort consisted of the sub-sample of 12,094 live births who were members of Kaiser Permanente from January 1, 1981 through December 31, 1997.

Dr. Brown and colleagues from the PDS team measured influenza antibody in archived serum samples derived from the blood of 64 pregnant women whose offspring later developed adult schizophrenia and from a comparison group of 125 pregnant women whose offspring did not develop schizophrenia. They found an association between the presence of elevated influenza antibody levels and schizophrenia in the adult offspring suggesting that prenatal exposure to influenza may increase the vulnerability for schizophrenia.

This study was funded by the National Institute of Mental Health, the National Alliance for Research on Schizophrenia and Depression, and the Lieber Center for Schizophrenia Research.

The PDS research is part of a number of "life course studies" being overseen by Dr. Susser at the Mailman School. In addition to the CHDS study, Dr. Susser and his team are looking at large birth cohorts from the U.S., Israel and Norway to observe the pathogenesis of chronic and acute diseases and their links to prenatal and postnatal exposure to environmental factors such as viruses and toxins.

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The only accredited school of public health in New York City, and among the first in the nation, Columbia University's Mailman School of Public Health provides instruction and research opportunities to more than 850 graduate students in pursuit of masters and doctoral degrees. Its students and nearly 250 multi-disciplinary faculty engage in research and service in the city, nation, and around the world, concentrating on biostatistics, environmental health sciences, epidemiology, health policy and management, population and family health, and sociomedical sciences.
www.mailman.hs.columbia.edu

Founded in 1896, the New York State Psychiatric Institute (PI) continues to contribute importantly to knowledge about understanding and treating psychiatric disorder and is ranked among the best psychiatric research facilities in the world today. Noted for its research on depression and suicide, schizophrenia, anxiety and child psychiatric disorders, PI is also at the forefront of research dedicated to unraveling the brain's mysteries. Its scientists constitute the core of the Department of Psychiatry at Columbia University. In 2000, Dr. Eric Kandel was awarded the Nobel Prize in Physiology or Medicine for research in his labs at PI on the cellular basis of memory.
www.nyspi.org

Founded in 1959 by Jacob Yerushalmy at the University of California, Berkeley, The Child Health and Development Studies (CHDS) enrolled 15,000 families who were members of the Kaiser Permanente Health Plan between 1959 and 1967. CHDS scientists discovered ways to make pregnancy safer for mothers and their babies. Now they are discovering connections between early life and cancer, heart disease, diabetes, fertility and mental illness. The National Institute of Child Health and Development makes this unique research possible through continuing support over 40 years. The CHDS is now a part of the Public Health Institute, Berkeley California.
www.chdstudies.org


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