BMJ 1999;318:421-426 ( 13 February )

Papers

Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study

Christina M Hultman, research fellow, ^a Pär Sparén, research fellow, ^b Noriyoshi Takei, associate professor, ^c Robin M Murray, professor, ^d Sven Cnattingius, associate professor. ^e

^a Department of Neuroscience, Psychiatry, Ulleråker, University of Uppsala, S-750 17 Uppsala 17, Sweden, ^b Stockholm Centre on Health of Societies in Transition, Huddinge, Sweden, ^c Department of Psychiatry and Neurology, Hamamtsu University School of Medicine, Hamamtsu, Japan, ^d Department of Psychological Medicine, Institute of Psychiatry, London, ^e Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden

Correspondence to: Christina M Hultman christina.hultman{at}ullpsyk.uu.se

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 15-21 years 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.

Key messages The role of prenatal and perinatal risk factors in the development of schizophrenia and affective and reactive psychosis in early adult life were investigated by linking individual data from the Swedish birth and inpatient registries Adverse prenatal and perinatal factors were more common in patients with schizophrenia of early onset than in controls and seemed more important in the aetiology of schizophrenia than in that of affective and reactive psychosis Multiparity, bleeding during pregnancy, and small size for gestational age were associated with a threefold to fourfold increased risk for schizophrenia among males There was no support for previous claims that head circumference is small in preschizophrenic infants Late winter birth was associated with increased risk of both schizophrenia and affective psychosis

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Rapid Responses:

Read all Rapid Responses

Is late winter really a season for the birth of schizophrenics?

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bmj.com, 1 Mar 1999 [Full text]

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Author's response

Christina M Hultman
bmj.com, 30 Mar 1999 [Full text]

Response to electronic mail from dr Iskaros

Christina M Hultman
bmj.com, 31 Mar 1999 [Full text]