孕妇细菌感染与后代精神障碍风险：感染严重程度和后代性别存在差异。
Maternal Bacterial Infection During Pregnancy and Offspring Risk of Psychotic Disorders: Variation by Severity of Infection and Offspring Sex.
机构信息
Department of Epidemiology, Brown University, Providence, R.I. (Lee, Savitz, Buka); Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston (Cherkerzian); Department of Medicine, Harvard Medical School, Boston (Cherkerzian, Goldstein); Division of Public Psychiatry, Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston (Seidman); Department of Psychiatry, Massachusetts General Hospital, Boston (Seidman, Goldstein); Department of Psychiatry, Harvard Medical School, Boston (Seidman, Goldstein); Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston (Goldstein); Center for Statistical Sciences, Brown University, Providence, R.I. (Papandonatos); and Department of Psychiatry, University of California San Diego, La Jolla (Tsuang).
出版信息
Am J Psychiatry. 2020 Jan 1;177(1):66-75. doi: 10.1176/appi.ajp.2019.18101206. Epub 2019 Oct 4.
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.
目的
先前的研究表明，产前免疫挑战可能会增加后代患精神分裂症和相关精神病的风险，但针对母体细菌感染的研究有限。作者假设，母体在怀孕期间的细菌感染会增加后代成年后患精神障碍的风险，并且这种关联的程度因感染暴露的严重程度和后代性别而异。
方法
作者分析了在 1959 年至 1966 年期间通过合作围产期项目在两个研究地点招募的 15421 例妊娠的前瞻性收集数据。该样本包括 116 例确诊的精神障碍后代。作者估计了母体在怀孕期间的细菌感染与随后 40 年精神疾病风险之间的关联，按后代性别和报告的父母精神疾病的存在进行分层，并对协变量进行了调整。
结果
母体在怀孕期间的细菌感染与后代的精神病显著相关（调整后的优势比=1.8，95%可信区间=1.2-2.7），并且因感染的严重程度和后代的性别而异。多系统细菌感染的影响（调整后的优势比=2.9，95%可信区间=1.3-5.9）几乎是轻度局部细菌感染（调整后的优势比=1.6，95%可信区间=1.1-2.3）的两倍。在母体暴露于任何细菌感染后，男性比女性更有可能患上精神病。
结论
研究结果表明，母体在怀孕期间的细菌感染与后代精神障碍的风险增加有关，并且这种关联因感染严重程度和后代性别而异。这些发现呼吁进一步调查，如果这些发现得到复制，就需要采取公共卫生和临床措施，重点预防和管理孕妇的细菌感染。
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