Hoek H W, Brown A S, Susser E
The Hague Psychiatric Institute, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 1998 Aug;33(8):373-9. doi: 10.1007/s001270050068.
In the Dutch Hunger Winter at the end of World War II a combination of circumstances created the conditions of a natural experiment. Unlike other famines, the Dutch famine struck at a precisely circumscribed time and place, and in a society able to document the timing and severity of the nutritional deprivation as well as the effects on fertility and health. Because the Dutch maintained comprehensive military and health records, it was possible to compare the incidence of neurodevelopmental disorders in adulthood for birth cohorts exposed versus those unexposed to prenatal famine. We have conducted several studies guided by the hypothesis that prenatal micronutrient deficiencies can cause neurodevelopmental schizophrenia or related personality disorders. In this paper we shall summarize our previous work and combine the outcome data of the different studies. Early prenatal famine was found to be specifically and robustly associated with each of three conditions: (1) congenital anomalies of the central nervous system, (2) schizophrenia, and (3) schizophrenia spectrum personality disorders. We found that the greatest increase in the risk of schizophrenia spectrum disorder- schizophrenia plus spectrum personality disorder- occurred among males born in the famine cities in December 1945 (relative risk = 2.7; 95% confidence interval = 1.5-5.1). Persons born in December 1945 were generally conceived at the absolute peak of the famine (March-April 1945). In the hope that the associations we have found may offer clues to the aetiology of schizophrenia, we are currently tracing and examining the cases of schizophrenia after prenatal exposure to famine.
在第二次世界大战末期的荷兰饥荒之冬，多种情况共同构成了一项自然实验的条件。与其他饥荒不同，荷兰饥荒发生在一个时间和地点都精确界定的范围内，且所处社会能够记录营养匮乏的时间和严重程度以及对生育和健康的影响。由于荷兰保留了全面的军事和健康记录，因此可以比较产前暴露于饥荒与未暴露于饥荒的出生队列在成年后患神经发育障碍的发生率。我们开展了多项研究，其依据的假设是产前微量营养素缺乏会导致神经发育性精神分裂症或相关人格障碍。在本文中，我们将总结之前的工作，并整合不同研究的结果数据。研究发现，早期产前饥荒与以下三种情况均有明确且紧密的关联：（1）中枢神经系统先天性异常；（2）精神分裂症；（3）精神分裂症谱系人格障碍。我们发现，1945年12月在饥荒城市出生的男性中，精神分裂症谱系障碍（精神分裂症加谱系人格障碍）的风险增加幅度最大（相对风险 = 2.7；95%置信区间 = 1.5 - 5.1）。1945年12月出生的人通常是在饥荒的绝对高峰期（1945年3月至4月）受孕的。希望我们所发现的这些关联能够为精神分裂症的病因提供线索，我们目前正在追踪和研究产前暴露于饥荒后的精神分裂症病例。
