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Serological Documentation of Maternal Influenza Exposure and Bipolar Disorder in Adult Offspring
Sarah E. Canetta, Ph.D.; Yuanyuan Bao, M.S.; Mary Dawn T. Co, M.D.; Francis A. Ennis, M.D.; John Cruz, B.S.; Masanori Terajima, M.D., Ph.D.; Ling Shen, Ph.D.; Christoph Kellendonk, Ph.D.; Catherine A. Schaefer, Ph.D.; Alan S. Brown, M.D., M.P.H.
Am J Psychiatry 2014;:. doi:10.1176/appi.ajp.2013.13070943
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From the Department of Psychiatry, Columbia University College of Physicians and Surgeons, N.Y. State Psychiatric Institute, N.Y.; the Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, Mass., the Division of Research, Kaiser Permanente, Oakland, Calif.; and the Department of Epidemiology, Mailman School of Public Health, Columbia University, N.Y.

Presented in part at the 14th International Congress of Schizophrenia Research, Orlando, Fla., April 21–25, 2013.

Address correspondence to Dr. Brown (asb11@columbia.edu).

Copyright © 2014 by the American Psychiatric Association

Received July 17, 2013; Revised September 30, 2013; Accepted October 25, 2013.

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Objective  The authors examined whether serologically confirmed maternal exposure to influenza was associated with an increased risk of bipolar disorder in the offspring and with subtypes of bipolar disorder, with and without psychotic features.

Method  The study used a nested case-control design in the Child Health and Development Study birth cohort. In all, 85 individuals with bipolar disorder were identified following extensive ascertainment and diagnostic assessment and matched to 170 comparison subjects in the analysis. Serological documentation of maternal exposure to influenza was determined using the hemagglutination inhibition assay.

Results  No association was observed between serologically documented maternal exposure to influenza and bipolar disorder in offspring. However, maternal serological influenza exposure was related to a significant fivefold greater risk of bipolar disorder with psychotic features.

Conclusions  The results suggest that maternal influenza exposure may increase the risk for offspring to develop bipolar disorder with psychotic features. Taken together with earlier associations between prenatal influenza exposure and schizophrenia, these results may suggest that prenatal influenza is a risk factor for psychosis rather than for a specific psychotic disorder diagnosis.

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