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J Affect Disord. 2014 Feb;155:75-80. doi: 10.1016/j.jad.2013.10.026. Epub 2013 Oct 26.

Perinatal factors and the risk of bipolar disorder in Finland.

Author information

  • 1Department of Child Psychiatry, University of Turku, Finland. Electronic address: roschu@utu.fi.
  • 2Department of Child Psychiatry, University of Turku, Finland; Department of Child Psychiatry, Turku University Hospital, Finland; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA; Regional Centre for Child and Youth Mental Health and Child Welfare, University of Tromsø, Norway.
  • 3Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.
  • 4Department of Child Psychiatry, University of Turku, Finland.
  • 5Department of Child Psychiatry, University of Turku, Finland; Nordic School of Public Health, Gothenburg, Sweden; National Institute for Health and Welfare, Finland.
  • 6Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA.

Abstract

BACKGROUND:

Complications during the perinatal period have been associated with neurodevelopmental disorders like schizophrenia and autism. However, similar studies on bipolar disorder (BPD) have been limited and the findings are inconsistent. The aim of this study was to examine the association between perinatal risk factors and BPD.

METHODS:

This nested case-control study, based on the Finnish Prenatal Study of Bipolar Disorders (FIPS-B), identified 724 cases and 1419 matched controls from population based registers. Conditional logistic regression was used to examine the associations between perinatal factors and BPD adjusting for potential confounding due to maternal age, psychiatric history and educational level, place of birth, number of previous births and maternal smoking during pregnancy.

RESULTS:

Children delivered by planned cesarean section had a 2.5-fold increased risk of BPD (95% CI: 1.32-4.78, P<0.01). No association was seen between other examined perinatal risk factors and BPD.

LIMITATIONS:

The limitations of this study include: the restriction in the sample to treated cases of BPD in the population, and usage of hospital based clinical diagnosis for case ascertainment. In addition, in spite of the large sample size, there was low power to detect associations for certain exposures including the lowest birth weight category and pre-term birth.

CONCLUSIONS:

Birth by planned cesarean section was associated with risk of BPD, but most other perinatal risk factors examined in this study were not associated with BPD. Larger studies with greater statistical power to detect less common exposures and studies utilizing prospective biomarker-based exposures are necessary in the future.

© 2013 Published by Elsevier B.V.

KEYWORDS:

Bipolar disorder; Fetal growth; Gestational age; Obstetric complications; Perinatal complications

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