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Psychol Med. 2014 Nov;44(15):3249-61. doi: 10.1017/S0033291714000683. Epub 2014 Mar 26.

Prenatal maternal immune disruption and sex-dependent risk for psychoses.

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Connors Center for Women's Health and Gender Biology,Brigham and Women's Hospital, Boston, MA,USA.
Division of Psychiatric Neuroscience,Department of Psychiatry,Massachusetts General Hospital, Boston, MA,USA.
Department of Epidemiology,Brown University,Providence, RI,USA.
Beth Israel Deaconess Hospital,Department of Psychiatry,Division of Public Psychiatry, Massachusetts Mental Health Center and Harvard Medical School, Boston, MA,USA.
Department of Epidemiology, Mailman School of Public Health,Columbia University,New York, NY,USA.



Previous studies suggest that abnormalities in maternal immune activity during pregnancy alter the offspring's brain development and are associated with increased risk for schizophrenia (SCZ) dependent on sex.


Using a nested case-control design and prospectively collected prenatal maternal sera from which interleukin (IL)-1β, IL-8, IL-6, tumor necrosis factor (TNF)-α and IL-10 were assayed, we investigated sex-dependent associations between these cytokines and 88 psychotic cases [SCZ = 44; affective psychoses (AP) = 44] and 100 healthy controls from a pregnancy cohort followed for > 40 years. Analyses included sex-stratified non-parametric tests adjusted for multiple comparisons to screen cytokines associated with SCZ risk, followed by deviant subgroup analyses using generalized estimating equation (GEE) models.


There were higher prenatal IL-6 levels among male SCZ than male controls, and lower TNF-α levels among female SCZ than female controls. The results were supported by deviant subgroup analyses with significantly more SCZ males with high IL-6 levels (>highest quartile) compared with controls [odd ratio (OR)75 = 3.33, 95% confidence interval (CI) 1.13-9.82], and greater prevalence of low TNF-α levels (<lowest quartile) among SCZ females compared with their controls (OR25 = 6.30, 95% CI 1.20-33.04) and SCZ males. Higher levels of IL-6 were only found among SCZ compared with AP cases. Lower TNF-α levels (non-significant) also characterized female AP cases versus controls, although the prevalence of the lowest levels was higher in SCZ than AP females (70% v. 40%), with no effect in SCZ or AP males.


The results underscore the importance of immunologic processes affecting fetal brain development and differential risk for psychoses depending on psychosis subtype and offspring sex.

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