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The Fetal Origins of Mental Illness

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  • The Fetal Origins of Mental Illness

    Am J Obstet Gynecol. 2019 Jun 14. pii: S0002-9378(19)30777-X. doi: 10.1016/j.ajog.2019.06.013. [Epub ahead of print]
    The Fetal Origins of Mental Illness.

    Al-Haddad BJS1, Oler E2, Armistead B3, Elsayed NA4, Weinberger DR5, Bernier R6, Burd I7, Kapur R8, Jacobsson B9, Wang C10, Mysorekar I11, Rajagopal L12, Adams Waldorf KM13.
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    The impact of infections and inflammation during pregnancy on the developing fetal brain remains incompletely defined with important clinical and research gaps. Though the classic infectious TORCH pathogens [i.e. Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex virus] are known to be directly teratogenic, emerging evidence suggests that these infections represent the most extreme end of a much larger spectrum of injury. We present the accumulating evidence that prenatal exposure to a wide variety of viral and bacterial infections - or simply inflammation - may subtly alter fetal brain development, leading to neuropsychiatric consequences for the child later in life. The link between influenza infections in pregnant women and an increased risk for development of schizophrenia in their children was first described more than 30 years ago. Since then, evidence suggests that a range of infections during pregnancy may also increase risk for autism spectrum disorder and depression in the child. Subsequent studies in animal models demonstrated that both pregnancy infections and inflammation can result in direct injury to neurons and neural progenitor cells or indirect injury through activation of microglia and astrocytes, which can trigger cytokine production and oxidative stress. Infectious exposures can also alter placental serotonin production, which can perturb neurotransmitter signaling in the developing brain. Clinically, detection of these subtle injuries to the fetal brain is difficult. As the neuropsychiatric impact of perinatal infections or inflammation may not be known for decades after birth, our construct for defining teratogenic infections in pregnancy (e.g. TORCH) based on congenital anomalies is insufficient to capture the full adverse impact on the child. We discuss the clinical implications of this body of evidence and how we might place greater emphasis on prevention of prenatal infections. For example, increasing uptake of the seasonal influenza vaccine is a key strategy to reduce perinatal infections and the risk for fetal brain injury. An important research gap exists in understanding how antibiotic therapy during pregnancy impacts the fetal inflammatory load and how to avoid inflammation-mediated injury to the fetal brain. In summary, we discuss the current evidence and mechanisms linking infections and inflammation with the increased lifelong risk of neuropsychiatric disorders in the child, and how we might improve prenatal care to protect the fetal brain.
    Copyright ? 2019. Published by Elsevier Inc.


    TORCH; autism; brain; depression; fetus; infection; inflammation; influenza virus; microglia; neuronal injury; pregnancy; schizophrenia; seasonality of birth hypothesis; urinary tract infection

    PMID: 31207234 DOI: 10.1016/j.ajog.2019.06.013