Short inter-pregnancy interval and schizophrenia: Overestimating the risk

Downs, Johnny M and Jonas, Sarah (2012) Short inter-pregnancy interval and schizophrenia: Overestimating the risk. The British Journal of Psychiatry, 200 (2). p. 160. ISSN Online ISSN: 1472-1465; Print ISSN: 0007-1250 Full text available

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Comments on an article, Pre-conception inter-pregnancy interval and risk of schizophrenia by L. Gunawardana et al. (2011). The short report by Gunawardana et al. succinctly argues that a short inter-pregnancy interval, a proxy for fetal under nutrition and stress, increases the offspring’s risk of later schizophrenia. The authors hint at a causal relationship. This is compelling because it suggests that an affordable public health intervention via the promotion of dietary supplements in the postpartum period may later reduce schizophrenia prevalence. Although the authors compare pre- and post-birth intervals and adjust for a number of confounders, their findings may still relate to bias and residual confounding. First, the timing of schizophrenia measurement may distort the prevalence and gender ratio of schizophrenia. This is important because a short inter-pregnancy interval is known to favour male offspring. Epidemiological designs will only drive hypotheses so far in examining the causal relationship between prenatal micronutrient depletion and later psychopathology. That said, there would be scientific value in examining cohorts pre- and post-introduction of public health recommendations of periconceptional folic acid vitamin supplementation. Introducing postnatal vitamin supplementation to reduce schizophrenia prevalence is an enticing idea; however, it would be important to use a variety of research designs to establish or exclude causality before implementing any change in public health policy. [Comment/Reply]

Item Type: Article
Subjects: Disabilities & Disorders (mental & physical) > Schizophrenia
Department/People: Children, Young Adult and Family Services

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