Examining the association between maternal analgesic use during pregnancy and risk of psychotic symptoms during adolescence

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Abstract

Background

Children and adolescents who report psychotic symptoms in non-clinical samples are at an increased risk of developing schizophrenia. Study of such ‘high risk’ groups may increase our understanding of early risk factors for psychotic illnesses. Maternal infection during pregnancy is associated with an increased risk of schizophrenia in the offspring, and it has been hypothesised that exposure to maternal intake of analgesics during pregnancy, taken to alleviate the symptoms of viral infections, may partly explain this association. The aim of this study was to examine the relationship between maternal use of aspirin and other analgesics during pregnancy and the occurrence of psychotic symptoms in the offspring.

Methods

This was a longitudinal study of 6437 children belonging to the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who participated in the psychosis-like-symptoms semi-structured interview (PLIKSi) at 12 years of age. Data on in-utero exposure to analgesics were obtained from self-report questionnaires completed by the mothers during pregnancy.

Results

Increasing frequency of aspirin use during pregnancy was associated with an increased risk of psychotic experiences (adjusted OR 1.44, 95% CI 1.08–1.92). Risk was highest in those whose mothers used aspirin most days or daily (adjusted OR 2.79, 95% CI 1.27–6.07). Paracetamol and other analgesic use during pregnancy were not associated with the risk of offspring psychotic symptoms.

Conclusions

Medications such as aspirin that interfere with the prostaglandin pathway, taken during pregnancy, may influence the risk of schizophrenia in the offspring. Other epidemiological studies are needed to examine this association further.

Section snippets

Background

Children and adolescents reporting psychotic symptoms appear to be at increased risk for psychotic disorders in adulthood (Poulton et al., 2000). They may represent a ‘high risk’ group for psychotic illness and used to explore early risk factors for psychosis vulnerability (Kelleher et al., 2008, van Os et al., 2009).

An association between prenatal exposure to influenza or other infections and schizophrenia in later life has been observed in several epidemiological studies (Barr et al., 1990,

Sample

This study examines data from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. The cohort was set up to examine genetic and environmental determinants of health and development (Golding et al., 2001). The initial cohort consisted of 14,062 children born to residents of the Bristol area, UK, who had an expected date of delivery between 1st April 1991 and 31st December 1992 (www.alspac.bris.ac.uk) The parents completed regular postal questionnaires concerning their child's

Results

Of the 6437 cohort members who participated in the PLIKSi, 880 (13.6%) were rated as having suspected or definite psychotic symptoms at age 12. Of these, 409 were male (46%) and 471 were female. There were 3901 (63%) adolescents whose mothers took analgesics at some point during their pregnancy; 3758 (58.4% of sample) used paracetamol, 345 (5.7%) used aspirin, and 209 (3.2%) used other types of analgesics. There were 398 (6.2%) mothers who used more than one type of analgesic. Use of

Discussion

In this study increasing frequency of aspirin use during pregnancy was associated with an increased risk of the offspring reporting psychotic experiences. Risk was more than two-fold greater in those who were exposed to aspirin most days throughout their foetal development. Maternal use of paracetamol and other analgesics were not associated with the risk of psychotic symptoms.

We found no evidence that the association between exposure to aspirin in-utero and psychotic symptoms was stronger when

Role of funding source

The UK Medical Research Council, the Wellcome Trust and the University of Bristol provide core support for ALSPAC. This study was funded by the Wellcome Trust grant no. GR072043MA. SZ was funded through a Clinician Scientist Award funded by the National Assembly for Wales.

Contributors

SZ designed the study and wrote the protocol. LG managed the literature searches and analyses. SZ and LG undertook the statistical analysis and wrote the manuscript. All authors contributed to and have approved the final manuscript.

Conflict of interest

All authors declare they have no conflict of interest.

Acknowledgements

We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses.

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