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Do prenatal risk factors cause psychiatric disorder? Be wary of causal claims

  • Anita Thapar (a1) and Michael Rutter (a2)

Summary

Many prenatal risk factors are known to have adverse consequences on fetal development and there is increasing interest in effects on the mental health of offspring. However, associations with prenatal risk factors may arise because of postnatal risk or through confounders, including inherited ones. As a result, caution is required in assuming causation.

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Copyright

Corresponding author

Anita Thapar, Department of Psychological Medicine and Neurology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. Email: thapar@cf.ac.uk

Footnotes

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We thank the Wellcome Trust for funding research that led to this editorial.

Declaration of interest

None.

Footnotes

References

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1 Swanson, JD, Wadhwa, PM. Developmental origins of child mental health disorders. J Child Psychol Psychiatry 2008; 10: 1009–19.
2 Huizink, AC, Mulder, EJ. Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neurosci Biobehav Rev 2006; 30: 2441.
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4 Rutter, M. Epidemiological methods to tackle causal questions. Intl J Epidemiology 2009; 38: 36.
5 Susser, ES, Lin, SP. Schizophrenia after prenatal exposure to the Dutch Hunger Winter of 1944–1945. Arch Gen Psychiatry 1992; 49: 983–8.
6 St Clair, D, Xu, M, Wang, P, Yu, Y, Fang, Y, Zhang, F, et al. Rates of adult schizophrenia following prenatal exposure to the Chinese famine of 1959–1961. JAMA 2005; 294: 557–62.
7 Academy of Medical Sciences Working Group. Identifying the Environmental Causes of Disease: How Should We Decide What to Believe and When to Take Action? Academy of Medical Sciences, 2007.
8 Knopik, VS, Heath, AC, Jacob, T, Slutske, WS, Bucholz, KK, Madden, PA, et al. Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design. Psychol Med 2006; 36: 1461–71.
9 Rice, F, Harold, G, Boivin, J, Hay, D, van den Bree, M, Thapar, A. Disentangling prenatal and inherited influences in humans with an experimental design. Proc Natl Acad Sci USA 2009; 106: 2464–7.
10 D'Onofrio, BM, Van Hulle, CA, Waldman, ID, Rodgers, JL, Harden, KP, Rathouz, PJ, et al. Smoking during pregnancy and offspring externalizing problems: an exploration of genetic and environmental confounds. Dev Psychopathol 2008; 20: 139–64.

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Do prenatal risk factors cause psychiatric disorder? Be wary of causal claims

  • Anita Thapar (a1) and Michael Rutter (a2)
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