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Maternal antenatal daytime sleepiness and child neuropsychiatric and neurocognitive development

Published online by Cambridge University Press:  08 October 2018

M. Lahti-Pulkkinen ,
T. H. Mina ,
R. L. Riha ,
K. Räikkönen ,
A. K. Pesonen ,
A. J. Drake ,
F. C. Denison  and
R. M. Reynolds Open the ORCID record for R. M. Reynolds [Opens in a new window]
M. Lahti-Pulkkinen
Affiliation:
British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
T. H. Mina
Affiliation:
British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
R. L. Riha
Affiliation:
Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
K. Räikkönen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
A. K. Pesonen
Affiliation:
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
A. J. Drake
Affiliation:
British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
F. C. Denison
Affiliation:
Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
R. M. Reynolds*
Affiliation:
British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK Tommy's Centre for Maternal and Fetal Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK
*
Author for correspondence: R. M. Reynolds, E-mail: R.Reynolds@ed.ac.uk
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Abstract

Background

The prevalence of sleep problems among pregnant women is over 50%, and daytime sleepiness is among the most common sleep problems. Previous studies have associated antenatal sleep problems with adverse maternal health and neonatal outcomes, but the consequences of antenatal sleep problems and particularly daytime sleepiness on child psychological development have not been assessed prospectively.

Methods

In this prospective cohort study including 111 mother-child dyads, we examined the associations of maternal daytime sleepiness during pregnancy, assessed at 17 and 28 weeks of gestation using the Epworth Sleepiness Scale, with child neuropsychiatric problems and neuropsychological development, assessed with mother-rated questionnaires and individually administered neuropsychological tests, at child age 2.6–5.7 years (mean = 4.3 years).

Results

Independently of sociodemographic and perinatal covariates and maternal depressive and anxiety symptoms during and/or after pregnancy, maternal antenatal daytime sleepiness was associated with increased total [unstandardized regression coefficient (B) = 0.25 standard deviation (s.d.) units; 95% confidence interval (CI) 0.01–0.48] and internalizing (B = 0.25 s.d.s: 95% CI 0.01–0.49) psychiatric problems and ADHD symptoms (B = 0.27 s.d.s: 95% CI 0.04–0.50) in children, and with poorer executive function, particularly in the areas of attention, working memory and inhibitory control (B = −0.39 s.d.s: 95% CI −0.69 to −0.10).

Conclusions

Maternal antenatal daytime sleepiness carries adverse consequences for offspring psychological development. The assessment of sleep problems may be an important addition to standard antenatal care.

Keywords

ADHDexecutive functionpregnancypsychiatricsleepiness
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 12 , September 2019 , pp. 2081 - 2090
Copyright
Copyright © Cambridge University Press 2018 

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References

Abbott, SM, Attarian, H and Zee, PC (2014) Sleep disorders in perinatal women. Elsevier Ltd. Best Practice and Research: Clinical Obstetrics and Gynaecology 28, 159–168.Google Scholar
Achenbach, TM and Rescorla, LA (2000) Manual for the ASEBA Preschool Forms & Profiles. Burlington, Vermont: University of Vermont, Research Center for Children, Youth, & Families.Google Scholar
Amador-Licona, N and Guízar-Mendoza, JM (2012) Daytime sleepiness and quality of life: are they associated in obese pregnant women? Archives of Gynecology and Obstetrics 285, 105–109.Google Scholar
Armstrong, KL, O'Donnell, H, McCallum, R and Dadds, M (1998) Childhood sleep problems: association with prenatal factors and maternal distress/depression. Journal of Paediatrics and Child Health 34, 263–266.Google Scholar
Barnes, LLB, Harp, D and Jung, WS (2002) Reliability generalization of scores on the Spielberger state-trait anxiety inventory. Educational and Psychological Measurement 62, 603–618.Google Scholar
Baumgartel, KL, Terhorst, L, Conley, YP and Roberts, JM (2013) Psychometric evaluation of the Epworth Sleepiness Scale in an obstetric population. Elsevier B.V. Sleep Medicine 14, 116–121.Google Scholar
Betts, KS, Williams, GM, Najman, JM and Alati, R (2014) Maternal depressive, anxious, and stress symptoms during pregnancy predict internalizing problems in adolescence. Depression and Anxiety 31, 9–18.10.1002/da.22210Google Scholar
Betts, KS, Williams, GM, Najman, JM and Alati, R (2015) The relationship between maternal depressive, anxious, and stress symptoms during pregnancy and adult offspring behavioral and emotional problems. Blackwell Publishing Inc. Depression and Anxiety 32, 82–90.10.1002/da.22272Google Scholar
Braithwaite, EC, Kundakovic, M, Ramchandani, PG, Murphy, SE and Champagne, FA (2015) Maternal prenatal depressive symptoms predict infant NR3C1 1F and BDNF IV DNA methylation. Epigenetics 10, 408–417.10.1080/15592294.2015.1039221Google Scholar
Brown, AS, Sourander, A, Hinkka-Yli-Salomäki, S, McKeague, IW, Sundvall, J and Surcel, H-M (2013) Elevated maternal C-reactive protein and autism in a national birth cohort. Molecular Psychiatry 19, 259–264.Google Scholar
Buss, C, Davis, EP, Shahbaba, B, Pruessner, JC, Head, K and Sandman, CA (2012) Maternal cortisol over the course of pregnancy and subsequent child amygdala and hippocampus volumes and affective problems. Proceedings of the National Academy of Sciences of the United States of America 109, E1312–9.Google Scholar
Canetta, S, Sourander, A, Surcel, H, Hinkka-Yli-Salomäki, S, Leiviskä, J, Kellendonk, C, Ian, W and Brown, AS (2015) Elevated maternal C-reactive protein and increased risk of schizophrenia in a national birth cohort. American Journal of Psychiatry 171, 960–968.10.1176/appi.ajp.2014.13121579Google Scholar
Croft, S, Stride, C, Maughan, B and Rowe, R (2015) Validity of the strengths and difficulties questionnaire in preschool-aged children. Pediatrics 135, e1210–e1219.Google Scholar
D⊘rheim, SK, Bjorvatn, B and Eberhard-Gran, M (2012) Insomnia and depressive symptoms in late pregnancy: a population-based study. Behavioral Sleep Medicine 10, 152–166.Google Scholar
Dickinson, DL, Wolkow, AP, Rajaratnam, SMW and Drummond, SPA (2018) Personal sleep debt and daytime sleepiness mediate the relationship between sleep and mental health outcomes in young adults. Depression and Anxiety, 35, 775–783.Google Scholar
Edwards, RC and Hans, SL (2016) Prenatal depressive symptoms and toddler behavior problems: the role of maternal sensitivity and child sex. Springer US. Child Psychiatry and Human Development 47, 696–707.Google Scholar
Erhart, M, Döpfner, M, Ravens-Sieberer, U and Group, BS (2008) Psychometric properties of two ADHD questionnaires: comparing the Conners’ scale and the FBB-HKS in the general population of German children and adolescents–results of the BELLA study. European Child & Adolescent Psychiatry 17, 106–115.Google Scholar
Facco, FL, Kramer, J, Ho, KH, Zee, PC and Grobman, WA (2010) Sleep disturbances in pregnancy. Obstetrics & Gynecology 115, 77–83.Google Scholar
Gilman, SE, Cherkerzian, S, Buka, SL, Hahn, J, Hornig, M and Goldstein, JM (2016) Prenatal immune programming of the sex-dependent risk for major depression. Nature Publishing Group. Translational Psychiatry 6, e822.Google Scholar
Gjerde, LC, Eilertsen, EM, Reichborn-Kjennerud, T, McAdams, TA, Zachrisson, HD, Zambrana, IM, Røysamb, E, Kendler, KS and Ystrom, E (2017) Maternal perinatal and concurrent depressive symptoms and child behavior problems: a sibling comparison study. Journal of Child Psychology and Psychiatry 58, 779–786.Google Scholar
Goldberg, DP and Blackwell, B (1970) Psychiatric illness in general practice: a detailed study using a new method of case identification. British Medical Journal 2, 439–443.Google Scholar
Goodlin-Jones, BL, Sitnick, SL, Tang, K, Liu, J and Anders, TF (2008) The children's sleep habits questionnaire in toddlers and preschool children. Journal of Developmental and Behavioural Pediatrics 29, 82–88.Google Scholar
Goodman, R (1997) The strengths and difficulties questionnaire: a research note. Journal of Child Psychology and Psychiatry, and Allied Disciplines 38, 581–586.Google Scholar
Heslehurst, N, Ells, LJ, Simpson, H, Batterham, A, Wilkinson, J and Summerbell, CD (2007) Trends in maternal obesity incidence rates, demographic predictors, and health inequalities in 36 821 women over a 15-year period. BJOG: An International Journal of Obstetrics and Gynaecology 114, 187–194.10.1111/j.1471-0528.2006.01180.xGoogle Scholar
Izci, B, Martin, SE, Dundas, KC, Liston, WA, Calder, AA and Douglas, NJ (2005) Sleep complaints: snoring and daytime sleepiness in pregnant and pre-eclamptic women. Sleep Medicine 6, 163–169.Google Scholar
Jaussent, I, Morin, CM, Ivers, H and Dauvilliers, Y (2017) Incidence, worsening and risk factors of daytime sleepiness in a population-based 5-year longitudinal study. Springer US. Scientific Reports 7, 1–11.10.1038/s41598-017-01547-0Google Scholar
Johns, MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep: Journal of Sleep Research & Sleep Medicine 14, 540–545.Google Scholar
Kendzerska, TB, Smith, PM, Brignardello-Petersen, R, Leung, RS and Tomlinson, GA (2014) Evaluation of the measurement properties of the Epworth sleepiness scale: a systematic review. Elsevier Ltd. Sleep Medicine Reviews 18, 321–331.Google Scholar
Kerstjens, JM, Bos, AF, ten Vergert, EMJ, de Meer, G, Butcher, PR and Reijneveld, SA (2009) Support for the global feasibility of the Ages and Stages Questionnaire as developmental screener. Early Human Development 85, 443–447.10.1016/j.earlhumdev.2009.03.001Google Scholar
Korhonen, M, Luoma, I, Salmelin, R and Tamminen, T (2014) Maternal depressive symptoms: associations with adolescents’ internalizing and externalizing problems and social competence. Nordic Journal of Psychiatry 68, 323–332.10.3109/08039488.2013.838804Google Scholar
Kuckertz, JM, Mitchell, C and Wiggins, JL (2018) Parenting mediates the impact of maternal depression on child internalizing symptoms. Depression and Anxiety, 35, 89–97.Google Scholar
Lahti, M, Savolainen, K, Tuovinen, S, Pesonen, A-K, Lahti, J, Heinonen, K, Hämäläinen, E, Laivuori, H, Villa, PM, Reynolds, RM, Kajantie, E and Räikkönen, K (2017) Maternal depressive symptoms during and after pregnancy and psychiatric problems in children. Journal of the American Academy of Child & Adolescent Psychiatry 56, 30–39, e7.10.1016/j.jaac.2016.10.007Google Scholar
Loomans, EM, van Der Stelt, O, Van Eijsden, M, Gemke, RJBJ, Vrijkotte, T and den Bergh, BRHV (2011) Antenatal maternal anxiety is associated with problem behaviour at age five. Elsevier Ltd. Early Human Development 87, 565–570.Google Scholar
Lundin, A, Hallgren, M, Theobald, H, Hellgren, C and Torgén, M (2016) Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population. Public Health 136, 66–74.Google Scholar
Mansell, T, Vuillermin, P, Ponsonby, A-L, Collier, F, Saffery, R and Ryan, J (2016) Maternal mental well-being during pregnancy and glucocorticoid receptor gene promoter methylation in the neonate. Development and Psychopathology 28, 1421–1430.Google Scholar
Maurovich-Horvat, E, Keckeis, M, Lattová, Z, Kemlink, D, Wetter, TC, Schuld, A, Sonka, K and Pollmächer, T (2014) Hypothalamo-pituitary-adrenal axis, glucose metabolism and TNF-α in narcolepsy. Journal of Sleep Research 23, 425–431.Google Scholar
Mcloone, P (2004) Carstairs Scores for Scottish Postcode Sectors From the 2001 Census. Glasgow, UK: MRC Social & Public Health Sciences Unit, University of Glasgow.Google Scholar
Mellor, R, Chua, SC and Boyce, P (2014) Antenatal depression: an artefact of sleep disturbance? Archives of Women's Mental Health 17, 291–302.10.1007/s00737-014-0427-6Google Scholar
Micheli, K, Komninos, I, Bagkeris, E, Roumeliotaki, T, Koutis, A, Kogevinas, M and Chatzi, L (2011) Sleep patterns in late pregnancy and risk of preterm birth and fetal growth restriction. Epidemiology (Cambridge, Mass.) 22, 738–744.Google Scholar
Mina, TH, Denison, FC, Forbes, S, Stirrat, LI, Norman, JE and Reynolds, RM (2015) Associations of mood symptoms with ante- and postnatal weight change in obese pregnancy are not mediated by cortisol. Psychological Medicine, 1–14.Google Scholar
Mina, TH, Lahti, M, Drake, AJ, Raikkonen, K, Minnis, H, Denison, FC, Norman, JE and Reynolds, RM (2017) Prenatal exposure to very severe maternal obesity is associated with adverse neuropsychiatric outcomes in children. Psychological Medicine 47, 353–362.10.1017/S0033291716002452Google Scholar
Mindell, JA, Cook, RA and Nikolovski, J (2015) Sleep patterns and sleep disturbances across pregnancy. Elsevier B.V. Sleep Medicine 16, 483–488.Google Scholar
Mischel, W, Ayduk, O, Berman, MG, Casey, BJ, Gotlib, IH, Jonides, J, Kross, E, Teslovich, T, Wilson, NL, Zayas, V and Shoda, Y (2011) ‘Willpower’ over the life span: decomposing self-regulation. Social Cognitive and Affective Neuroscience 6, 252–256.Google Scholar
Murphy, SK, Fineberg, AM, Maxwell, SD, Alloy, LB, Zimmermann, L, Krigbaum, NY, Cohn, BA, Drabick, DAG and Ellman, LM (2017) Maternal infection and stress during pregnancy and depressive symptoms in adolescent offspring. Elsevier Ireland Ltd. Psychiatry Research 257, 102–110.10.1016/j.psychres.2017.07.025Google Scholar
Nishiyama, T, Mizuno, T, Kojima, M, Suzuki, S, Kitajima, T, Ando, KB, Kuriyama, S and Nakayama, M (2014) Criterion validity of the Pittsburgh sleep quality index and Epworth sleepiness scale for the diagnosis of sleep disorders. Elsevier B.V. Sleep Medicine 15, 422–429.10.1016/j.sleep.2013.12.015Google Scholar
O'Donnell, KJ, Glover, V, Barker, ED and O'Connor, TG (2014) The persisting effect of maternal mood in pregnancy on childhood psychopathology. Development and Psychopathology 26, 393–403.Google Scholar
Owens, JA, Spirito, A and McGuinn, M (2000) The Children's Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 23, 1043–1051.10.1093/sleep/23.8.1dGoogle Scholar
Paavonen, EJ, Saarenpää-Heikkilä, O, Pölkki, P, Kylliäinen, A, Porkka-Heiskanen, T and Paunio, T (2016) Maternal and paternal sleep during pregnancy in the child-sleep birth cohort. Sleep Medicine 29, 47–56.10.1016/j.sleep.2016.09.011Google Scholar
Palagini, L, Gemignani, A, Banti, S, Manconi, M, Mauri, M and Riemann, D (2014) Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome. Elsevier B.V. Sleep Medicine 15, 853–859.Google Scholar
Palma-Gudiel, H, Córdova-Palomera, A, Eixarch, E, Deuschle, M and Fañanás, L (2015) Maternal psychosocial stress during pregnancy alters the epigenetic signature of the glucocorticoid receptor gene promoter in their offspring: a meta-analysis. Epigenetics 10, 893–902.Google Scholar
Parade, SH, Ridout, KK, Seifer, R, Armstrong, DA, Marsit, CJ, McWilliams, MA and Tyrka, AR (2016) Methylation of the glucocorticoid receptor gene promoter in preschoolers: links with internalizing behavior problems. Child Development 87, 86–97.10.1111/cdev.12484Google Scholar
Pearson, RM, Bornstein, MH, Cordero, M, Scerif, G, Mahedy, L, Evans, J, Abioye, A and Stein, A (2016) Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function. Journal of Child Psychology and Psychiatry and Allied Disciplines 57, 491–501.10.1111/jcpp.12483Google Scholar
Plant, DT, Pariante, CM, Sharp, D and Pawlby, S (2015) Maternal depression during pregnancy and offspring depression in adulthood: role of child maltreatment. British Journal of Psychiatry 207, 213–220.Google Scholar
Ponitz, CC, McClelland, MM, Matthews, JS and Morrison, FJ (2009) A structured observation of behavioral self-regulation and its contribution to kindergarten outcomes. Developmental Psychology 45, 605–619.Google Scholar
Pyhälä, R, Wolford, E, Kautiainen, H, Andersson, S, Bartmann, P, Baumann, N, Brubakk, A-M, Evensen, KAI, Hovi, P, Kajantie, E, Lahti, M, Van Lieshout, RJ, Saigal, S, Schmidt, LA, Indredavik, MS, Wolke, D and Räikkönen, K (2017) Self-Reported mental health problems among adults born preterm: a meta-analysis. Pediatrics 139, e20162690.Google Scholar
Sandman, CA, Buss, C, Head, K and Davis, EP (2015) Fetal exposure to maternal depressive symptoms is associated with cortical thickness in late childhood. Elsevier. Biological Psychiatry 77, 324–334.Google Scholar
Sarberg, M, Bladh, M, Svanborg, E and Josefsson, A (2016) Postpartum depressive symptoms and its association to daytime sleepiness and restless legs during pregnancy. BMC Pregnancy and Childbirth 16, 137.Google Scholar
Sedov, ID, Cameron, EE, Madigan, S and Tomfohr-Madsen, LM (2018) Sleep quality during pregnancy: a meta-analysis. Elsevier Ltd. Sleep Medicine Reviews 8, 168–176.Google Scholar
Signal, TL, Paine, SJ, Sweeney, B, Priston, M, Muller, D, Smith, A, Lee, KA, Huthwaite, M, Reid, P and Gander, P (2014) Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population. Elsevier B.V. Sleep Medicine 15, 1477–1483.Google Scholar
Smarr, BL, Grant, AD, Perez, L, Zucker, I and Kriegsfeld, LJ (2017) Maternal and early-life circadian disruption have long-lasting negative consequences on offspring development and adult behavior in mice. Scientific Reports 7, 1–12.Google Scholar
Smoller, JW, Craddock, N, Kendler, K, Lee, PH and Neale, BM (2013) Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis. Lancet 381, 1371–1379.Google Scholar
Spielberger, CD (1987) State-trait anxiety inventory. Anxiety 19, 2009.Google Scholar
Squires, J, Bricker, D and Potter, L (1997) Revision of a parent-completed development screening tool: ages and stages questionnaire. Pediatric Psychology 22, 313–328.Google Scholar
Stein, A, Pearson, RM, Goodman, SH, Rapa, E, Rahman, A, McCallum, M, Howard, LM and Pariante, CM (2014) Effects of perinatal mental disorders on the fetus and child. Elsevier Ltd. The Lancet 384, 1800–1819.10.1016/S0140-6736(14)61277-0Google Scholar
Tarabulsy, GM, Pearson, J, Vaillancourt-Morel, M-P, Bussières, E-L, Madigan, S, Lemelin, J-P, Duchesneau, A-A, Hatier, D-E and Royer, F (2014) Meta-analytic findings of the relation between maternal prenatal stress and anxiety and child cognitive outcome. Journal of Developmental and Behavioral Pediatrics: JDBP 35, 38–43.Google Scholar
Theunissen, MHC, Vogels, AGC, de Wolff, MS and Reijneveld, SA (2013) Characteristics of the strengths and difficulties questionnaire in preschool children. Pediatrics 131, e446–e454.Google Scholar
Van Batenburg-Eddes, T, Brion, MJ, Henrichs, J, Jaddoe, VWV, Hofman, A, Verhulst, FC, Lawlor, DA, Davey Smith, G and Tiemeier, H (2013) Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross-cohort consistency study. Journal of Child Psychology and Psychiatry and Allied Disciplines 54, 591–600.Google Scholar
van Dalfsen, JH and Markus, CR (2018) The influence of sleep on human hypothalamic-pituitary-adrenal (HPA) axis reactivity: a systematic review. Elsevier Ltd. Sleep Medicine Reviews 39, 187–194.Google Scholar
Van den Bergh, BRH, van den Heuvel, MI, Lahti, M, Braeken, M, de Rooij, SR, Entringer, S, Hoyer, D, Roseboom, T, Räikkönen, K, King, S and Schwab, M (2017) Prenatal developmental origins of behavior and mental health: the influence of maternal stress in pregnancy. Neuroscience & Biobehavioral Reviews. Advance Online Publication. doi: 10.1016/j.neubiorev.2017.07.003.Google Scholar
Van Der Knaap, LJ, Van Oort, FVA, Verhulst, FC, Oldehinkel, AJ and Riese, H (2015) Methylation of NR3C1 and SLC6A4 and internalizing problems. the TRAILS study. Elsevier. Journal of Affective Disorders 180, 93–103.Google Scholar
Walder, DJ, Laplante, DP, Sousa-Pires, A, Veru, F, Brunet, A and King, S (2014) Prenatal maternal stress predicts autism traits in 61/2 year-old children: project ice storm. Elsevier Psychiatry Research 219, 353–360.Google Scholar
Westerlund, J, Ek, U, Holmberg, K, Näswall, K and Fernell, E (2009) The Conners’ 10-item scale: findings in a total population of Swedish 10–11-year-old children. Acta Paediatrica, International Journal of Paediatrics 98, 828–833.Google Scholar
Xiang, AH, Wang, X, Martinez, MP, Walthall, JC, Curry, ES, Page, K, Buchanan, TA, Coleman, KJ and Getahun, D (2015) Association of maternal diabetes with autism in offspring. JAMA 313, 1425–1434.Google Scholar
Zerbo, O, Traglia, M, Yoshida, C, Heuer, LS, Ashwood, P, Delorenze, GN, Hansen, RL, Kharrazi, M, Van de Water, J, Yolken, RH, Weiss, LA and Croen, LA (2016) Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study. Translational Psychiatry 6, e783.Google Scholar
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