Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review

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Abstract

Inflammation is increasingly recognized as a cause or consequence of common problems of humanity including obesity, stress, depression, pollution and disease states such as autoimmunity, asthma, and infection. Maternal immune activation (MIA), triggered by both acute and systemic chronic inflammation, is hypothesized to be one of the mechanisms implicated in the pathogenesis of neurodevelopmental disorders (NDD). Although there is substantial preclinical evidence to support the MIA hypothesis, the human evidence is disparate. We performed a systematic review on human studies examining associations between maternal inflammatory states and offspring NDDs (autism spectrum disorder- ASD, attention deficit hyperactivity disorder-ADHD, Tourette syndrome-TS). 32 meta-analyses and 26 additional individual studies were identified. Maternal states associated with ASD include obesity, gestational diabetes mellitus, pre-eclampsia, pollution, stress, depression, autoimmune diseases, and infection. Maternal states associated with ADHD include obesity, pre-eclampsia, smoking, low socioeconomic status (SES), stress, autoimmune disease, and asthma. Maternal states associated with TS include low SES, depression, and autoimmune diseases. Diverse maternal inflammatory states in pregnancy are associated with common offspring NDDs. Given the increased prevalence of NDDs, there is urgent need to explore relative and cumulative maternal risk factors and disease mechanisms. Defining preventable risk factors in high-risk pregnancies could mitigate the expression and severity of NDDs.

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Epidemiological evidence implicates maternal infection as a risk factor for autism spectrum disorder and schizophrenia. Animal models corroborate this link and demonstrate that maternal immune activation (MIA) alone is sufficient to impart lifelong neuropathology and altered behaviors in offspring. This Review describes common principles revealed by these models, highlighting recent findings that strengthen their relevance for schizophrenia and autism and are starting to reveal the molecular mechanisms underlying the effects of MIA on offspring. The role of MIA as a primer for a much wider range of psychiatric and neurologic disorders is also discussed. Finally, the need for more research in this nascent field and the implications for identifying and developing new treatments for individuals at heightened risk for neuroimmune disorders are considered.

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Author and article information

Contributors

Russell C. Dale:

ORCID: http://orcid.org/0000-0002-2495-1826

russell.dale@sydney.edu.au

Journal

Journal ID (nlm-ta): Transl Psychiatry

Journal ID (iso-abbrev): Transl Psychiatry

Title: Translational Psychiatry

Publisher: Nature Publishing Group UK (London )

ISSN (Electronic): 2158-3188

Publication date (Electronic): 21 January 2021

Publication date PMC-release: 21 January 2021

Publication date Collection: 2021

Volume: 11

Electronic Location Identifier: 71

Affiliations

[1 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, , University of Sydney, ; Sydney, NSW Australia

[2 ]GRID grid.410759.e, ISNI 0000 0004 0451 6143, Khoo Teck Puat-National University Children’s Medical Institute, , National University Health System, ; Singapore, Singapore

[3 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, , University of Sydney, ; Sydney, NSW Australia

[4 ]GRID grid.414054.0, ISNI 0000 0000 9567 6206, Department of Neuroservices, Starship Children’s Hospital, ; Auckland, New Zealand

[5 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Child Population and Translational Health Research, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, , The University of Sydney, ; Sydney, NSW Australia

[6 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The Brain and Mind Centre, , The University of Sydney, ; Sydney, NSW Australia

[7 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, School of Life and Environmental Sciences and Charles Perkins Centre, , The University of Sydney, ; Sydney, NSW Australia

[8 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, The University of Sydney, School of Medical Sciences and Discipline of Child and Adolescent Health, Faculty of Medicine and Health, ; Sydney, NSW Australia

[9 ]GRID grid.413973.b, ISNI 0000 0000 9690 854X, Molecular Neurobiology Research Laboratory, Kids Research, Children’s Hospital at Westmead, and The Children’s Medical Research Institute, ; Westmead, NSW Australia

[10 ]GRID grid.413973.b, ISNI 0000 0000 9690 854X, Kids Neuroscience Centre, Kids Research, Children’s Hospital at Westmead, ; Westmead, NSW Australia

[11 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, School of Medical Sciences, Discipline of Applied Medical Science, Faculty of Medicine and Health, , The University of Sydney, ; Sydney, NSW Australia

Author information

Velda X. Han http://orcid.org/0000-0003-4633-4316

Shrujna Patel http://orcid.org/0000-0003-4928-692X

Timothy C. Nielsen http://orcid.org/0000-0002-8801-572X

Shekeeb S. Mohammad http://orcid.org/0000-0003-1219-4781

Markus J. Hofer http://orcid.org/0000-0001-5111-3978

Fabienne Brilot http://orcid.org/0000-0002-7025-2276

Russell C. Dale http://orcid.org/0000-0002-2495-1826

Article

Publisher ID: 1198

DOI: 10.1038/s41398-021-01198-w

PMC ID: 7820474

PubMed ID: 33479207

SO-VID: 0642aba7-f0f9-4455-aab7-85613b4a6a1a

License:

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