University of Oulu

Yin W, Ludvigsson JF, Åden U, Risnes K, Persson M, Reichenberg A, et al. (2023) Paternal and maternal psychiatric history and risk of preterm and early term birth: A nationwide study using Swedish registers. PLoS Med 20(7): e1004256.

Paternal and maternal psychiatric history and risk of preterm and early term birth : a nationwide study using Swedish registers

Saved in:
Author: Yin, Weiyao1,2; Ludvigsson, Jonas F.1,3; Åden, Ulrika4,5;
Organizations: 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
2Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China
3Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
4Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
5Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
6Department of Clinical and Molecular Medicine, NTNU, Trondheim, Norway
7Children’s Clinic, St Olav University Hospital, Trondheim, Norway
8Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet, Stockholm, Sweden
9Department of Clinical Science and Education, Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
10Sachsska Childrens’ and Youth Hospital, Stockholm, Sweden
11Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
12Seaver Center for Autism Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
13Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
14Population Health Unit, Finnish Institute for Health and Welfare, Helsinki and Oulu, Finland
15Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
Persistent link:
Language: English
Published: Public Library of Science, 2023
Publish Date: 2023-10-17


Background: Women with psychiatric diagnoses are at increased risk of preterm birth (PTB), with potential life-long impact on offspring health. Less is known about the risk of PTB in offspring of fathers with psychiatric diagnoses, and for couples where both parents were diagnosed. In a nationwide birth cohort, we examined the association between psychiatric history in fathers, mothers, and both parents and gestational age.

Methods and findings: We included all infants live-born to Nordic parents in 1997 to 2016 in Sweden. Psychiatric diagnoses were obtained from the National Patient Register. Data on gestational age were retrieved from the Medical Birth Register. Associations between parental psychiatric history and PTB were quantified by relative risk (RR) and two-sided 95% confidence intervals (CIs) from log-binomial regressions, by psychiatric disorders overall and by diagnostic categories. We extended the analysis beyond PTB by calculating risks over the whole distribution of gestational age, including “early term” (37 to 38 weeks).

Among the 1,488,920 infants born throughout the study period, 1,268,507 were born to parents without a psychiatric diagnosis, of whom 73,094 (5.8%) were born preterm. 4,597 of 73,500 (6.3%) infants were born preterm to fathers with a psychiatric diagnosis, 8,917 of 122,611 (7.3%) infants were born preterm to mothers with a pscyhiatric diagnosis, and 2,026 of 24,302 (8.3%) infants were born preterm to both parents with a pscyhiatric diagnosis. We observed a shift towards earlier gestational age in offspring of parents with psychiatric history. The risks of PTB associated with paternal and maternal psychiatric diagnoses were similar for different psychiatric disorders. The risks for PTB were estimated at RR 1.12 (95% CI [1.08, 1.15] p < 0.001) for paternal diagnoses, at RR 1.31 (95% CI [1.28, 1.34] p < 0.001) for maternal diagnoses, and at RR 1.52 (95% CI [1.46, 1.59] p < 0.001) when both parents were diagnosed with any psychiatric disorder, compared to when neither parent had a psychiatric diagnosis. Stress-related disorders were associated with the highest risks of PTB with corresponding RRs estimated at 1.23 (95% CI [1.16, 1.31] p < 0.001) for a psychiatry history in fathers, at 1.47 (95% CI [1.42, 1.53] p < 0.001) for mothers, and at 1.90 (95% CI [1.64, 2.20] p < 0.001) for both parents. The risks for early term were similar to PTB. Co-occurring diagnoses from different diagnostic categories increased risk; for fathers: RR 1.10 (95% CI [1.07, 1.13] p < 0.001), 1.15 (95% CI [1.09, 1.21] p < 0.001), and 1.33 (95% CI [1.23, 1.43] p < 0.001), for diagnoses in 1, 2, and ≥3 categories; for mothers: RR 1.25 (95% CI [1.22, 1.28] p < 0.001), 1.39 (95% CI [1.34, 1.44] p < 0.001) and 1.65 (95% CI [1.56, 1.74] p < 0.001). Despite the large sample size, statistical precision was limited in subgroups, mainly where both parents had specific psychiatric subtypes. Pathophysiology and genetics underlying different psychiatric diagnoses can be heterogeneous.

Conclusions: Paternal and maternal psychiatric history were associated with a shift to earlier gestational age and increased risk of births before full term. The risk consistently increased when fathers had a positive history of different psychiatric disorders, increased further when mothers were diagnosed and was highest when both parents were diagnosed.

see all

Series: PLoS medicine
ISSN: 1549-1277
ISSN-E: 1549-1676
ISSN-L: 1549-1277
Volume: 20
Issue: 7
Article number: e1004256
DOI: 10.1371/journal.pmed.1004256
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: The study was supported by grant from the Swedish Research Council ( 2021-0214 (grant for S.S.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright information: © 2023 Yin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.