The role of prenatal and early developmental influences in later antisocial behavior is of particular interest because such factors may be susceptible to intervention. This study sought to determine whether prenatal exposure to maternal nutritional deficiency predicts an increased risk of antisocial personality disorder (ASPD) at age 18 years. The study took advantage of the conditions created by the Dutch Hunger Winter of 1944 and 1945, when the German army kept food supplies from The Netherlands. Food became plentiful in mid-1945 after a period of increasingly meager nutrition. Food intake was based on the caloric content of weekly government wartime food rations. Dutch criteria for ASPD are quite similar to those in the fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
The risk of ASPD was increased for men exposed to severe (but not moderate) prenatal nutritional deficiency in the region of famine. Odds ratios for exposure in the first and second trimesters ranged from 2.1 to 3.0, but no increased risk was attached to third trimester deficiency. None of the offspring exposed to severe nutritional deficiency had other psychiatric diagnoses. Further analysis showed that the increased risk of ASPD was limited to men born in the famine region who had been exposed in the first and/or second trimester to severe maternal nutritional deficiency. A majority of cases occurring in the famine region (69 of 86) were classified as violent ASPD.
These findings suggest that severe nutritional deprivation of the developing brain in utero may raise the risk of antisocial behavior at the time of late adolescence. Numerous conditions, including war, forced migration, and natural disasters, may be responsible. In developed countries, specific micronutrient deficiencies, such as that of folate, probably are more important than severe prenatal protein-calorie deficiency.
J Am Med Assoc 1999;282:455-462