A previous study demonstrated a higher risk of major affective disorder requiring hospital admission in those exposed to famine in middle to late prenatal life. The population base for this study was made up of people living under famine conditions during the Dutch Hunger Winter of 1944-1945, the result of a Nazi blockade in the last year of the war. Data on more than 90 percent of psychiatric hospitalizations in the Netherlands from 1978 to 1991 were available for analysis. The current study expands the database to include admissions from 1970 to 1977 and from 1992 to 1996. The birth cohort comprises persons born in six cities in western Holland from 1944 to 1946.
The risk of major affective disorder leading to hospital admission was increased in those exposed to famine conditions in the second and third trimesters. Neither men nor women were at significantly increased risk when exposed during the first trimester. Similar results were found for unipolar and bipolar affective disorders, although the association was strongest for those with unipolar disorder. Men exposed during midpregnancy were at particular risk, but among women there was no major difference between the second and third trimesters. Individuals exposed in utero to a moderate level of famine had a risk similar to the risk of those exposed to severe famine.
These updated findings continue to support a connection between prenatal malnutrition in middle and late pregnancy and serious affective disorder requiring hospitalization. Direct diagnostic interviews might well elucidate the neurodevelopmental basis of this relationship.
Am J Psychiatry 2000;157:190-195