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Birth by cesarean section and schizophrenia: results from the multicenter FACE-SZ data-set

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Abstract

Children born by cesarean section (“c-birth”) are known to have different microbiota and a natural history of different disorders including allergy, asthma and overweight compared to vaginally born (“v-birth”) children. C-birth is not known to increase the risk of schizophrenia (SZ), but to be associated with an earlier age at onset. To further explore possible links between c-birth and SZ, we compared clinical and biological characteristics of c-born SZ patients compared to v-born ones. Four hundred and fifty-four stable community-dwelling SZ patients (mean age = 32.4 years, 75.8 % male gender) were systematically included in the multicentre network of FondaMental Expert Center for schizophrenia. Overall, 49 patients (10.8 %) were c-born. These subjects had a mean age at schizophrenia onset of 21.9 ± 6.7 years, a mean duration of illness of 10.5 ± 8.7 years and a mean PANSS total score of 70.9 ± 18.7. None of these variables was significantly associated with c-birth. Multivariate analysis showed that c-birth remained associated with lower CRP levels (aOR = 0.07; 95 % CI 0.009–0.555, p = 0.012) and lower premorbid ability (aOR = 0.945; 95 % CI 0.898–0.994, p = 0.03). No significant association between birth by C-section and, respectively, age, age at illness onset, sex, education level, psychotic and mood symptomatology, antipsychotic treatment, tobacco consumption, birth weight and mothers suffering from schizophrenia or bipolar disorder has been found. Altogether, the present results suggest that c-birth is associated with lower premorbid intellectual functioning and lower blood CRP levels in schizophrenia. Further studies should determine the mechanisms underlying this association.

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Acknowledgments

This work was funded by AP-HP (Assistance Publique des Hôpitaux de Paris), Fondation FondaMental (RTRS Santé Mentale), by the Investissements d’Avenir program managed by the ANR under reference ANR-11-IDEX-0004-02 and ANR-10-COHO-10-01, and by INSERM (Institut National de la Santé et de la Recherche Médicale). We express all our thanks to the nurses and to the patients who were included in the present study.

FACE-SCZ Group: Aouizerate Ba,l, MD PhD, Berna Fb,l, MD PhD, Blanc Oc,l, Msc, Brunel Ld,l, Msc, Bulzacka Ed,l, Msc, Capdevielle De,l, MD PhD, Chereau-Boudet Ic,l, MD, Chesnoy-Servanin Gf,l, Msc, Danion JMb,l, MD, D’Amato Tf,l, MD PhD, Deloge Ag,l, MD PhD, Delorme Ch,l, Msc, Denizot Hc,l, MD, De Pradier Mi,l, MD, Dorey JMf,l, MD, Dubertret Ci,l, MD PhD, Dubreucq Jh,l, MD, Faget Cj,l, MD, Fluttaz Ch,l, Msc, Fond Gd,l, MD, Fonteneau Sk,l, Msc, Gabayet Fh,l, Msc, Giraud-Baro Eh,l, MD, Hardy-Bayle MCk,l, MD PhD, Lacelle Dc,l, Msc, Lançon Cj,l, MD PhD, Laouamri Hl, Msc, Leboyer Md,l, MD PhD, Le Gloahec Td,l, Msc, Le Strat Yi,l, MD PhD, Llorcac,l PM, MD PhD, Metairie Ej,l, Msc, Misdrahi Dg,l, MD, Offerlin-Meyer Ib,l, PhD, Passerieux Ck,l, MD PhD, Peri Pj,l, Msc, Pires Sc,l, Msc, Portalier Ci,l, Msc, Rey Rf,l, MD, Roman Ch,l, Msc, Sebilleau Mk,l, Msc, Schandrin Ae,l, MD, Schurhoff Fd,l, MD PhD, Tessier Ag,l, Msc, Tronche AMc,l, MD, Urbach Mk,l, MD, Vaillant Fj,l, Msc, Vehier Af,l, Msc, Vidailhet Pb,l, MD PhD, MD, Vilà Eg,l, Msc, Yazbek He,l, PhD, Zinetti-Bertschy Ab,l, Msc.

aCentre Hospitalier Charles Perrens, F-33076 Bordeaux, France; Université de Bordeaux, Inserm, Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, U862, F-33000 Bordeaux, France. b Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France. c CMP B, CHU, EA 7280 Faculté de Médecine, Université d’Auvergne, BP 69 63003 Clermont-Ferrand Cedex 1. d AP-HP, DHU Pe-PSY, Pôle de Psychiatrie et d’addictologie des Hôpitaux Universitaires H Mondor,INSERM U955, Eq 15 Psychiatrie Translationelle,, Université Paris Est-Créteil, Créteil, France. e Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, Université Montpellier 1, Inserm 1061, Montpellier, France. f Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est BP 300 39 - 95 bd Pinel - 69678 BRON Cedex, France. g Centre Hospitalier Charles Perrens, F-33076 Bordeaux, France; Université de Bordeaux, CNRS UMR 5287-INCIA. h Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France. i AP-HP, Department of Psychiatry, Louis Mourier Hospital, Colombes, Inserm U894 Université Paris Diderot, Sorbonne Paris Cité, Faculté de médecine, France. j Assistance Publique des Hôpitaux de Marseille (AP-HM), pôle universitaire de psychiatrie, Marseille, France. k Service de psychiatrie d’adulte, Centre Hospitalier de Versailles, Le Chesnay, EA 4047 HANDIReSP, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France. l Fondation Fondamental.

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Authors and Affiliations

  1. Fondation FondaMental, Créteil, France

    G. Fond, E. Bulzacka, P. M. Llorca, O. Godin, L. Brunel, M. G. Andrianarisoa, B. Aouizerate, F. Berna, D. Capdevielle, I. Chereau, H. Denizot, J. M. Dorey, C. Dubertret, J. Dubreucq, C. Faget, F. Gabayet, Y. Le Strat, D. Misdrahi, R. Rey, R. Richieri, M. Roger, C. Passerieux, A. Schandrin, M. Urbach, F. Schürhoff & M. Leboyer

  2. Translational Psychiatry Laboratory, INSERM U955, Créteil, France

    G. Fond, E. Bulzacka, L. Brunel, M. G. Andrianarisoa, M. Roger, F. Schürhoff & M. Leboyer

  3. DHU Pe-PSY, Pôle de Psychiatrie des Hôpitaux Universitaires H Mondor, Paris Est University, Créteil, France

    G. Fond, E. Bulzacka, L. Brunel, M. G. Andrianarisoa, M. Roger, F. Schürhoff & M. Leboyer

  4. UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM, 75013, UPMC Univ Paris 06, Sorbonne Universités, 75013, Paris, France

    O. Godin

  5. Centre Hospitalier Charles Perrens, Université de Bordeaux, 33076, Bordeaux, France

    B. Aouizerate & D. Misdrahi

  6. INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France

    F. Berna & P. Vidalhet

  7. Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, Inserm 1061, CHRU Montpellier, Université Montpellier 1, Montpellier, France

    D. Capdevielle & A. Schandrin

  8. CMP B, CHU, EA 7280 Faculté de Médecine, Université d’Auvergne, BP 69, 63003, Clermont-Ferrand Cedex 1, France

    P. M. Llorca, I. Chereau & H. Denizot

  9. Université Claude Bernard Lyon 1/Centre Hospitalier Le Vinatier Pole Est, BP 300 39, 95 bd Pinel, 69678, Bron Cedex, France

    J. M. Dorey & R. Rey

  10. AP-HP, Department of Psychiatry, Faculté de Médecine, Louis Mourier Hospital, Inserm U894, Université Paris Diderot, Sorbonne Paris Cité, Colombes, France

    C. Dubertret & Y. Le Strat

  11. Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France

    J. Dubreucq & F. Gabayet

  12. Assistance Publique des Hôpitaux de Marseille (AP-HM), Pôle Universitaire de Psychiatrie, Marseille, France

    C. Faget & R. Richieri

  13. Service de Psychiatrie d’Adulte, Centre Hospitalier de Versailles, UFR des Sciences de la Santé Simone Veil, Université Versailles Saint-Quentin en Yvelines, Versailles, France

    C. Passerieux & M. Urbach

  14. Bordeaux Sleep Clinique, Pellegrin University Hospital, USR CNRS 3413 SANPSY, Research Unit, Bordeaux University, 33000, Bordeaux, France

    J. A. Micoulaud-Franchi

  15. Neurocentre Magendie, Physiopathologie de la Plasticité Neuronale, Inserm, U862, 33000, Bordeaux, France

    B. Aouizerate

  16. CNRS UMR 5287-INCIA, Talence, France

    D. Misdrahi

  17. CHU Sainte-Marguerite, Pôle Psychiatrie Universitaire, 13274, Marseille Cedex 09, France

    L. Boyer

  18. Hôpital A. Chenevier, Pole de Psychiatrie, 40 rue de Mesly, 94010, Créteil, France

    G. Fond

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  1. G. Fond
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  2. E. Bulzacka
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  3. L. Boyer
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  4. P. M. Llorca
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  5. O. Godin
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  6. L. Brunel
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  7. M. G. Andrianarisoa
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  8. B. Aouizerate
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  9. F. Berna
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  10. D. Capdevielle
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  11. I. Chereau
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  12. H. Denizot
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  13. J. M. Dorey
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  14. C. Dubertret
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  15. J. Dubreucq
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  16. C. Faget
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  17. F. Gabayet
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  18. Y. Le Strat
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  19. J. A. Micoulaud-Franchi
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  20. D. Misdrahi
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  23. M. Roger
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  24. C. Passerieux
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  25. A. Schandrin
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  26. M. Urbach
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  27. P. Vidalhet
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  28. F. Schürhoff
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  29. M. Leboyer
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Consortia

FondaMental Academic Centers of Expertise for Schizophrenia (FACE-SZ) Group

  • B. Aouizerate
  • , F. Berna
  • , O. Blanc
  • , L. Brunel
  • , E. Bulzacka
  • , D. Capdevielle
  • , I. Chereau-Boudet
  • , G. Chesnoy-Servanin
  • , J. M. Danion
  • , T. D’Amato
  • , A. Deloge
  • , C. Delorme
  • , H. Denizot
  • , M. De Pradier
  • , J. M. Dorey
  • , C. Dubertret
  • , J. Dubreucq
  • , C. Faget
  • , C. Fluttaz
  • , G. Fond
  • , S. Fonteneau
  • , F. Gabayet
  • , E. Giraud-Baro
  • , M. C. Hardy-Bayle
  • , D. Lacelle
  • , C. Lançon
  • , H. Laouamri
  • , M. Leboyer
  • , T. Le Gloahec
  • , Y. Le Strat
  • , P. M. Llorca
  • , E. Metairie
  • , D. Misdrahi
  • , I. Offerlin-Meyer
  • , C. Passerieux
  • , P. Peri
  • , S. Pires
  • , C. Portalier
  • , R. Rey
  • , C. Roman
  • , M. Sebilleau
  • , A. Schandrin
  • , F. Schurhoff
  • , A. Tessier
  • , A. M. Tronche
  • , M. Urbach
  • , F. Vaillant
  • , A. Vehier
  • , P. Vidailhet
  • , E. Vilà
  • , H. Yazbek
  •  & A. Zinetti-Bertschy

Corresponding author

Correspondence to G. Fond.

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Fond, G., Bulzacka, E., Boyer, L. et al. Birth by cesarean section and schizophrenia: results from the multicenter FACE-SZ data-set. Eur Arch Psychiatry Clin Neurosci 267, 587–594 (2017). https://doi.org/10.1007/s00406-016-0708-3

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  • DOI: https://doi.org/10.1007/s00406-016-0708-3

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