title: Early risk factors for psychopathology in offspring of parents with bipolar disorder: the role of obstetric complications and maternal comorbid anxiety.
abstract: OBJECTIVE
  Offspring of parents with bipolar disorder (BD) are at increased risk for developing a range of psychiatric disorders. Although genetic factors clearly confer risk to offspring, environmental factors also play a role in increasing vulnerability. Such environmental factors may occur at the initial stages of development in the form of obstetric complications (OCs). The current investigation examined the relationship between OCs and the development of psychopathology in offspring at risk for BD and the influence of parental psychopathology in this relationship.
  
  
  METHODS
  This cross-sectional study included 206 offspring of 119 parents with BD. Probit regression analyses examined associations between: (1) OC history and offspring psychopathology; and (2) maternal lifetime comorbid anxiety diagnoses and OCs in pregnancy/delivery with their offspring. Path analyses then tested whether OCs mediate the relationship between maternal comorbid anxiety disorders and offspring lifetime psychopathology.
  
  
  RESULTS
  Results indicated a specific association between OCs, particularly delivery complications, and increased risk for offspring anxiety disorders. Data also showed a significant relationship between maternal anxiety disorder comorbidity and OCs. Finally, path analyses suggested that delivery complications act as a mediator in the relationship between comorbid maternal anxiety disorder and offspring anxiety disorder.
  
  
  CONCLUSIONS
  Our findings lend support to the importance of identifying and reducing anxiety in pregnant woman with BD. The identification of OCs as early vulnerability factors for psychopathology in offspring at familial risk may also lead to earlier detection and intervention in these offspring.
authors.affiliation: Department of Psychology, Boston University, Boston, Massachusetts.
authors.forename: Rachel D
authors.initials: RD
authors.lastname: Freed
authors.forename: Martha C
authors.initials: MC
authors.lastname: Tompson
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
authors.forename: Dina
authors.initials: D
authors.lastname: Hirshfeld-Becker
authors.forename: Christine H
authors.initials: CH
authors.lastname: Wang
authors.forename: Aude
authors.initials: A
authors.lastname: Henin
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D001714:Bipolar Disorder / Q000453:epidemiology*; D002648:Child; D016241:Child of Impaired Parents / Q000523:psychology / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D012307:Risk Factors; D055815:Young Adult
keywords: anxiety disorder; bipolar disorder; obstetric complications; offspring of impaired parents; risk factors