title: Mediators of the association between parental severe mental illness and offspring neurodevelopmental problems.
abstract: OBJECTIVE
  Parental severe mental illness (SMI) is associated with an increased risk of offspring autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). We conducted a study to examine the extent to which risk of preterm birth, low birth weight, and small for gestational age mediated this association.
  
  
  METHODS
  We obtained data on offspring born 1992-2001 in Sweden (n = 870,017) through the linkage of multiple population-based registers. We used logistic and Cox regression to assess the associations between parental SMI, adverse pregnancy outcomes, and offspring ASD and ADHD, as well as tested whether adverse pregnancy outcomes served as mediators.
  
  
  RESULTS
  After controlling for measured covariates, maternal and paternal SMI were associated with an increased risk for preterm birth, low birth weight, and gestational age, and for offspring ASD and ADHD. These pregnancy outcomes were also associated with an increased risk of ASD and ADHD. We found that pregnancy outcomes did not mediate the association between parental SMI and offspring ASD and ADHD, as there was no substantial change in magnitude of the risk estimates after controlling for pregnancy outcomes.
  
  
  CONCLUSIONS
  Parental SMI and adverse pregnancy outcomes appear to be independent risk factors for offspring ASD and ADHD.
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: McCoy
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Rickert
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington.
authors.forename: Quetzal A
authors.initials: QA
authors.lastname: Class
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Larsson
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.affiliation: Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington. Electronic address: bmdonofr@indiana.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: D'Onofrio
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D002648:Child; D002659:Child Development Disorders, Pervasive / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D016241:Child of Impaired Parents; D005220:Fathers / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D009035:Mothers / Q000523:psychology* / Q000706:statistics & numerical data; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013548:Sweden; D055815:Young Adult
keywords: Attention deficit hyperactivity disorder; Autism spectrum disorder; Birth weight; Gestational age; Infant; Small for gestational age