title: Gestational influenza and risk of hypomania in young adulthood: prospective birth cohort study.
abstract: Previous studies have suggested a possible link between exposure to influenza in utero and bipolar disorder in adulthood. Using data from a prospective birth cohort, we aimed to test for an association between exposure to gestational influenza and the experience of hypomania assessed in early adulthood.
  
  
  
  We used data on 2957 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC). The two main outcomes of interest were hypomania, assessed using the Hypomania Checklist (HCL-32) at age 22-23, and 'hypomania plus previous psychotic experiences (PE)'. Maternally-reported gestational influenza was the exposure of interest. Multivariable logistic regression was used and estimates of association were adjusted for a range of possible confounding factors, including maternal smoking in pregnancy.
  
  
  
  Relative to controls, rates of exposure to gestational influenza were higher for participants with hypomania (24.0%) and for participants with 'hypomania plus PE' (34.2%), but univariate and multivariable analyses of an association between gestational influenza and hypomania (with and without previous PE) were not significant.
  
  
  
  The response rate to those who were sent the HCL-32 questionnaire was 36.8%. As a result, some analyses may have been under-powered to detect a true effect. Influenza infection during pregnancy was self-reported by mothers.
  
  
  
  In this prospective population study, gestational influenza was not identified as a clear risk factor for lifetime hypomania or for 'hypomania with PEs' in young adult offspring. It is possible that previous reports of an association between gestational influenza and bipolar disorder in adulthood have been confounded by factors such as maternal smoking during pregnancy.
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ Glasgow, Scotland, UK.
authors.forename: Jana J
authors.initials: JJ
authors.lastname: Anderson
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ Glasgow, Scotland, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Hoath
authors.affiliation: Department of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Wales, UK.
authors.forename: Stanley
authors.initials: S
authors.lastname: Zammit
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, TX, USA.
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Meyer
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ Glasgow, Scotland, UK.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Pell
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ Glasgow, Scotland, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mackay
authors.affiliation: Institute of Health & Wellbeing, University of Glasgow, 1 Lilybank Gardens, G12 8RZ Glasgow, Scotland, UK. Electronic address: Daniel.Smith@Glasgow.ac.uk.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Smith
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000821:virology*; D005260:Female; D006801:Humans; D007251:Influenza, Human / Q000150:complications*; D008137:Longitudinal Studies; D008297:Male; D009035:Mothers; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects / Q000821:virology*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: ALSPAC; Bipolar disorder; Influenza; Pregnancy; Psychotic disorders