Cited by 18Tryptophan and brain disordersMaternal Mental Health During Pregnancy and PostpartumNeonatal and fetal brain pathology

The long-term impact of elevated C-reactive protein levels during pregnancy on brain morphology in late childhood

Open access
Suleri, Anna, Blok, Elisabet, Durkut, Melisa, Rommel, Anna-Sophie, Witte, Lot de, Jaddoe, Vincent, Bergink, Veerle, White, Tonya·2022·Brain, Behavior, and Immunity

Abstract

IMPORTANCE: Animal studies show that Maternal Immune Activation (MIA) may have detrimental effects on fetal brain development. Clinical studies provide evidence for structural brain abnormalities in human neonates following MIA, but no study has investigated the long-term effects of MIA (as measured with biomarkers) on human brain morphology ten years after the exposure. OBJECTIVE: Our aim was to evaluate the long-term impact of MIA on brain morphology in 10-year-old children, including the possible mediating role of gestational age at birth. DESIGN: We leveraged data from Generation R, a large-scale prospective pregnancy cohort study. Pregnant women were included between 2002 and 2006, and their children were invited to participate in the MRI study between 2013 and 2015. To be included, mother-child dyads had to have data on maternal C-reactive protein levels during gestation and a good quality MRI-scan of the child's brain at age 10 years. Of the 3,992 children scanned, a total of 2,053 10-year-old children were included in this study. EXPOSURE: Maternal C-reactive protein was measured in the first 18 weeks of gestation. For the analyses we used both a continuous approach as well as a categorical approach based on clinical cut-offs to determine if there was a dose-response relationship. MAIN OUTCOMES AND MEASURES: High-resolution MRI brain morphology measures were used as the primary outcome. Gestational age at birth, established using ultrasound, was included as a mediator using a causal mediation analysis. Corrections were made for relevant confounders and multiple comparisons. Biological sex was investigated as moderator. RESULTS: We found a direct association between continuous MIA and lower cerebellar volume. In girls, we demonstrated a negative indirect association between continuous MIA and total brain volume, through the mediator gestational age at birth. We observed no associations with categorical MIA after multiple testing correction. CONCLUSION AND RELEVANCE: Our results suggest sex-specific long-term effects in brain morphology after MIA. Categorical analyses suggest that this association might be driven by acute infections or other sources of severe inflammation, which is of clinical relevance given that the COVID-19 pandemic is currently affecting millions of pregnant women worldwide.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.bbi.2022.03.018

Cites

82 of 82 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Elevated gestational CRP levels are associated with adverse infant and child brain developmental outcomes.

    “Additionally, C-reactive protein (CRP), an inflammatory marker, is elevated as prenatal maternal mental distress increases [142, 143], and elevated gestational CRP levels have been associated with increased risk of preterm birth [144], adverse infant and child brain developmental outcomes [144, 145], as well as autism and schizophrenia in the offspring [146, 147].”

    From Brain structural and functional outcomes in the offspring of women experiencing psychological distress during pregnancy (2024) · cites this paper as [145]

    The Results (Child brain morphology) and Discussion report that higher maternal CRP in early pregnancy was associated with smaller cerebellar volume in children, supporting the child-brain portion of the claim. The study did not assess infant brain outcomes; its Introduction mentions neonatal and toddler findings only as background from other studies. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [57]Nehring S, Goyal A, Bansal P, Nehring SM, Goyal A, Bansal P, et al. C Reactive Protein. [Updated 2021 Dec 28]. https://www.ncbi.nlm.nih.gov/books/NBK441843/

Cited by

Sorted by citations

Authors
Suleri, A., Blok, E., Durkut, M., Rommel, A.-S., Witte, L. D., Jaddoe, V., Bergink, V., & White, T.
Affiliations
  • Erasmus MC (NL)
  • Icahn School of Medicine at Mount Sinai (US)
Corresponding author
White, Tonya
Venue
Brain, Behavior, and Immunity
Publisher
Elsevier BV
Published
2022-07
Volume
103
Pages
63-72
ISSN
0889-1591 (ISSN-L)
OpenAlex
W4223962277
Cited by
18
References
82
Citations by year
2026: 2 · 2025: 1 · 2024: 10 · 2023: 5
FWCI
1.39
Type
journal article
Language
en
Open access
Locations
  • Brain Behavior and Immunity (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Funders
NIMH
Topics
  • Life Sciences › Neuroscience › Biological Psychiatry › Tryptophan and brain disorders
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal and fetal brain pathology
Keywords
maternal immune activation, C-reactive protein, pregnancy, fetal brain development, brain structure, cerebellar volume, total brain volume, gestational age, sex differences, mediation analysis, prenatal inflammation, COVID-19 in pregnancy, Generation R cohort
MeSH terms
COVID-19, Animals, Brain, C-Reactive Protein, Child, Female, Humans, Male, Pregnancy, Prenatal Exposure Delayed Effects, Prospective Studies, Cohort Studies, Pandemics

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review