Elevated maternal C-reactive protein and autism in a national birth cohort
Open accessAbstract
Autism is a complex neuropsychiatric syndrome with a largely unknown etiology. Inflammation during pregnancy may represent a common pathway by which infections and other insults increase risk for the disorder. Hence, we investigated the association between early gestational C-reactive protein (CRP), an established inflammatory biomarker, prospectively assayed in maternal sera, and childhood autism in a large national birth cohort with an extensive serum biobank. Other strengths of the cohort included nearly complete ascertainment of pregnancies in Finland (N=1.2 million) over the study period and national psychiatric registries consisting of virtually all treated autism cases in the population. Increasing maternal CRP levels, classified as a continuous variable, were significantly associated with autism in offspring. For maternal CRP levels in the highest quintile, compared with the lowest quintile, there was a significant, 43% elevated risk. This finding suggests that maternal inflammation may have a significant role in autism, with possible implications for identifying preventive strategies and pathogenic mechanisms in autism and other neurodevelopmental disorders.
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- Findingown data
Maternal CRP in the highest decile (>9.55 mg/dl) compared with the lowest decile (0.10-0.57 mg/dl) was associated with an 80% increased risk of childhood autism (OR=1.80, 95% CI 1.09-2.97, p=.02).
“We observed an 80% increase in risk of childhood autism following exposure to elevated maternal CRP, defined a priori as a CRP level in the highest decile (>9.55 mg/dl), compared to the lowest decile (0.10–0.57 mg/dl) (OR=1.80, 95% CI=1.09–2.97, p=.02).”
Quote in the paperSubstantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Findingown data
There was no statistical evidence of interaction between maternal CRP and sex on autism risk (p=0.50).
“There was no statistical evidence of interaction between maternal CRP and sex on the relationship with autism (p=0.50).”
Quote in the paperNot a substantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Findingown data
In analyses stratified by mental retardation status, highest versus lowest quintile maternal CRP was associated with childhood autism similarly for cases with MR (OR=1.43, 95% CI 1.02-2.01, p=0.16) and without MR (OR=1.41, 95% CI 0.96-2.08, p=0.08).
“For maternal CRP measured as a categorical variable (highest quintile versus lowest quintile), the findings were also similar between cases with (OR=1.43, 95% CI=1.02–2.01, p=0.16) and without (OR=1.41, 95% CI=0.96–2.08, p=0.08) MR.”
Quote in the paperNot a substantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Findingown data
After adjustment for maternal lifetime depression, the associations for highest versus lowest quintile (OR=1.41, 95% CI 1.00-1.98, p=.049) and highest versus lowest decile (OR=1.79, 95% CI 1.08-2.97, p=.023) were essentially unchanged.
“The findings were also essentially unchanged adjusting for maternal lifetime depression in both the quintile and decile analysis (quintile: OR=1.41, 95% CI=1.00–1.98, p=.049; 1.79, 95% CI=1.08–2.97, p=.023).”
- Also stated in: § Discussion · plain
“However, the associations were essentially unchanged after adjustment for maternal lifetime depression”
Quote in the paperSubstantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Also stated in: § Discussion · plain
- Findingown data
In analyses stratified by mental retardation status, continuous maternal CRP was associated with childhood autism similarly for cases with MR (OR=1.17, 95% CI 0.94-1.45, p=0.17) and without MR (OR=1.11, 95% CI 0.99-1.25, p=0.06).
“For maternal CRP measured as a continuous variable in relation to childhood autism, the relationships were similar for cases with mental retardation (MR) (OR=1.17, 95% CI=0.94–1.45, p=0.17) and without MR (OR=1.11, 95% CI=0.99–1.25, p=0.06).”
Quote in the paperNot a substantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Findingown data
Maternal CRP in the highest quintile (>5.84 mg/dl) compared with the lowest quintile (0.10-0.92 mg/dl) was associated with a 43% increased risk of childhood autism (OR=1.43, 95% CI 1.02-2.01, p=.039).
“For maternal CRP levels in the highest quintile, compared to the lowest quintile, there was a significant, 43% elevated risk.”
- Also stated in: § CRP as a categorical variable · plain
“There was a greater than 40% increase in risk of childhood autism following exposure to elevated maternal CRP, defined a priori as a CRP level in the highest quintile (>5.84 mg/dl), compared to maternal CRP in the lowest quintile (0.10–0.92 mg/dl) (OR=1.43, 95% CI=1.02–2.01, p=.039).”
Quote in the paperSubstantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Also stated in: § CRP as a categorical variable · plain
- Findingown data
In the FiPS-A nested case-control sample, higher maternal CRP measured as a continuous variable was associated with increased odds of childhood autism in offspring (OR=1.12, 95% CI 1.02-1.24, p=0.02).
“Increasing maternal CRP levels, classified as a continuous variable, were significantly associated with autism in offspring.”
- Also stated in: § CRP as a continuous variable · plain
“The analysis revealed a significant association between increasing maternal CRP and risk of autism (OR=1.12, 95% CI=1.02–1.24, p=0.02).”
Quote in the paperSubstantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
- Also stated in: § CRP as a continuous variable · plain
- Interpretationcitation
The results are consistent with findings from a previous national registry-based study that demonstrated associations between hospitalizations for infections during pregnancy and ASD.
“Our results are consistent with findings from a previous national registry-based study, which demonstrated associations between hospitalizations for infections during pregnancy and ASD18.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] Atladottir HO, Thorsen P, Ostergaard L, Schendel DE, Lemcke S, Abdallah M et al. Maternal infection requiring hospitalization during pregnancy and autism spectrum disorders. J Autism Dev Disord 2010; 40: 1423–1430. source
Not checked in the free run.
- Premisecitation
Prenatal infection and immune dysfunction are biologically plausible potential causes of autism.
“Prenatal infection and immune dysfunction are biologically plausible potential causes of autism7, 8.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [7] Patterson PH . Immune involvement in schizophrenia and autism: Etiology, pathology, and animal models. Behav Brain Res 2009; 204: 313–321. source
Not checked in the free run.
- cites [8] Patterson PH . Maternal infection and immune involvement in autism. Trends Mol Med 2011; 17: 389–394. source
Not checked in the free run.
- Study design and conductnone given
This potential misclassification is unlikely to have had an appreciable effect on the results.
“However, this is unlikely to have had an appreciable effect on the results.”
Quote in the paperNot a substantial claim - Study design and conductown data
There was no evidence of confounding following extensive testing of many covariates.
“although there was no evidence of confounding following extensive testing of many covariates”
Quote in the paperSubstantial claim - Interpretationown data
The similar magnitudes of association between maternal CRP and childhood autism in the supplemental analysis stratified by concurrent mental retardation suggest that this relationship is not accounted for by this developmental disorder.
“The similar magnitudes of association between maternal CRP and childhood autism in the supplemental analysis stratified by concurrent mental retardation suggests that this relationship is not accounted for by this developmental disorder.”
Quote in the paperNot a substantial claim - Study design and conductown data
Among 80 cases of infantile autism from the Finnish Hospital and Outpatient Discharge Registry assessed with the ADI-R, 77 (96%) met criteria for childhood autism.
“In order to validate the registry diagnoses, 80 cases of infantile autism from the Finnish Hospital and Outpatient Discharge Registry were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Among these cases, 77 (96%) met the criteria for childhood autism by the ADI-R23.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Lampi KM, Sourander A, Gissler M, Niemela S, Rehnstrom K, Pulkkinen E et al. Brief report: validity of Finnish registry-based diagnoses of autism with the ADI-R. Acta Paediatr 2010; 99: 1425–1428. source
Not checked in the free run.
- Study design and conductown data
The 677 included childhood autism cases did not differ from the 455 excluded cases on maternal age, paternal age, sex, previous number of births, maternal socioeconomic status, gestational age, or birthweight (p values 0.11-0.91).
“These cases did not differ from the 455 cases that were not included on maternal age (p=0.78), paternal age (p=0.31), sex (p=0.11), previous numbers of births (p=0.41), maternal socioeconomic status (p=0.91), gestational age (p=0.38), or birthweight (p=0.37).”
Quote in the paperNot a substantial claim - Premisecitation
There is substantial evidence that the immune response alters the development of the CNS during fetal life.
“There is substantial evidence that the immune response alters the development of the CNS during fetal life8, 9”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Patterson PH . Maternal infection and immune involvement in autism. Trends Mol Med 2011; 17: 389–394. source
Not checked in the free run.
- cites [9] Ashwood P, Willis S, van de Water J . The immune response in autism: a new frontier for autism research. J Leukoc Biol 2006; 80: 1–15. source
Not checked in the free run.
- May combine two claims. 12
- Classified as probably not a substantial claim. 16
May combine two claims.
Findingown dataIn sex-stratified analyses, maternal CRP was associated with autism in males (OR=1.10, 95% CI 0.98-1.24, p=0.09) and females (OR=1.20, 95% CI 0.97-1.49, p=0.10), with neither association statistically significant.
“There were associations between maternal CRP and risk of autism in both sexes, with a numerically greater association for females, but the findings fell short of statistical significance (males: OR=1.10, 95% CI=0.98–1.24, p=0.09; females: OR=1.20, 95% CI=0.97–1.49, p=0.10).”
Quote in the paperNot a substantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
May combine two claims.
Findingown dataAfter adjustment for number of previous births and gestational week of blood draw, the associations for highest versus lowest quintile (OR=1.46, 95% CI 1.01-2.11, p=.045) and highest versus lowest decile (OR=1.83, 95% CI 1.06-3.17, p=.03) remained significant.
“The findings were not altered appreciably following adjustment for number of previous births and gestational week of the blood draw (highest versus lowest quintile: OR=1.46, 95% CI=1.01–2.11, p=.045; highest versus lowest decile: OR=1.83, 95% CI=1.06–3.17, p=.03).”
Quote in the paperSubstantial claim- Rests on an assumption: Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
- Rests on an assumption: Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
- Rests on an assumption: Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
- Rests on an assumption: CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
- Rests on an assumption: The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
Probably not a substantial claim: may not pass S3 (load-bearing).
Findingown dataThe median age of onset in the sample was 4 years.
“Third, given that the median age of onset in the sample was 4 years”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe finding suggests that maternal inflammation may play a significant role in autism, with possible implications for identifying preventive strategies and pathogenic mechanisms in autism and other neurodevelopmental disorders.
“This finding suggests that maternal inflammation may play a significant role in autism, with possible implications for identifying preventive strategies and pathogenic mechanisms in autism and other neurodevelopmental disorders.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
InterpretationreasoningElevated maternal CRP may represent a common pathway by which infections and other inflammatory insults elevate risk for autism.
“Elevated maternal CRP may represent a common pathway by which infections and other inflammatory insults elevate risk for autism.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductreasoningThe cases and controls were derived from a large, population-based national birth cohort that included all childhood autism cases diagnosed in Finland through psychiatric registries covering the entire population, indicating minimal potential for selection bias.
“Second, the cases and controls were derived from a large, population-based national birth cohort including all childhood autism cases diagnosed in Finland through psychiatric registries which cover the entire population. This indicates that the potential for selection bias was minimal.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).
InterpretationreasoningThese findings may have important implications for prevention, given that many standard approaches already exist to reduce the incidence of infections.
“These findings may also have important implications for prevention, given that many standard approaches already exist to reduce the incidence of infections.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductnone givenThe diagnoses were restricted to the childhood autism subtype and were validated by directly administered ADI-R interviews.
“Third, the diagnoses were restricted to the childhood autism subtype, and were validated by directly administered ADI-R interviews.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe sample size of the present study was substantially larger than the previously cited studies on prenatal cytokines and autism.
“Finally, the sample size of the present study was substantially larger than the previously cited studies on prenatal cytokines and autism.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Study design and conductnone givenMaternal depression may have confounded the findings.
“Finally, the possibility that maternal depression may have confounded the findings should be considered.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductreasoningThe study sought to test a single hypothesis related to a single exposure, so multiple comparison issues do not arise.
“First, we sought to test a single hypothesis, related to a single exposure, so multiple comparison issues do not arise.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe CRP assay had between-series precision (coefficient of variation) of 5.1% ± 2.3%, systematic error (bias) of −2.7% ± 7.4, and sensitivity of 0.10 mg/dL.
“During the course of the study, the precision between series expressed as the coefficient of variation (mean ± SD) was 5.1% ± 2.3% and the systematic error (bias) (mean ± SD) was −2.7% ± 7.4. Assay sensitivity is 0.10 mg/dL.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataNo covariate met the a priori criteria for confounding; specifically, no covariate was associated with both maternal CRP level and childhood autism.
“None of the covariates met the a priori criteria for confounding, which are based on standard epidemiologic texts (see “Methods”)24–26. Specifically, no covariate was associated with both maternal CRP level and childhood autism.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationown dataThese findings, if replicated, may have important implications for elaborating the role of immune system dysfunction in autism.
“These findings, if replicated, may have important implications for elaborating the role of immune system dysfunction in autism.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenResidual confounding by unmeasured factors is possible.
“there is the possibility of residual confounding by unmeasured factors”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenCRP measurements were carried out blind to case/control status.
“CRP measurements were carried out blind to case/control status.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
InterpretationcitationElevated maternal CRP may not be specific to childhood autism among developmental disorders.
“Second, elevated maternal CRP may not be specific to childhood autism among developmental disorders.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [15] Goines PE, Croen LA, Braunschweig D, Yoshida CK, Grether J, Hansen R et al. Increased midgestational IFN-γ, IL-4 and IL-5 in women bearing a child with autism: A case-control study. Mol Autism 2011; 2: 13. source
Not checked in the free run.
- cites [16] Abdallah MW, Larsen N, Grove J, Norgaard-Pedersen B, Thorsen P, Mortensen EL et al. Amniotic fluid inflammatory cytokines: potential markers of immunologic dysfunction in autism spectrum disorders. World J Biol Psychiatry 2011 epub ahead of print. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningA small proportion of cases who later developed autism may have been misclassified as controls because the most recently born subjects would not have been followed up through a portion of the period of risk.
“Third, given that the median age of onset in the sample was 4 years, a small proportion of cases who later developed autism may have been misclassified as controls, since the most recently born subjects would not have been followed up through a portion of the period of risk.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationCRP is an acute-phase reactant and an established marker of low-grade inflammation from infectious and non-infectious exposures, and may become substantially elevated during acute infection chiefly by IL-6 secretion.
“C-reactive protein (CRP) is an acute-phase reactant which is a well-established marker of low-grade inflammation from both infectious and non-infectious exposures but which may also become substantially elevated during acute infection, chiefly by secretion of interleukin-6 (IL-6)21.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [21] Gabay C, Kushner I . Acute-phase proteins and other systemic response to inflammation. N Engl J Med 1999; 340: 448–454. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationCumulative, rather than current, depressive episodes were previously related to peripheral CRP.
“cumulative, rather than current, depressive episodes were previously related to peripheral CRP50.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [50] Copeland WE, Shanahan L, Worthman C, Angold A, Costello EJ . Cumulative depression episodes predict later c-reactive protein levels: a prospective analysis. Biol Psychiatry 2012; 71: 15–21. source
Not checked in the free run.
May combine two claims.
PremisecitationAccording to a meta-analysis, the relationship between CRP and depression in women was weak (d=0.14) and not statistically significant (p<.08).
“In addition, according to a meta-analysis, the relationship between CRP and depression in women was weak (d=0.14) and not statistically significant (p<.08)29.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [29] Howren MB, Lamkin DM, Suls J . Association of depression with C-reactive protein, Il-1, and Il-6: a meta-analysis. Psychosom Med 2009; 71: 171–186. source
Not checked in the free run.
May combine two claims.
PremisecitationUse of serotonin reuptake inhibitors, which have been related to autism when taken during pregnancy, were not associated with CRP levels.
“Furthermore, use of serotonin reuptake inhibitors, which have been related to autism when taken during pregnancy51 were not associated with CRP levels52.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [51] Croen LA, Grether JK, Yoshida CK, Odouli R, Hendrick V . Antidepressant use during pregnancy and childhood autism spectrum disorder. Arch Gen Psychiatry 2011; 68: 1104–1112. source
Not checked in the free run.
- cites [52] Hamer M, Batty GD, Marmot MG, Singh-Manoux A, Kivimaki M . Anti-depressant medication use and C-reactive protein: results from two population-based studies. Brain Behav Immu 2011; 25: 168–173. source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationCRP levels are markedly increased following infection, and these increases are induced by IL-6 and other cytokines.
“it is well-established that CRP levels are markedly increased following infection, and these increases are induced by IL-6 and other cytokines21.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [21] Gabay C, Kushner I . Acute-phase proteins and other systemic response to inflammation. N Engl J Med 1999; 340: 448–454. source
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationMaternal inflammation may represent a pathway by which infectious and other insults may give rise to neurodevelopmental disorders.
“it has been proposed that maternal inflammation may represent a pathway by which infectious and other insults may give rise to neurodevelopmental disorders8, 10.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [8] Patterson PH . Maternal infection and immune involvement in autism. Trends Mol Med 2011; 17: 389–394. source
Not checked in the free run.
- cites [10] Brown AS, Derkits EJ . Prenatal infection and schizophrenia: a review of epidemiologic and translational studies. Am J Psychiatry 2010; 167: 261–280. source
Not checked in the free run.
The paper relies on this without support.
Maternal CRP measured in archived serum samples drawn in early pregnancy reflects the relevant inflammatory exposure for fetal neurodevelopment.
“Sera are drawn during the first and early second trimesters from over 98% of pregnant women in Finland”
“One maternal serum sample is obtained for each pregnancy.”
The paper relies on this without support.
Registry-based diagnoses of childhood autism in the full sample are accurate enough to classify cases and controls.
“In order to validate the registry diagnoses, 80 cases of infantile autism from the Finnish Hospital and Outpatient Discharge Registry were assessed using the Autism Diagnostic Interview-Revised (ADI-R).”
The paper relies on this without support.
Controls without ASD or severe/profound mental retardation on registry are free of childhood autism.
“The childhood autism cases were matched 1:1 to controls drawn from the birth cohort who were without ASD or severe/profound mental retardation on date of birth, sex, birthplace, and residence in Finland.”
The paper relies on this without support.
CRP levels in stored serum remain stable and valid over long-term storage at −25°C.
“After the screening, serum samples are stored as one aliquot at −25°C in a single, centralized biorepository at the National Institute of Health and Welfare (THL) in Oulu, Finland.”
The paper relies on this without support.
The timing of the maternal blood draw (first/early second trimester) captures the etiologically relevant period for autism risk.
“Sera are drawn during the first and early second trimesters from over 98% of pregnant women in Finland”
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 autism and schizophrenia in the offspring.
“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 [147]
The Results and Discussion report an association between elevated maternal CRP during pregnancy and autism in offspring. The paper does not report an association between maternal CRP and offspring schizophrenia; its Introduction mentions other maternal cytokines in connection with schizophrenia. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMaternal immune activation is associated with ASD risk.
“While mounting evidence points to the role of maternal immune activation in ASD risk,”
From The contribution of environmental exposure to the etiology of autism spectrum disorder (2019) · cites this paper as [102]
The link between MIA and enhanced risk for ASD is bolstered by large-scale population-based studies showing small but significantly increased risk due to maternal prenatal infections.
“The link between MIA and enhanced risk for ASD is bolstered by large-scale population-based studies showing small but significantly increased risk due to maternal prenatal infections [117–122].”
From The ASD Living Biology: from cell proliferation to clinical phenotype (2019) · cites this paper as [122]
Brown et al. found an association between autism and elevated early gestational maternal C-reactive protein in Finnish children.
“an earlier investigation of Finnish children that showed an association between autism and elevated early gestational maternal C-reactive protein”
From The Role of the Immune System in Autism Spectrum Disorder (2017) · cites this paper as Brown et al, 2014
Maternal immune activation (MIA) via infection during pregnancy increases risk for autism spectrum disorder (ASD).
“Maternal immune activation (MIA) via infection during pregnancy is known to increase risk for autism spectrum disorder (ASD).”
From Maternal immune activation dysregulation of the fetal brain transcriptome and relevance to the pathophysiology of autism spectrum disorder (2018) · cites this paper as [24]
Infections during pregnancy are correlated with increased frequency of neurodevelopmental disorders in offspring.
“Prior literature has substantiated that infections during pregnancy have been correlated with increased frequency of neurodevelopmental disorders in offspring [16, 17, 76–78].”
From Gut microbiota changes in children with autism spectrum disorder: a systematic review (2020) · cites this paper as [17]
There is an association between ASD and maternal infection requiring hospitalization during pregnancy.
“Specifically, there is an association between ASD and maternal infection requiring hospitalization during pregnancy, elevated C-reactive protein, and a family history of autoimmune diseases.”
From Gut microbiota changes in children with autism spectrum disorder: a systematic review (2020) · cites this paper as [17]
There is an association between ASD and elevated C-reactive protein.
“Specifically, there is an association between ASD and maternal infection requiring hospitalization during pregnancy, elevated C-reactive protein, and a family history of autoimmune diseases.”
From Gut microbiota changes in children with autism spectrum disorder: a systematic review (2020) · cites this paper as [17]
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A structural approach to selection bias
Hernán, M. A., Hernández-Díaz, S., & Robins, J. M. (2004) · Epidemiology · doi:10.1097/01.ede.0000135174.63482.43 · Cited by 2,844 · see citing works
Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis.
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- Authors
- Brown, A. S., Sourander, A., Hinkka-Yli-Salomäki, S., McKeague, I. W., Sundvall, J., & Surcel, H.-M.
- Affiliations
- New York State Psychiatric Institute (US)
- University of Turku (FI)
- Columbia University (US)
- Finnish Institute for Health and Welfare (FI)
- Corresponding author
- Brown, A S
- Venue
- Molecular Psychiatry
- Published
- 2013-01-22
- Volume
- 19
- Issue
- 2
- Pages
- 259-264
- ISSN
- 1359-4184 (ISSN-L)
- 1476-5578
- PMC
- PMC3633612
- OpenAlex
- W2048843644
- Cited by
- 343
- References
- 52
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 30 · 2023: 28 · 2022: 37 · 2021: 25 · 2020: 26 · 2019: 24 · 2018: 40 · 2017: 19 · 2016: 35 · 2015: 18 · 2014: 20 · 2013: 12
- FWCI
- 15.26
- Type
- journal article
- Language
- en
- Update notices
- correction (2025-09-15)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Molecular Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- STM:n Hallinnonalan avoin julkaisuarkisto (Julkari) (submittedVersion)
- Funders
- National Institute of Mental Health (K02MH065422)
- National Institute of Environmental Health Sciences (R01ES019004)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- 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
- Keywords
- autism spectrum disorder, C-reactive protein, maternal inflammation, pregnancy, prenatal infection, neurodevelopmental disorders, autism risk, maternal serum biomarkers, birth cohort
- MeSH terms
- Adult, Autistic Disorder, C-Reactive Protein, Female, Finland, Humans, Inflammation, Male, Intellectual Disability, Pregnancy, Pregnancy Complications, Registries, Risk, Sex Factors, Cohort Studies, Case-Control Studies
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.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.
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 ›
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