The Association Between Prenatal Infection and Adolescent Behavior: Investigating Multiple Prenatal, Perinatal, and Childhood Second Hits

Anna Suleri, Tonya White, Elisabet Blok, Charlotte A.M. Cecil, Irwin Reiss, Vincent W.V. Jaddoe, F. A.J. Gigase, Manon H.J. Hillegers, Lot de Witte, Veerle Bergink, Anna Sophie Rommel

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: Exposure to infections during pregnancy may be a potential risk factor for later psychopathology, but large-scale epidemiological studies investigating associations between prenatal infection and long-term offspring behavioral problems in the general population are scarce. In our study, we aimed to investigate the following: (1) the association between prenatal infection and adolescent behavior, (2) putative underlying pathways (mediation), and (3) “second hits” interacting with prenatal infection to increase the risk of adolescent behavior problems (moderation). Method: Our study was embedded in a prospective Dutch pregnancy cohort (Generation R; n = 2,213 mother−child dyads). We constructed a comprehensive prenatal infection score comprising common infections for each trimester of pregnancy. At age 13 to 16 years, we assessed total, internalizing, and externalizing problems, and autistic traits using the Child Behavioral Checklist and the Social Responsiveness Scale, respectively. We investigated maternal lifestyle and nutrition, perinatal factors (placental health and delivery outcomes), and child health (lifestyle, traumatic events, infections) as mediators and moderators. Results: We observed associations of prenatal infection with adolescent total behavioral, internalizing, and externalizing problems. The association between prenatal infection and internalizing problems was moderated by higher levels of maternal psychopathology, alcohol and tobacco use, and a higher number of traumatic childhood events. We found no association between prenatal infection and autistic traits. Yet, children exposed to prenatal infections and maternal substance use, and/or traumatic childhood events, had a higher risk of autistic traits in adolescence. Conclusion: Prenatal infection may be a risk factor for later psychiatric problems as well as a disease primer making individuals susceptible to other hits later in life. Study preregistration information: Prenatal maternal infection and adverse neurodevelopment: a structural equation modelling approach to downstream environmental hits;; cp85a. Diversity & Inclusion Statement: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants.

Original languageEnglish
Pages (from-to)1340-1350
Number of pages11
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number12
StatePublished - Dec 2023


  • child health
  • maternal health
  • maternal immune activation
  • neurodevelopment
  • pregnancy


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