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Open Access Research article

Prenatal risk factors for Tourette Syndrome: a systematic review

Ting-Kuang Chao1, Jing Hu2 and Tamara Pringsheim23*

Author Affiliations

1 Department of Medicine, University of Alberta, Alberta, Canada

2 Department of Clinical Neurosciences, University of Calgary, Calgary, Canada

3 Alberta Children’s Hospital, C4-431, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada

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BMC Pregnancy and Childbirth 2014, 14:53  doi:10.1186/1471-2393-14-53

Published: 30 January 2014

Abstract

Background

Tourette Syndrome (TS) appears to be an inherited disorder, although genetic abnormalities have been identified in less than 1% of patients, and the mode of inheritance is uncertain. Many studies have investigated environmental factors that might contribute to the onset and severity of tics and associated comorbidities such as obsessive compulsive disorder (OCD) and attention deficit hyperactive disorder (ADHD). A systematic review and qualitative analysis were performed to provide a broad view of the association between pre- and perinatal factors and TS.

Methods

The Medline, Embase and PsycINFO databases were searched using terms specific to Tourette’s syndrome and keywords such as “pregnancy”, “prenatal”, “perinatal”, “birth” and “neonatal”. Studies were limited to studies on human subjects published in English or French through October 2012.

Results

22 studies were included. Studies were of limited methodological quality, with most samples derived from specialty clinics, and most exposures ascertained retrospectively. The majority of the results for demographic factors of parents, including age, education, socioeconomic status, and marital status, revealed no significant association with the onset of TS, or the presence of comorbidity. Many factors were reported to be significantly associated with the onset of TS, the presence of comorbidity and symptom severity, but the most consistently reported factors were maternal smoking and low birth weight.

Conclusions

There are few studies evaluating the relationship between pre and perinatal events and TS, and existing studies have major limitations, including the use of clinic rather than epidemiologically derived samples, retrospective data collection on pre and perinatal events and multiple hypothesis testing without appropriate statistical correction. The mechanism by which prenatal and perinatal adversities could lead to TS onset or symptom severity is unknown, but may be related to changes in the dopaminergic system as a result of early brain injury.

Keywords:
Tourette syndrome; Tic disorders; Prenatal morbidity; Risk factors