Prenatal Risk Factors for Tourette Syndrome: a Systematic Review Update
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TOURETTE’S SYNDROME (E RICKETTS AND M YADEGAR, SECTION EDITORS)
Prenatal Risk Factors for Tourette Syndrome: a Systematic Review Update Joseph Girgis 1 & Tamara Pringsheim 2,3,4,5 Accepted: 24 September 2020 # Springer Nature Switzerland AG 2020
Abstract Purpose of Review Tourette’s syndrome (TS), a neurodevelopmental disorder characterized by persistent motor and vocal tics, is understood to be a genetic disorder with a complex pattern of inheritance and a high degree of heritability. Nonetheless, adversity during pregnancy and early life has been associated with the onset of TS. Understanding these associations may reveal more about the pathogenesis and disease processes of TS. Recent Findings All of the studies included in the review found at least one association between a peri-/prenatal risk factor and TS, although inconsistencies were present. Maternal prenatal smoking, low birth weight, and nulliparity were the only risk factors found in multiple studies. Summary Nulliparity has emerged as a novel risk factor for TS. Prenatal maternal smoking was found to be associated with TS with comorbid ADHD, rather than pure TS. Additional evidence was found to support the relationship between lower birth weight and TS. Keywords Tourette syndrome . Prenatal . Perinatal . Environmental risk factors
Introduction Tourette’s syndrome (TS) is a neurodevelopmental disorder which is characterized by persistent motor and vocal tics. It begins in childhood and often attenuates in late adolescence [1]. TS is highly heritable with complex patterns of inheritance, as genetic studies have identified a wide array of genes that may contribute to its pathogenesis [2]. Environmental
This article is part of the Topical Collection on Tourette’s Syndrome * Tamara Pringsheim [email protected] 1
Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
2
Department of Clinical Neurosciences and Pediatrics, University of Calgary, Calgary, Alberta, Canada
3
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
4
Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
5
Mathison Centre for Mental Health Research & Education, 3280 Hospital Drive NW, Calgary, AB T2N4Z6, Canada
factors, especially in the prenatal/perinatal period, have also been implicated in the development of TS [3]. A previous systematic review that analyzed studies on the association between pre-/perinatal adversities and TS identified 21 manuscripts published before 2012 [3]. Many potential associations were noted; however, the strongest evidence of an association with TS was among various prenatal factors, in comparison with the perinatal factors which had weaker evidence. Prenatal maternal smoking was found to be significantly associated with TS in many studies and had stronger associations with TS with comorbid ADHD. Of all the factors studied, prenatal maternal smoking and low birth weight had the strongest evidence for an association with TS, although there were inc
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