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AIMS: Prenatal exposure to severe famine has been associated with an increased risk of schizophrenia and affective disorders. We studied the relationship between prenatal exposure to famine during the Dutch hunger winter of 1944-45 and addiction later in life. DESIGN: A case-control study. SETTING: The Rotterdam city area during the Dutch hunger winter lasting from mid-October 1944 to mid-May 1945. From February 1945 to mid-May 1945 the hunger winter was characterized by a famine peak. PARTICIPANTS: Patients are native Dutch addicted patients from the Rotterdam Addiction Treatment Program and controls are native Dutch inhabitants of Rotterdam, born between 1944 and 1947. MEASUREMENT: Exposure to the whole hunger winter (< 1400 kcal/day) and the peak of the hunger winter (< 1000 kcal/day) was determined for each trimester of gestation. For each trimester the exposed/unexposed ratios were compared between patients and controls and quantified as odds ratios (OR). FINDINGS: The odds of first-trimester gestational exposure to famine during the total hunger winter was significantly higher among patients receiving treatment for an addictive disorder [OR = 1.34, 95% confidence interval (CI) 1.10-1.64]. Stratification by sex shows that the odds of exposure during the first trimester was significantly higher only among men (OR = 1.34, 95% CI 1.05-1.72), but not among women (OR = 1.26, 95% CI 0.88-1.81). The odds of exposure to the peak of the hunger winter during the first trimester of gestation were also significantly higher among addiction treatment patients (OR = 1.61, 95% CI 1.22-2.12). We did not find any significant differences for the second and third trimesters of gestation. CONCLUSION: First-trimester prenatal exposure to famine appears to be associated with addiction later in life. The study confirms the adverse influence of severe malnutrition on brain development and maturation, confirms the influence of perinatal insults on mental health in later life and gives rise to great concern about the possible future consequences for the hunger regions in our world.

Original publication




Journal article



Publication Date





433 - 438


Case-Control Studies, Female, Humans, Male, Middle Aged, Netherlands, Pregnancy, Pregnancy Trimesters, Prenatal Exposure Delayed Effects, Prenatal Nutritional Physiological Phenomena, Seasons, Sex Factors, Starvation, Substance-Related Disorders