Birth weight and later risk of depression in a national birth cohort

Preterm birth and psychiatric medication prescription in young adulthood: a Swedish national cohort study

BACKGROUND

Recent studies suggest an increased risk of adverse mental health outcomes among young adults who were born preterm. These studies have been based mainly on hospital data, thus missing large numbers of mental health problems that do not require inpatient treatment. We used national outpatient and inpatient pharmacy data to evaluate whether individuals who were born preterm were more likely to be prescribed psychiatric medications during young adulthood than individuals who were born full term.

METHODS

A national cohort of all infants born in Sweden from 1973 through 1979 [N = 635,933, including 28,799 who were born preterm (<37 weeks)] was followed to ages 25.5-34.0 years to determine whether psychotropic medications (antidepressants, antipsychotics, anxiolytics, hypnotics/sedatives and/or psychostimulants) were prescribed in 2005-06.

RESULTS

A trend of increasing rate of prescriptions for antipsychotics, antidepressants and hypnotics/sedatives in young adulthood was observed by earlier gestational age at birth. Young adults who were extremely preterm at birth (23-27 weeks) were 3.1 times more likely to be prescribed antipsychotics [95% confidence interval (CI) 1.66-5.93], 1.8 times more likely to be prescribed antidepressants (95% CI 1.26-2.64) and 1.8 times more likely to be prescribed hypnotics/sedatives (95% CI 1.15-2.96) than individuals who were full term at birth, after adjusting for potential confounders.

CONCLUSIONS

This national cohort study, using outpatient and inpatient pharmacy data, suggests that preterm birth has important independent effects on mental health that extend at least into young adulthood.

Diethylstilbestrol exposure in utero and depression in women

Diethylstilbestrol (DES) is an estrogenic endocrine disruptor with long-term health effects, possibly including depression, following exposure in utero. Understanding the relation between in utero DES exposure and depression will provide insight to the potential adverse effects of bisphenol A, a functionally similar and ubiquitous endocrine disruptor. The association between in utero DES exposure and depression was assessed among participants in the Nurses' Health Study II who first reported their history of antidepressant use in 1993 and lifetime history of depressive symptoms in 2001. DES exposure was reported by 1,612 (2.2%) women. A history of depression at baseline was higher among women exposed to DES in utero compared with those not exposed (age-adjusted odds ratio (OR) = 1.47, 95% confidence interval (CI): 1.26, 1.72) (P < 0.001). Incident depression (first use of antidepressants among women who also reported depressive symptoms) during follow-up (1995-2005) was reported by 19.7% of women exposed to DES and 15.9% unexposed (age-adjusted OR = 1.41, 95% CI: 1.22, 1.63) (P < 0.001). Adjustment for risk factors of depression and correlates of DES exposure moderately attenuated the association (multivariable-adjusted OR = 1.30, 95% CI: 1.13, 1.51) (P = 0.0004). These results suggest that the neurophysiologic effects of in utero exposure to DES could lead to an increased risk of depression in adult life. Further research should assess whether in utero exposure to bisphenol A has similar adverse effects.

Children of addicted women

The purpose of this article was to review follow up studies of children with prenatal drug exposure from preschool through adolescence. Specifically, the authors focus on the effects of prenatal exposure to cocaine, methamphetamine, and opiates on behavior and development. The largest number of studies have examined cocaine-exposed children. The authors identified 42 studies that suggest that there are unique effects of prenatal cocaine exposure on 4- to 13-year-old children, particularly in the areas of behavior problems, attention, language, and cognition. In addition, studies make reasonable attempts to control for possible confounding factors. Systematic research on the long-term effects of prenatal methamphetamine exposure is just beginning but seems to be showing similar effects to that of cocaine. The literature on the on the long-term effects of children with prenatal opiate exposure is more substantial than the methamphetamine literature but it is still relatively sparse and surprising in that there is little recent work. Thus, there are no studies on the current concerns with opiates used for prescription mediation. There is a growing literature using neuroimaging techniques to study the effects of prenatal drug exposure that holds promise for understanding brain/behavior relationships. In addition to pharmacological and teratogenic effects, drugs can also be viewed from a prenatal stressor model. The author discuss this "fetal origins" approach that involves fetal programming and the neuroendocrine system and the potential implications for adolescent brain and behavioral development.

Prenatal stress during the 1999 bombing associated with lower birth weight-a study of 3,815 births from Belgrade

During the 3-month bombing of Serbia (March 24-June 9, 1999), the entire population, including pregnant females as an especially vulnerable group, was exposed to a high degree of stress. This is the first study to explore the effects of prenatal stress during the 1999 bombing of Belgrade on the main obstetric characteristics of newborns. The design of the study was retrospective cross-sectional. The total number of birth records in the sample was 3,815, namely, 1,198 from the group exposed to prenatal stress and 1,251 and 1,366 from the respective control periods, years 1996 and 2003, when no stressful events affected the city. We found that exposed mothers gave birth to infants with statistically significantly lower birth weight (BW; mean difference = 86 g, 95% confidence interval = 67 to 104; F ((1, 3,349)) = 80.8, p < 0.001, eta (p) (2) = 0.024), when controlling for confounding effects of body length and head circumference. There was no specific relation between the trimester of stress exposure and BW in infants born in 1999. Neither increased frequency of preterm deliveries nor more complications of pregnancy and delivery were found in the given sample. Possible consequences of lower BW on psychosocial and somatic functioning should be evaluated through the lifetime.

Downstream targets of homeobox gene HLX show altered expression in human idiopathic fetal growth restriction

Fetal growth restriction (FGR), a clinically significant pregnancy disorder, is poorly understood at the molecular level. This study investigates idiopathic FGR associated with placental insufficiency. Previously, we showed that the homeobox gene HLX is expressed in placental trophoblast cells and that HLX expression is significantly decreased in human idiopathic FGR. Here, we used the novel approach of identifying downstream targets of HLX in cell culture to detect potentially important genes involved in idiopathic FGR. Downstream targets were revealed by decreasing HLX expression in cultured trophoblast cells with HLX-specific small interfering RNAs to model human idiopathic FGR and comparing these levels with controls using a real-time PCR-based gene profiling system. Changes in candidate HLX target mRNA levels were verified in an independent trophoblast cell line, and candidate target gene expression was assessed in human idiopathic FGR-affected placentae (n = 25) compared with gestation-matched controls (n = 25). The downstream targets RB1 and MYC, cell cycle regulatory genes, showed significantly increased mRNA levels in FGR-affected tissues compared with gestation-matched controls, whereas CCNB1, ELK1, JUN, and CDKN1 showed significantly decreased mRNA levels (n = 25, P < 0.001, t-test). The changes for RB1 and CDKN1C were verified by Western blot analysis in FGR-affected placentae compared with gestation-matched controls (n = 6). We conclude that cell cycle regulatory genes RB1, MYC, CCNB1, ELK1, JUN, and CDKN1C, which control important trophoblast cell functions, are targets of HLX.

Fetal origins of mental health: evidence and mechanisms

The concept of fetal programming states that changes in the fetal environment during sensitive periods of organ development may cause long-lasting changes in the structure and functioning of these organs later in life and influence the risk for chronic diseases such as coronary heart disease and type 2 diabetes. Fetal growth is a summary marker of the fetal environment and is reflected by relatively easy-to-obtain measures of size at birth such as birth weight. In the last two decades, a body of evidence emerged linking fetal growth with behavioural and mental health outcomes later in life. Cognitive functioning and behavioural problems in childhood, in particular inattention/hyperactivity, have been shown to be inversely related to fetal growth. Although results are mixed, risk for personality disorders and schizophrenia seems to be linked with fetal growth and adversity, while the evidence for mood disorders is weak. Vulnerability for psychopathology may also be influenced by prenatal adversity. There is evidence for associations of fetal growth with temperament in childhood as well as stress reactivity and distress. The associations of fetal growth with mental health later in life are potentially caused by specific prenatal factors such as maternal smoking, alcohol, toxins/drugs, nutrition, psychosocial stress and infection during pregnancy. The mechanisms likely involve changes in neurodevelopment and in the set point of neuroendocrine systems, and there is evidence that prenatal adversity interacts with genetic and postnatal environmental factors. Future studies should examine the effects of specific prenatal factors and attempt to disentangle genetic and prenatal environmental effects.

Fetal effects of psychoactive drugs

Psychoactive drug use by pregnant women has the potential to effect fetal development; the effects are often thought to be drug-specific and gestational age dependent. This article describes the effects of three drugs with similar molecular targets that involve monoaminergic transmitter systems: cocaine, methamphetamine, and selective serotonin re-uptake inhibitors (SSRIs) used to treat maternal depression during pregnancy. We propose a possible common epigenetic mechanism for their potential effects on the developing child. We suggest that exposure to these substances acts as a stressor that affects fetal programming, disrupts fetal placental monoamine transporter expression and alters neuroendocrine and neurotransmitter system development. We also discuss neurobehavioral techniques that may be useful in the early detection of the effects of in utero drug exposure.

Mechanisms of gene-environment interactions in depression: evidence that genes potentiate multiple sources of adversity

BACKGROUND

Previous work suggests that daily life stress-sensitivity may be an intermediary phenotype associated with both genetic risk for depression and developmental stress exposures. In the current analysis we hypothesized that genetic risk for depression and three environmental exposures over the course of development [prenatal stress, childhood adversity and adult negative life events (NLEs)] combine synergistically to produce the phenotype of stress-sensitivity.

METHOD

Twin pairs (n=279) participated in a momentary assessment study using the Experience Sampling Method (ESM), collecting appraisals of stress and negative affect (NA) in the flow of daily life. Prospective data on birthweight and gestational age, questionnaire data on childhood adversity and recent NLEs, and interview data on depression were used in the analyses. Daily life stress-sensitivity was modelled as the effect of ESM daily life stress appraisals on ESM NA.

RESULTS

All three developmental stress exposures were moderated by genetic vulnerability, modelled as dizygotic (DZ) or monozygotic (MZ) co-twin depression status, in their effect on daily life stress-sensitivity. Effects were much stronger in participants with MZ co-twin depression and a little stronger in participants with DZ co-twin depression status, compared to those without co-twin depression. NLE main effects and NLE genetic moderation were reducible to birthweight and childhood adversity.

CONCLUSIONS

The findings are consistent with the hypothesis that adult daily life stress-sensitivity is the result of sensitization processes initiated by developmental stress exposures. Genes associated with depression may act by accelerating the process of stress-induced sensitization.

The factors affecting pregnancy outcomes in the second trimester pregnant women

Adequate nutrient intake during pregnancy is important to fetal and maternal health. The purpose of this study was to investigate the factors affecting birth weight and gestational age and to provide basic data to promote more favorable pregnancy outcomes. Data were collected from 234 pregnant women at two hospitals in Seoul. Demographic characteristics, anthropometric measurements and health related habits were obtained using a questionnaire at the hospital visit during the second trimester. Dietary intakes were estimated by 24 hour recall at the hospital visit during the second trimester. Data on pregnancy outcomes, including birth weights and gestational ages, were obtained from hospital records after delivery. Birth weights were divided into a low birth weight group (birth weight<3.1 kg), a normal birth weight group (3.1-3.6 kg) and a high birth weight group (>3.6 kg). Gestational ages were divided into tertiles according to the gestational age of the subjects: group 1 (<38.53 weeks), group 2 (38.53-40.00 weeks) and group 3 (>40.00 weeks). The number of family members was significantly lower in the low birth weight group than in the normal birth weight group (p<0.05). In the low birth weight group, pregnancy weight was significantly lower than in the high birth weight group (p<0.05). Health related habits were not significantly different among any of the groups. Intakes of fiber, phosphorous, iron, vitamin B₆ and folic acid were significantly higher in the high birth weight group than the low birth weight group (p<0.05). Gestational age was not significantly affected by nutrient intakes, but birth weight was affected by nutrient intake in the results of this study. Therefore, the adequacy of nutrient intake is important for the improvement of pregnancy outcomes.

Low birthweight and subsequent emotional and behavioural outcomes in 12-year-old children in Soweto, South Africa: findings from Birth to Twenty

BACKGROUND

The fetal origins hypothesis suggests that an adverse prenatal environment, indexed by low birthweight (LBW), may increase the risk of developing later disease. Recently the hypothesis has been extended to psychological outcomes, especially depression. The aim of this analysis was to test, for the first time in a developing country setting, the association between LBW and psychological symptoms, in Soweto, South Africa.

METHODS

A sample of 1029 children was drawn from Birth to Twenty, a longitudinal cohort followed from pregnancy to young adulthood. This sample completed the Youth Self Report at age 12 years, a validated psychological measure of behavioural and emotional adjustment. Scores were compared between LBW (<2500 g) and normal birthweight children using multivariate analysis with adjustment for potential birth and life events confounding factors.

RESULTS

No associations were found between LBW and total [adjusted odds ratio (OR) 1.09, 95% confidence interval (CI) 0.69-1.74], internalizing (adjusted OR 0.81, 95% CI 0.52-1.28) or externalizing profiles (adjusted OR 0.81, 95% CI 0.49-1.36). The only difference detected was for the internalizing sub-profile of Somatic Complaints (adjusted OR 2.02, 95% CI 1.21-3.38), which on subgroup analysis was greatest among females.

CONCLUSIONS

We found no convincing evidence of an association between LBW and emotional and behavioural outcomes in 12-year olds in this sample in urban South Africa. To our knowledge, this is the first published assessment of this association in a developing world context.

Explaining educational inequalities in birthweight: the Generation R Study

Although low socio-economic status has consistently been associated with lower birthweight, little is known about the factors whereby socio-economic disadvantage influences birthweight. We therefore examined explanatory mechanisms that may underlie the association between the educational level of pregnant women, as an indicator of socio-economic status, and birthweight. The study was embedded within a population-based cohort study in the Netherlands. Information on maternal education, offspring's birthweight and several determinants of birthweight was available for 3546 pregnant women of Dutch origin. Infants of the lowest educated women had a statistically significantly lower birthweight than infants of the highest educated women [difference adjusted for gender and gestational age: -123 g (95% CI -167, -79)]. Parity, age of the pregnant women, hypertension, parental height and parental birthweight, marital status, pregnancy planning, financial concerns, number of people in household, weight gain and smoking habits individually explained part of the differences in birthweight, while adjustment for working hours and body mass index resulted in increases in birthweight differences between the educational levels. After full adjustment, the difference in birthweight between lowest and highest education was reduced by 66%. Our study confirmed remarkable educational inequalities in birthweight, a large part of which was explained by pregnancy characteristics, anthropometrics, the psychosocial and material situation, and lifestyle-related factors. Altering smoking habits may be an option to reduce educational differences in birthweight, as many lower-educated women tend to continue smoking during pregnancy. In order to tackle inequalities in birthweight, it is important that interventions are accessible for pregnant women in lower socio-economic strata.

Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort

OBJECTIVE

Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization.

METHOD

A population-based registry study of psychiatric hospitalization of in total 155,994 boys and 148,281 girls born in Sweden in 1973-1975.

RESULTS

The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49-3.21); at-term SGA boys (OR 1.55, 95% CI 1.34-1.79); at-term SGA girls (OR 1.31, 95% CI 1.15-1.50). At-term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18-2.45 and OR 1.49, 95% CI 1.14-1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16-9.41) and psychotic disorders (OR 4.36, 95% CI 1.85-10.30).

CONCLUSION

The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.

Effects of maternal prenatal stress on offspring development: a commentary

Pregnancy is associated with major physiological changes and adaptation to these changes is crucial for normal fetal development. Heightened emotional stress during pregnancy may interfere with the necessary adaptation and lead to dysregulation of the two major stress response systems: the Hypothalamic-Pituitary-Adrenal (HPA) Axis and the Autonomic Nervous System (ANS). Negative effects on the fetus of such maladaptation have been documented in both animals and humans and range from poor birth outcomes to negative impacts on neurodevelopment, as well as long term emotional and behavioural disturbances. Conversely, it has been hypothesized that low levels of maternal prenatal stress may actually have an adaptive value for the offspring. Investigation of these associations employing physiological markers and repeated measures throughout pregnancy and postpartum of both the mother and the offspring, is required in order to understand the various effects of prenatal stress on the development of the offspring. It is also crucial to explore the possibility of variable periods of vulnerability throughout gestation. The aim of this commentary is to reexamine the current literature on the ill-effects of maternal stress during pregnancy on the offspring and to explore avenues for future treatment and prevention.

Early environment and major depression in young adults: a longitudinal study

Post-natal incubator care represents an early specific environment that may affect the risk for major depression later in life. A subsample of 1212 young adults from the French-speaking general population of the region of Quebec were selected from an ongoing longitudinal study that started during their kindergarten years. Information on peri-natal condition, obstetrical complications and incubator care was collected by consulting hospital medical records. Participants were evaluated using DSM III-R based psychiatric assessment when they were 15 and 21 years old. Incubator care predicted an approximate two- to three-fold decreased risk for depressive disorder at age 21. Results from three different logistic models adjusting for family adversity and for maternal depression confirmed this relationship. Analyses were replicated for depression at age 15, showing the same association in female adolescents. This study suggests that post-natal incubator care may paradoxically decrease the occurrence of major depression later in life. This protective effect might be direct (through optimized biological, physiological and sensory parameters) or indirect (induction of specific parent-child interactions due to the perception of their infant's vulnerability). This study could enhance understanding of the links between early post-natal environment and affective disorders later in life.

Quantitative immunohistochemical analysis of nitric oxide synthases and apoptosis regulator proteins in the fetal rat brain following maternal uterine artery ligation

The purpose of this study was to determine the relation between nitric oxide synthases (calcium-independent iNOS and calcium-dependent eNOS) and apoptosis regulator proteins (anti-apoptotic Bcl-2, pro-apoptotic p53) of fetal rat brain in experimental intrauterine growth retardation (IUGR) model via quantitative immunohistochemistry. Cortical zone of parietal cerebral cortex and ventricular zone of third ventricle were studied following bilateral uterine artery ligation on gestational day 18. Significant increase in iNOS immunoreactivity was determined in parietal cerebral cortex and ventricular zones as eNOS immunoreactivity increased in ventricular zone of IUGR group. Bcl-2 expression was significantly decreased in ventricular zone; whereas cortical zone of IUGR group expressed p53 immunoreactivity.

Birth measures and depression at age 31 years: the Northern Finland 1966 Birth Cohort Study

The aim of the study was to explore whether there is an association between body size at birth measured by birth weight and ponderal index and later depression at the age of 31 years. The analyses were based on 4,007 males and 4,332 females born in 1966 in the two northernmost provinces of Finland with data on current depression measured by the Hopkins Symptom Checklist-25 questionnaire (HSCL-25) and self-reported physician-diagnosed lifetime depression at 31 years and childhood characteristics. The associations between birth measures and later depression were analysed with several confounding factors including maternal depression during pregnancy. Low birth measures did not associate with adult depression in men or women. Women with high birth weight (>or=4,500 g) had a higher risk for current depression compared to women with birth weight 3,000 g-3,499 g. Women with high ponderal index (the highest 90-95 percentiles and >or=95 percentiles) had a 1.53-1.55 higher likelihood for current depression compared with women with normal ponderal index. Based on this study, large body size at birth may be a risk factor for later depression.

Psychiatric disorder in young adults born very preterm: Role of family history

Objective

To investigate whether young adults born very preterm (VPT) (<33 weeks) are at increased risk for psychiatric illness in adulthood and whether a family history of psychiatric disorder further increases this risk.

Methods

We assessed 169 VPT and 101 term born individuals using the Clinical Interview Schedule – Revised.

Results

Young adults born VPT had an increased risk for psychiatric disorder compared to controls (OR = 3.1, 95% CI = 1.1–8.6, p = 0.03). Those born VPT who had a history of psychiatric disorder in a first-degree relative, had an increase in risk for psychiatric disorder compared to those born VPT without a family history (OR = 5.2, 95% CI = 1.8–14.9, p = 0.002).

Conclusion

Individuals born VPT are at increased risk of psychiatric illness in young adulthood compared to controls. In addition, a family history of psychiatric disorder in a first-degree relative may leave young adults born VPT particularly vulnerable to psychiatric illness.

Body size at birth and socio-economic status in childhood: implications for Cloninger's psychobiological model of temperament at age 60

Small birth size predicts various psychiatric outcomes, including depression. While biologically based temperamental traits may constitute a vulnerability factor for depression, the extent to which birth size predicts these traits in adulthood is not known. We studied, in 1369 women and men identified from a cohort born in 1934-44 in Helsinki, Finland, whether birth size predicts the temperamental traits measured with Cloninger's Tridimensional Personality Questionnaire at an average age of 63 years. Moreover, we examined whether socio-economic status (SES) in childhood modified the associations. Data on birth size were obtained from birth records, and SES in childhood was obtained from school records. Weight and length at birth showed curvilinear, reverse J-shaped effects on harm avoidance (HA), such that the highest HA scores were most characteristic of those born small. Furthermore, high HA was confined to those belonging to a low SES group in childhood regardless of birth size, and to those belonging to the high SES group in childhood if their birth size was small. The associations were independent of several confounders. Since small birth size as well as high HA in adulthood may associate with subsequent depression, our findings might shed light on understanding the early neurodevelopmental processes that predispose to depression through vulnerability characteristics.

Prenatal origins of adult disease

PURPOSE OF REVIEW

Human epidemiological and animal studies show that many chronic adult conditions have their antecedents in compromised fetal and early postnatal development. Developmental programming is defined as the response by the developing mammalian organism to a specific challenge during a critical time window that alters the trajectory of development with resulting persistent effects on phenotype. Mammals pass more biological milestones before birth than any other time in their lives. Each individual's phenotype is influenced by the developmental environment as much as their genes. A better understanding is required of gene-environment interactions leading to adult disease.

RECENT FINDINGS

During development, there are critical periods of vulnerability to suboptimal conditions when programming may permanently modify disease susceptibility. Programming involves structural changes in important organs; altered cell number, imbalance in distribution of different cell types within the organ, and altered blood supply or receptor numbers. Compensatory efforts by the fetus may carry a price. Effects of programming may pass across generations by mechanisms that do not necessarily involve structural gene changes. Programming often has different effects in males and females.

SUMMARY

Developmental programming shows that epigenetic factors play major roles in development of phenotype and predisposition to disease in later life.

Psychosis and autism as diametrical disorders of the social brain

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions.

Pregnancies in high psychosocial risk groups: research findings and implications for early intervention

Besides the well-known risk factors for youth suicidal behavior, recent evidence suggests that risk for youth suicidal behavior can be determined even very early in life, during the prenatal and perinatal period. Low birth weight and short birth length adjusted for gestational age were found to increase the risk for suicidal behavior, particularly by violent means. Several parental factors like low parental socioeconomic status, teenage and single parenthood, multiparity and parental psychopathology, substance abuse and suicidal behavior have been linked to an increase in youth suicidal behavior. Effective collaboration among the sectors within health care and social services is crucial for early detection and adequate intervention.

Loss to follow up did not bias associations between early life factors and adult depression

OBJECTIVE

This study examines the consequences of nonresponse in a follow-up survey for the associations of early life factors with adult depression.

STUDY DESIGN AND SETTING

A cohort of 11,532 Danish men born in 1953 had nearly complete follow up for outcomes retrieved from the Danish Psychiatric Register and the National Prescription Register, but only 66% of 9,507 eligible cohort members participated in a follow-up survey in 2004. We examined whether characteristics measured at birth and at ages 12 and 18 years, were associated with survey response. Associations between early life characteristics and four measures of depression were described by odd ratios (OR), estimated by logistic regression. For the register-based measures the effect of nonresponse was described by a relative OR(OR(responders)/OR(entire cohort)=ROR).

RESULTS

Nonresponse at 50 years of age was related to having a single mother at birth, low educational attainment at age 18, and low cognitive function at ages 12 and 18. Hospitalizations for depression and having claimed a prescription for an antidepressive drug were also most frequent among men who did not respond in the follow up. However, the effect of this nonresponse on the estimated ORs was small, and all ROR were nonsignificant.

CONCLUSION

Although early life characteristics were related to response in a follow-up survey, the ORs for the exposure-risk associations were not biased by nonresponse.

Birth factors and common mental health problems in young adults: a population-based study in North Staffordshire

BACKGROUND

Birth-related factors have been associated with adult chronic disease. Whilst the potential association between these factors and depression in adulthood was been described rather less is known about the role of these exposures in the development of anxiety.

METHOD

Cross-sectional population-based survey recruited adults aged 18-25 years. Participants were classified on the basis of responses to the Hospital Anxiety and Depression Scale. Birth-related exposures were determined by hospital medical record review. A proportional odds model was used to assess associations between birth factors and anxiety and depression.

RESULTS

No significant associations were found between birth factors and anxiety. Significant associations were found between depression with low birth weight (odds ratio 2.88, 95% confidence interval 1.26-6.59) and neonatal admission to ITU (3.12, 1.25, 7.78).

CONCLUSION

Low birth weight and neonatal intensive care unit admission are significantly associated with depression in adults. Other birth related variables were not significantly associated with either depression or anxiety.

Fetal growth restriction and the development of major depression

OBJECTIVE

To test the association between fetal growth restriction and the lifetime risk of major depression and the number of recurrent episodes.

METHOD

Study subjects (n = 1101) were offspring of participants in the Providence, RI, site of the National Collaborative Perinatal Project. Cox regression was used to investigate the relation between measures of birth size and the lifetime risk of depression and the mean number of depressive episodes was compared across categories of birth size.

RESULTS

There was no association between low birth weight, gestational age, ponderal index and small for gestational age and the lifetime risk of major depression, or the number of recurrent episodes.

CONCLUSION

Fetal growth restriction, as reflected by multiple measures of birth size, is not associated with the risk of a major depression or the subsequent recurrence of depressive episodes. Results of this study do not support a 'fetal programming' effect in depression.

Early-life events. Effects on aging

During the last two decades, a considerable body of evidence has emerged showing that circumstances during the fetal period and childhood may have lifelong programming effects on different body functions with a considerable impact on disease susceptibility. From a medical point of view, these long-term effects are today referred to as the Developmental Origins of Health and Disease (DOHaD) concept. The DOHaD concept may have a fundamental impact on our ideas about when and how to intervene in order to prevent aging-related loss of function and disease. The aim of this review is to provide a synopsis of epidemiological findings relating early-life conditions with key aging-related disorders, including cardiovascular disease, type 2 diabetes, depression, cognitive impairments and osteoporosis. There are several mechanisms that have been suggested as linking early-life events with late-life disease. This review will discuss programming of the hypothalamic-pituitary-adrenal axis function as one of the best characterised examples of such mechanisms.

Susceptibility to depression expressed as alterations in cortisol day curve: a cross-twin, cross-trait study

OBJECTIVE

To examine, using a cross-twin cross-trait design, the hypotheses 1) that the genetic and environmental susceptibility to depression is expressed, in part, as alterations in cortisol day curves and 2) that cortisol abnormalities are not merely the consequence of depressive states or the stressors associated with its onset. Alteration of diurnal secretion of cortisol is a possible endophenotype of depression, as depressed patients show alterations in cortisol dynamics over the day.

METHODS

Salivary cortisol measurements were obtained in a sample of 279 twin pairs at 10 random times a day for 5 days. A structured clinical interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) axis I mood disorder (SCID) was administered. Using multilevel regression analysis, the moderating influence of a lifetime diagnosis of depression in the co-twin on the association between time of day and cortisol concentrations in the proband twin was examined.

RESULTS

Diurnal variation in cortisol in the proband twin differed as a function of lifetime diagnosis of depression in the co-twin. In addition, this moderating effect was significantly stronger for dizygotic than for monozygotic twins.

CONCLUSIONS

Probands of co-twins with lifetime depression have a different diurnal cortisol profile than those without, suggesting that altered hypothalamic-pituitary-adrenal axis functioning is an indicator of depression susceptibility.

Intrauterine growth and infant temperamental difficulties: the Generation R Study

OBJECTIVE

To determine whether intrauterine growth trajectories are associated with temperamental difficulties in infancy.

METHOD

The Generation R Study is a population-based cohort study from fetal life onward. Size at different time points during gestation and growth trajectories, calculated on the basis of repeatedly measured fetal growth characteristics, were related to temperamental dimensions, assessed with the Infant Behavior Questionnaire-Revised, in 3,792 infants age 6 months.

RESULTS

Birth weight, adjusted for gestational age, was negatively associated with activity level and duration of orienting. These associations disappeared after additional adjustment for maternal height, age, educational level, and national origin. Similarly, the negative associations between intrauterine total body weight gain and falling reactivity and activity level diminished after correction for maternal and child characteristics. After full adjustment, reduced fetal weight gain was only related to prolonged duration of orienting. Children scored 0.38 (95% confidence interval 0.09-0.68) points higher on duration of orienting per SD decrease in total body weight gain from mid-pregnancy to birth.

CONCLUSIONS

After controlling for several genetic and socioeconomic status related factors, we found little indication of an association between intrauterine growth trajectories and temperamental difficulties in infants.

The developmental origins of adult disease (Barker) hypothesis

Many studies have provided evidence for the hypothesis that size at birth is related to the risk of developing disease in later life. In particular, links are well established between reduced birthweight and increased risk of coronary heart disease, diabetes, hypertension and stroke in adulthood. These relationships are modified by patterns of postnatal growth. The most widely accepted mechanisms thought to underlie these relationships are those of fetal programming by nutritional stimuli or excess fetal glucocorticoid exposure. It is suggested that the fetus makes physiological adaptations in response to changes in its environment to prepare itself for postnatal life. These changes may include epigenetic modification of gene expression. Less clear at this time are the relevance of fetal programming phenomena to twins and preterm babies, and whether any of these effects can be reversed after birth. Much current active research in this field will be of direct relevance to future obstetric practice.

Is birth weight associated with risk of depressive symptoms in young women? Evidence from the Southampton Women's Survey

Although some studies have shown negative associations between birth weight and risk of depression, others have not. Studies also differ regarding the age and gender specificity of reported associations. In this paper, the authors report on a study of 5,830 women aged 20-34 years from the general population in Southampton, United Kingdom, interviewed in 2000-2002 that found no relation between birth weight and current depressive symptoms or past treatment for depression. Prevalence ratios for current symptoms and for past treatment, in relation to reported or recorded birth weights, were all remarkably close to 1.0, with narrow 95% confidence intervals. For example, the prevalence ratio from the fully adjusted model for current depressive symptoms in relation to a standard deviation increase in reported birth weight was 1.01 (95% confidence interval: 0.98, 1.05). Generally, the associations reported elsewhere are not strong. The authors found a weak, inverse association in exploratory analyses of duration of gestation at birth in relation to depressive symptoms, but this finding requires replication. Because birth weight and duration of gestation are relatively poor markers of fetal development, other markers of fetal and early development should be explored. However, data from this study do not support a major developmental contribution to the etiology of depression in women.

A longitudinal typology of symptoms of depression and anxiety over the life course

BACKGROUND

Little is known about long-term profiles of depressive and anxious symptomatology over the life course and about the developmental determinants of different trajectories. The objective of this study was to identify a novel typology of symptoms of depression and anxiety over the life course and examine its neurodevelopmental antecedents in an epidemiological sample.

METHODS

A longitudinal latent variable analysis was conducted on measures of anxious and depressive symptoms at ages 13, 15, 36, 43, and 53 years among 4627 members of the Medical Research Council National Survey of Health & Development (the British 1946 birth cohort). Early life predictors of class membership were studied with ordinal logistic regression.

RESULTS

We identified six distinct profiles up to age 53: absence of symptoms (44.8% of sample); repeated moderate symptoms (33.6%); adult-onset moderate symptoms (11.3%); adolescent symptoms with good adult outcome (5.8%); adult-onset severe symptoms (2.9%); and repeated severe symptoms over the life course (1.7%). Heavier babies had lower likelihood of depressive and anxious symptoms (odds ratio [OR] = .92; 95% confidence interval [CI] .85-.99), whereas delay in first standing (OR = 1.19; 95% CI 1.11-1.28) and walking (OR = 1.22; 95% CI 1.14-1.31) was associated with subsequent higher likelihood of symptoms, controlling for social circumstances and stressful life events during childhood.

CONCLUSIONS

There was evidence of distinct profiles of depressive and anxious symptomatology over the life course and associations with markers of neurodevelopment. This suggests very early factors are associated with long-term experience of symptoms of depression and anxiety.

Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation

Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.

Consensus paper of the WFSBP Task Force on Biological Markers: biological markers in depression

Biological markers for depression are of great interest to aid in elucidating the causes of major depression. We assess currently available biological markers to query their validity for aiding in the diagnosis of major depression. We specifically focus on neurotrophic factors, serotonergic markers, biochemical markers, immunological markers, neuroimaging, neurophysiological findings, and neuropsychological markers. We delineate the most robust biological markers of major depression. These include decreased platelet imipramine binding, decreased 5-HT1A receptor expression, increase of soluble interleukin-2 receptor and interleukin-6 in serum, decreased brain-derived neurotrophic factor in serum, hypocholesterolemia, low blood folate levels, and impaired suppression of the dexamethasone suppression test. To date, however, none of these markers are sufficiently specific to contribute to the diagnosis of major depression. Thus, with regard to new diagnostic manuals such as DSM-V and ICD-11 which are currently assessing whether biological markers may be included in diagnostic criteria, no biological markers for major depression are currently available for inclusion in the diagnostic criteria.

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.

The role of perinatal problems in risk of co-morbid psychiatric and medical disorders in adulthood

BACKGROUND

Perinatal problems may be associated with an increased risk for psychological and physical health problems in adulthood, although it is unclear which perinatal problems (low birthweight, preterm birth, low Apgar scores, and small head circumference), or what clusters of problems, are more likely to be associated with later health problems. It is also not known whether perinatal problems (singly or together) are associated with co-morbidity between psychological and physical health problems.

METHOD

A regional random sample (from Baltimore) of mothers and their children (n=1525) was followed from birth to adulthood (mean age 29 years). Perinatal conditions were measured at delivery. Psychological problems (depression and suicidal ideation) were measured with the General Health Questionnaire-28 (GHQ-28) and physical problems (asthma and hypertension) with the RAND-36 Health Status Inventory.

RESULTS

Children with perinatal problems were generally at increased risk for depression, suicidal ideation and hypertension, and co-morbid depression and hypertension even after controlling for confounders. One possible underlying condition, preterm low birthweight (LBW), extracted by cluster analysis, considering all of the four perinatal problems, was associated with increased risk for psychological and physical health outcomes as well as co-morbidity of the two.

CONCLUSIONS

LBW, preterm birth and small head circumference singly increased the risk for both psychological and physical health problems, as well as co-morbid depression and hypertension, while low Apgar scores were only associated with psychological problems. Delineating different etiological processes, such as preterm LBW, considering various perinatal problems simultaneously, might be of benefit to understanding the fetal origin of adult illness and co-morbidity.

Low birth weight and risk of affective disorders and selected medical illness in offspring at high and low risk for depression

Numerous studies have demonstrated that low birth weight (LBW) is associated with the development of medical conditions, such as hypertension and diabetes, and psychiatric disorders, such as depression. One possible mechanism through which LBW might increase risk for both medical and psychiatric disorders is by altering the biologic systems (such as the hypothalamic-pituitary-adrenal [HPA] axis function) that govern emotion regulation and physical reactivity. In this study, we conducted secondary data analyses in a longitudinal study originally designed to understand the intergenerational transmission of major depressive disorder (MDD). We examined the risk for both medical and psychiatric illnesses known to be influenced by HPA axis dysregulation in the context of parental depression. The study had 2 primary objectives: (1) to examine whether LBW increases the risk of selected adult illness that may be influenced by the HPA axis and (2) to examine whether the increased risk of illness varies by parental depression status. We conducted longitudinal assessments of 244 offspring of depressed and nondepressed parents for more than 20 years. Psychopathology and medical illness were assessed by direct interview conducted by clinicians blind to risk status and previous diagnosis. We examined the effect of BW in 3 categories: less than 2.5 kg (LBW), 2.5-3.5 kg, and more than 3.5 kg (reference group). Offspring with LBW had a significantly increased risk of MDD, anxiety disorders, phobia, suicidal ideation, impaired functioning, allergies, and hypertension compared to those with BW exceeding 3.5 kg. The association between LBW and depression was stronger among children of depressed parents than among children of nondepressed parents, with an interaction term (BW and parental depression status) significant for MDD (P = .05), suggesting that parental depression may augment the impact of LBW on offspring depression:

Impaired executive functioning in young adults born very preterm

Individuals born very preterm (VPT) are at increased risk of perinatal brain injury and long-term cognitive and behavioral problems. Executive functioning, in particular, has been shown to be impaired in VPT children and adolescents. This study prospectively assessed executive function in young adults who were born VPT (<33 weeks of gestation) [n = 61; mean age, 22.25 (+/-1.07) years; range, 20.62-24.78 years] and controls [n = 64; mean age, 23.20 (+/-1.48) years; range, 19.97-25.46 years]. Tests used comprised the Wechsler Abbreviated Scale of Intelligence (WASI), the Hayling Sentence Completion Test (HSCT), the Controlled Oral Word Association Test (COWAT), the Animal and Object test, the Trail-Making Test (TMT), and the Test of Attentional Performance (TAP). VPT participants showed specific executive function impairments in tasks involving response inhibition and mental flexibility, even when adjusting for IQ, gender, and age. No significant associations were observed between executive function test scores and perinatal variables or neonatal ultrasound classification. The results suggest that, although free from major physical disability, VPT young adults perform worse than controls on tasks involving selective aspects of executive processing, such as mental flexibility and response inhibition.

Do intrauterine or genetic influences explain the foetal origins of chronic disease? A novel experimental method for disentangling effects

BACKGROUND

There is much evidence to suggest that risk for common clinical disorders begins in foetal life. Exposure to environmental risk factors however is often not random. Many commonly used indices of prenatal adversity (e.g. maternal gestational stress, gestational diabetes, smoking in pregnancy) are influenced by maternal genes and genetically influenced maternal behaviour. As mother provides the baby with both genes and prenatal environment, associations between prenatal risk factors and offspring disease maybe attributable to true prenatal risk effects or to the "confounding" effects of genetic liability that are shared by mother and offspring. Cross-fostering designs, including those that involve embryo transfer have proved useful in animal studies. However disentangling these effects in humans poses significant problems for traditional genetic epidemiological research designs.

METHODS

We present a novel research strategy aimed at disentangling maternally provided pre-natal environmental and inherited genetic effects. Families of children aged 5 to 9 years born by assisted reproductive technologies, specifically homologous IVF, sperm donation, egg donation, embryo donation and gestational surrogacy were contacted through fertility clinics and mailed a package of questionnaires on health and mental health related risk factors and outcomes. Further data were obtained from antenatal records.

RESULTS

To date 741 families from 18 fertility clinics have participated. The degree of association between maternally provided prenatal risk factor and child outcome in the group of families where the woman undergoing pregnancy and offspring are genetically related (homologous IVF, sperm donation) is compared to association in the group where offspring are genetically unrelated to the woman who undergoes the pregnancy (egg donation, embryo donation, surrogacy). These comparisons can be then examined to infer the extent to which prenatal effects are genetically and environmentally mediated.

CONCLUSION

A study based on children born by IVF treatment and who differ in genetic relatedness to the woman undergoing the pregnancy is feasible. The present report outlines a novel experimental method that permits disaggregation of maternally provided inherited genetic and post-implantation prenatal effects.

Association between antenatal depression and low birthweight in a developing country

OBJECTIVE

There is a high prevalence of depression in south Asian women. We aimed to examine the association between antenatal depression and low birthweight (LBW) in infants in a rural community in Rawalpindi, Pakistan.

METHOD

A total of 143 physically healthy mothers with ICD-10 depression in the third trimester of pregnancy and 147 non-depressed mothers of similar gestation were followed from birth. Infant weight was measured and information collected on socioeconomic status, maternal body-mass index and sociodemographic factors.

RESULTS

Infants of depressed mothers had lower birthweight (mean 2910 g) than infants of non-depressed mothers (mean 3022 g). The relative risk for LBW (< or =2500 g) in infants of depressed mothers was 1.9 (95% CI 1.3-2.9). The association remained significant after adjustment for confounders by multivariate analyses.

CONCLUSION

Low birthweight is a major public health problem in developing countries. Maternal depression during pregnancy predicts LBW. Interventions aimed at maternal depression may help improve infant outcomes.

Length of gestation and depressive symptoms at age 60 years

BACKGROUND

A non-optimal foetal environment, reflected in smaller birth size and shorter duration of gestation, is a risk factor for compromised health later in life.

AIMS

To examine whether smaller birth size and shorter gestation predict depressive symptoms.

METHOD

A total of 1371 members of a cohort born between 1934 and 1944 at term (259-294 days'gestation) in Helsinki, Finland, completed the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies Depression scale (CES-D) at an average age of 61.5 years (BDI) and 63.4 years (BDI and CES-D).

RESULTS

Gestational length predicted depressive symptoms linearly and independently of gender and birth weight: per day decrease in gestational length, depressive symptoms scores increased by 0.8-0.9% (95% CI 0.2-1.4, P<0.009). Weight, length and head circumference at birth showed no linear association with depression, adjusted for gender and gestational length. The results did not change when further controlled for socio-economic characteristics at birth and in adulthood, age and body mass index in adulthood.

CONCLUSIONS

Susceptibility to depressive symptoms may relate to shorter length of gestation.

Early developmental characteristics and features of major depressive disorder among child psychiatric patients in Hungary

OBJECTIVE

We investigate the relations of early atypical characteristics (perinatal problems, developmental delay, and difficult temperament) and onset-age (as well as severity of) first major depressive disorder (MDD) and first internalizing disorder in a clinical sample of depressed children in Hungary.

METHOD

Participants were 371 children (ages 7-14) with MDD, and their biological mothers, recruited through multiple clinical sites. Diagnoses (via DSM-IV criteria) and onset dates of disorders were finalized "best estimate" psychiatrists, and based on multiple information sources. Mothers provided developmental data in a structured interview.

RESULTS

Difficult temperament predicted earlier onset of MDD and first internalizing disorder, but its effect was ameliorated if the family was intact during early childhood. Further, the importance of difficult temperament decreased as a function of time. Perinatal problems and developmental delay did not impact onset ages of disorders, and none of the early childhood characteristics associated with MDD episode severity.

CONCLUSIONS

Children with MDD may have added disadvantage of earlier onset if they had a difficult temperament in infancy. Because early temperament mirrors physiological reactivity and regulatory capacity, it can affect various areas of functioning related to psychopathology. Early caregiver stability may attenuate some adverse effects of difficult infant temperament.

The effect of pre-employment factors on job control, job strain and psychological distress: a 31-year longitudinal study

This study examined the role of pre-employment factors, such as maternal antenatal depression, low birth weight, childhood socioeconomic position, early adolescence health risk behaviours and academic performance, in the relationship between work characteristics (low job control and high job demands, or job strain) and psychological distress at age 31. The data of 2062 women and 2231 men was derived from the prospective unselected population-based Northern Finland 1966 Birth Cohort study. Results of linear regression models showed that being female, father's low socioeconomic position, and poor academic achievement in adolescence were linked to low control and high job strain jobs at age 31, and that low control and high job strain were associated with psychological distress at age 31. Although having lower school grades, high absence rate from school, and moderate alcohol consumption at age 14 were significant predictors of psychological distress at age 31, the associations between job control, job strain and psychological distress remained after controlling for these and other pre-employment effects. As such, pre-employment factors do seem to link people to risky work environments, which in turn seem to relate strongly to psychological distress. However, the relationship between pre-employment factors and later psychological distress in adulthood is not completely explained by job environment.

Conjoined effects of low birth weight and childhood abuse on adaptation and well-being in adolescence and adulthood

OBJECTIVE

To characterize the conjoined effects of low birth weight (LBW) and childhood abuse on impaired adaptation and illness in adolescence and adulthood.

DESIGN

Longitudinal study of a birth cohort.

SETTING

Baltimore, Md.

PARTICIPANTS

Children (N = 1748) were followed from birth to adulthood (mean age, 26 years) as part of the Johns Hopkins Collaborative Perinatal Study.

MAIN EXPOSURES

Childhood abuse and LBW.

MAIN OUTCOME MEASURES

Indicators of adaptation were delinquency, school suspension, repeating grades, academic honors, quality of life, and socioeconomic status. Indicators of psychiatric and medical problems were depression, social dysfunction, somatization, asthma, and hypertension.

RESULTS

Participants with both LBW and subsequent childhood abuse, relative to those with neither risk, were at a substantially elevated risk for psychological problems: 10-fold for depression; nearly 9-fold for social dysfunction, and more than 4-fold for somatization. However, they were not at an elevated risk for medical problems in adulthood. Those exposed to childhood abuse were more likely to report delinquency, school suspension, repeating grades during adolescence, and impaired well-being in adulthood, regardless of LBW status. For those with LBW alone, the prevalence of those problems was comparable with that of individuals without either risk factor.

CONCLUSIONS

Children with LBW and childhood abuse are at much greater risk for poor adaptation and psychiatric problems than those with LBW alone and those with neither risk. Preventive interventions should target families with LBW children who are at greater risk for childhood abuse.

The impact of gestational stress and prenatal growth on emotional problems in offspring: a review

OBJECTIVE

Events occurring very early in life, even prenatally, may have long-term effects on future health and behaviour. The influence of poor foetal growth and gestational stress in the mother on the risk of emotional problems in offspring was reviewed.

METHOD

A selective review of the literature was undertaken.

RESULTS

Studies of preterm infants and infants born small for gestational age have shown increased levels of emotional problems across the lifespan. In general, studies examining maternal depression/anxiety during pregnancy and other indices of gestational stress have shown significant associations with emotional problems in children. The results of several studies also point to the importance of psychosocial and genetic factors in moderating associations.

CONCLUSION

Future research that focuses on identifying the mechanisms underlying these associations is needed. The moderating role of psychosocial and genetic risk factors is an important area in which future research should be directed. These findings have clinical implications for the provision of antenatal care.

Fetal programming of temperamental negative affectivity among children born healthy at term

The fetal programming hypothesis suggests that an adverse in utero environment, reflected in small body size at birth, has life-long effects on different physiological systems that may affect both health and behavior. We explored whether fetal growth was associated with biologically based temperamental outcomes (negative affectivity scales, the CBQ) among 5(1/2)-year-old children (n = 416) born healthy at term (gestational weeks 37-42). In line with the hypotheses, small body size at birth (thinness measured by ponderal index, kg/m(3)) was related to increased negative affectivity and its subscales: anger-, discomfort-, and sadness-proneness in childhood. Longer length at birth was predictive of higher levels of child anger- and sadness-proneness. Length of gestation moderated the associations of weight and length at birth with negative affectivity. The results suggest that the biological basis of temperament may be subjected to antenatal environmental influences, and that the mechanisms, proposed to be related to fetal glucocorticoid environment, may operate even within the normal range of term birth.

Additive Interaction of Child Abuse and Perinatal Risk as Signs of Resiliency in Adulthood

To find the biological basis of resilience, we exploited data from a longitudinal community-based study of 1,748 adult children, followed from birth to adulthood. Results showed that those with both abuse and perinatal problems demonstrated synergistically impaired well-being, a higher rate of school dropout, lower sense of success, and lower income. Among abused adult children (n = 271), we found that those without, relative to those with, perinatal problems had lower risk for adult psychopathology. An examination of the biological base of resilience could be added in a multidimensional/multifactorial model to help researchers identify ways to promote resiliency even before birth.

Fetal Origins of Stress-Related Adult Disease

During the past decade, a considerable body of evidence has emerged showing that circumstances during the fetal period may have lifelong programming effects on different body functions with a considerable impact on disease susceptibility. The purpose of this article is to provide a synopsis of these findings and their role in explaining the development of stress-related adult disease. In the context of Per Björntorp memorial symposium, stress-related disease will be interpreted broadly, including cardiovascular disease and components of the metabolic syndrome, for which the evidence of fetal origins is most abundant. It has however become evident that early-life programming has a much broader potential effect on an individual's health. For example, perinatal variables, such as low birth weight, have been associated with increased prevalence of depressive symptoms. Mechanistic studies in animals and humans have shown that lifelong programming of the hypothalamic-pituitary-adrenal axis (HPAA) function by fetal life conditions is likely to be a key factor in mediating associations with these disorders, which frequently are characterized by HPAA overactivity. Preliminary observations suggest a similar important role for early-life programming of sympathoadrenal function. Reduced HPAA activity is characteristic of a number of stress-related disorders, including posttraumatic stress disorder; chronic pain; fatigue; and atypical, melancholic depression. It is therefore highly plausible that susceptibility to these disorders originates in a similar manner during early life, although direct evidence is to a great deal lacking. Important targets for future research include distinction between the effects of different pregnancy conditions, such as maternal malnutrition, preeclampsia, and maternal infection, which may have dissimilar late-life consequences. This will be a crucial step when the associations that are currently emerging will be translated into disease prevention.