Low birth weight young adults: quality of life, academic achievements and social functioning

Self-reported mental health and cortisol activity at 27-28 years of age in individuals born with very low birthweight

Aim

To assess mental health outcomes of very low birthweight (VLBW, <1500 g) subjects to adulthood and to examine salivary cortisol and hair cortisol levels and their relation to birth characteristics and mental health.

Methods

A Swedish regional cohort of 56 VLBW subjects and 55 full‐term controls were assessed at the ages 27‐28 with adult self‐reported scales and the mean of 2 days diurnal salivary cortisol and hair cortisol. The cohorts had been assessed at 15 years of age with youth self‐reported scales.

Results

There were no differences between the groups in youth self‐reported scales and adult self‐reported scores. The 24 participating VLBW girls scored lower on youth self‐reported scales externalising and total problem scores than the control girls. In adulthood, the 21 participating VLBW women had significantly higher morning concentrations of salivary cortisol than control women, P = .014. No significant associations were found between cortisol concentrations and adult self‐reported scales internalising, externalising and total scores.

Conclusion

Self‐reported mental health in VLBW subjects was comparable with normal birthweight controls indicating a satisfying transition from adolescence to adulthood. VLBW females had higher morning salivary cortisol concentrations, suggesting a gender difference. We found no correlations between cortisol and mental health.

Birth weight and quality of life in midlife: a 50-year follow-up study of 2079 individuals in Denmark

PURPOSE

Low birth weight has been associated with a higher risk of reduced quality of life (QoL) in children, adolescents, and young adults, but the influence seems to diminish over time. However, previous studies have mainly focused on health-related QoL and compared individuals with low birth weight with individuals without low birth weight. The purpose of the present cohort study was to investigate the influence of the entire range of birth weights on three distinct measures of QoL in midlife.

METHODS

The study population consisted of all live-born singletons from the Copenhagen Perinatal Cohort (CPC, 1959-1961) who participated in a 50-year follow-up examination in 2009-2011 (N = 2079). Birth weight was measured by three pediatricians at birth. QoL was measured at the follow-up by the participants' scores on three QoL self-report measures: The Satisfaction With Life Scale, the Vitality Scale of the Medical Outcomes Study 36-Item Short-Form Health Survey, and a single-item QoL measure based on the question: "How is your quality of life at the moment?". General linear regression and binary logistic regression were used to estimate the association between birth weight and QoL in midlife.

RESULTS

Small, curvilinear associations of birth weight with life satisfaction, vitality, and the single-item QoL measure were found, suggesting that both low and high birth weights increase the risk of low satisfaction with life, low vitality and low QoL.

CONCLUSION

The study findings suggest that low and high-range birth weight exert a lasting influence on distinct, but complementary aspects of QoL in midlife.

Association of Preterm Birth and Low Birth Weight With Romantic Partnership, Sexual Intercourse, and Parenthood in Adulthood: A Systematic Review and Meta-analysis

IMPORTANCE

Social relationships are important determinants of well-being, health, and quality of life. There are conflicting findings regarding the association between preterm birth or low birth weight and experiences of social relationships in adulthood.

OBJECTIVE

To systematically investigate the association between preterm birth or low birth weight and social outcomes in adulthood.

DATA SOURCES

PubMed, PsycINFO, Web of Science, and Embase were searched for peer-reviewed articles published through August 5, 2018.

STUDY SELECTION

Prospective longitudinal and registry studies reporting on selected social outcomes in adults who were born preterm or with low birth weight (mean sample age ≥18 years) compared with control individuals born at term.

DATA EXTRACTION AND SYNTHESIS

The meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The data were collected and extracted by 2 independent reviewers. Pooled analyses were based on odds ratios (ORs) with 95% confidence intervals and Hedges g, which were meta-analyzed using random-effects models.

MAIN OUTCOMES AND MEASURES

Ever being in a romantic partnership, ever having experienced sexual intercourse, parenthood, quality of romantic relationship, and peer social support.

RESULTS

Twenty-one studies were included of the 1829 articles screened. Summary data describing a maximum of 4 423 798 adult participants (179 724 preterm or low birth weight) were analyzed. Adults born preterm or with low birth weight were less likely to have ever experienced a romantic partnership (OR, 0.72; 95% CI, 0.64-0.81), to have had sexual intercourse (OR, 0.43; 95% CI, 0.31-0.61), or to have become parents (OR, 0.77; 95% CI, 0.65-0.91) than adults born full-term. A dose-response association according to degree of prematurity was found for romantic partnership and parenthood. Overall, effect sizes did not differ with age and sex. When adults born preterm or with low birth weight were in a romantic partnership or had friends, the quality of these relationships was not poorer compared with adults born full-term.

CONCLUSIONS AND RELEVANCE

These findings suggest that adults born preterm or with low birth weight are less likely to experience a romantic partnership, sexual intercourse, or to become parents. However, preterm birth or low birth weight does not seem to impair the quality of relationships with partners and friends. Lack of sexual or partner relationships might increase the risk of decreased well-being and poorer physical and mental health.

Preterm Birth/Low Birth Weight and Markers Reflective of Wealth in Adulthood: A Meta-analysis

CONTEXT

Preterm birth and/or low birth weight (PT/LBW) increases the risk of cognitive deficits, which suggests an association between PT/LBW and lower wealth in adulthood. Nevertheless, studies have revealed inconsistent findings so far.

OBJECTIVE

To systematically investigate whether PT/LBW is associated with markers of adulthood wealth.

DATA SOURCES

We searched Medline, PubMed, PsycINFO, Web of Science, and Embase.

STUDY SELECTION

Prospective longitudinal and registry studies containing reports on selected wealth-related outcomes in PT/LBW-born adults compared with term-born controls.

DATA EXTRACTION

Two independent reviewers extracted data on educational qualifications, employment rates, social benefits, and independent living.

RESULTS

Of 1347 articles screened, 23 studies met the inclusion criteria. PT/LBW was associated with decreased likelihood of attainment of higher education qualifications (odds ratio [OR] = 0.74; 95% confidence interval [CI] = 0.69-0.80), lower employment rate (OR = 0.83; 95% CI = 0.74-0.92), and increased likelihood of receiving social benefits (OR = 1.25; 95% CI = 1.09-1.42). A dose-response relationship according to gestational age was only found for education qualifications. PT/LBW-born adults did not differ significantly from those born at term in independent living.

LIMITATIONS

There was high heterogeneity between studies. There were unequal numbers of studies from different regions in the world.

CONCLUSIONS

PT/LBW is associated with lower educational qualifications, decreased rate of employment, and an increased rate of receipt of social benefits in adulthood. Low educational qualifications were most prevalent in those born very preterm and consistent across geographic regions. However, the findings are less clear for independent living.

A longitudinal study of cognitive and educational outcomes of those born small for gestational age

AIM

This study examined the long-term cognitive and educational outcomes of being born small for gestational age (SGA) and assessed whether the family's attitude towards education modified the effect of being born SGA on educational attainment.

METHODS

We used anonymised data on 9598 individuals from the Stockholm Birth Cohort. This study focused on babies born in 1953 in the Stockholm metropolitan area, who were followed up for 50 years, and included educational data at the age of 13 and 48. Ordinary least squares regression analyses, modification analyses and logistic regression analyses were conducted.

RESULTS

The findings suggested that individuals who were born SGA (n = 798) had lower mean verbal, spatial and numerical test scores than those born appropriate for gestational age (AGA) (n = 7364) and large for gestational age (n = 1436). The SGA/AGA differences were small, but statistically significant, and the effects of being born SGA on the test scores was modified by the family's attitude towards education. The findings also suggested that attaining higher education was largely, but not entirely, explained by the family's attitude towards education.

CONCLUSION

The detrimental effects of being born SGA were limited on cognitive and educational outcomes, but may have been reduced by positive family attitudes.

Early developmental influences on self-esteem trajectories from adolescence through adulthood: Impact of birth weight and motor skills

While the trajectory of self-esteem from adolescence to adulthood varies from person to person, little research has examined how differences in early developmental processes might affect these pathways. This study examined how early motor skill development interacted with preterm birth status to predict self-esteem from adolescence through the early 30s. We addressed this using the oldest known, prospectively followed cohort of extremely low birth weight (<1000 g) survivors (N = 179) and normal birth weight controls (N = 145) in the world, born between 1977 and 1982. Motor skills were measured using a performance-based assessment at age 8 and a retrospective self-report, and self-esteem was reported during three follow-up periods (age 12-16, age 22-26, and age 29-36). We found that birth weight status moderated the association between early motor skills and self-esteem. Stable over three decades, the self-esteem of normal birth weight participants was sensitive to early motor skills such that those with poorer motor functioning manifested lower self-esteem, while those with better motor skills manifested higher self-esteem. Conversely, differences in motor skill development did not affect the self-esteem from adolescence to adulthood in individuals born at extremely low birth weight. Early motor skill development may exert differential effects on self-esteem, depending on whether one is born at term or prematurely.

Gait in Very Preterm School-Aged Children in Dual-Task Paradigms

OBJECTIVE

The control of gait requires executive and attentional functions. As preterm children show executive and attentional deficits compared to full-term children, performing concurrent tasks that impose additional cognitive load may lead to poorer walking performance in preterm compared to full-term children. Knowledge regarding gait in preterm children after early childhood is scarce. We examined straight walking and if it is more affected in very preterm than in full-term children in dual-task paradigms.

STUDY DESIGN

Twenty preterm children with very low birth-weight (≤ 1500 g), 24 preterm children with birth-weight > 1500 g, and 44 full-term children, born between 2001 and 2006, were investigated. Gait was assessed using an electronic walkway system (GAITRite) while walking without a concurrent task (single-task) and while performing one concurrent (dual-task) or two concurrent (triple-task) tasks. Spatio-temporal gait parameters (gait velocity, cadence, stride length, single support time, double support time), normalized gait parameters (normalized velocity, normalized cadence, normalized stride length) and gait variability parameters (stride velocity variability, stride length variability) were analyzed.

RESULTS

In dual- and triple-task conditions children showed decreased gait velocity, cadence, stride length, as well as increased single support time, double support time and gait variability compared to single-task walking. Further, results showed systematic decreases in stride velocity variability from preterm children with very low birth weight (≤ 1500 g) to preterm children with birth weight > 1500 g to full-term children. There were no significant interactions between walking conditions and prematurity status.

CONCLUSIONS

Dual and triple tasking affects gait of preterm and full-term children, confirming previous results that walking requires executive and attentional functions. Birth-weight dependent systematic changes in stride velocity variability indicate poorer walking performance in preterm children who were less mature at birth.

Mental health, quality of life and social relations in young adults born with low birth weight

Background

Being born with low birth weight may have an impact on different aspects of mental health, psychosocial functioning and well-being; however results from studies in young adulthood have so far yielded mixed findings. The aim of this study was to assess the long-term impact in young adulthood on self-reported mental health, health-related quality of life, self-esteem and social relations by investigating differences between two low birth weight groups and a control group.

Methods

In a follow-up at 20 years of age, 43 preterm VLBW (birth weight ≤ 1500 g), 55 term SGA (birth weight < 10th percentile) and 74 control subjects completed the Adult Self-Report (ASR) of the Achenbach System of Empirically Based Assessment, the Adult Autism Spectrum Quotient (AQ), the Short Form 36 Health Survey, the Self-Perception Profile for Adolescents-Revised, and the Wechsler Adult Intelligent Scale III assessment.

Results

The VLBW and SGA groups reported significantly more mental health problems than controls. The VLBW group predominantly had internalizing problems, and the non-significant association with ASR Total score was reduced by the Intelligence Quotient (IQ). The SGA group had increased scores on both internalizing and externalizing problems, and the association with ASR Total score remained significant after adjusting for IQ in this group. Both low birth weight groups reported less interaction with friends and lower quality of life related to mental health domains than controls. Self-esteem scores were lower than in the control group for athletic competence (VLBW) and social acceptance (SGA).

Conclusion

Our findings suggest that self-reported mental health and well-being in young adulthood may be adversely affected by low birth weight, irrespective of whether this is the result of premature birth or being born SGA at term.

Health related quality of life in adolescents with bladder exstrophy-epispadias as measured by the Child Health Questionnaire-Child Form 87

PURPOSE

We determined health related quality of life as reported by adolescents with bladder exstrophy or epispadias using a validated generic instrument.

MATERIALS AND METHODS

Adolescents age 11 to 18 years with bladder exstrophy or epispadias (57) completed a validated, generic, health related quality of life instrument, the CHQ-CF87 (Child Health Questionnaire-Child Form 87). Urinary incontinence, catheterization status, and medical and surgical history data were also obtained. Mean summary scores and 95% CIs for each subdomain of the CHQ-CF87 were calculated, and descriptively compared to 2 population based samples. In our sample health related quality of life outcomes by continence status were compared using univariate and multivariate analysis. However, this analysis was limited by a small sample size.

RESULTS

Mean age of the 49 patients with bladder exstrophy and the 8 with epispadias was 14.3 years, 67% were male and 81% were Caucasian. There were 31 participants who reported incontinence and the median number of lifetime surgeries was 9. The exstrophy population scored well in all subdomains of the instrument when descriptively compared to 2 large samples of adolescent populations. In our sample incontinent patients had lower scores by multivariate analysis in 7 of 10 domains and better scores in 3 of 10 domains, although these differences were not statistically significant.

CONCLUSIONS

Adolescents with bladder exstrophy and epispadias reported relatively good scores on the CHQ-CF87 when descriptively compared to other reference populations. This finding suggests that these children adapt well to the challenges of their condition. Analysis of the association of incontinence with health related quality of life was limited by the small sample size.

Psychiatric disorders in low birthweight young adults. Prevalence and association with assessments at 11 years

OBJECTIVE

To compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2,000 g) with 132 adults with normal birthweight (NBW).

METHOD

A cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age.

RESULTS

At 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P=0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9).

CONCLUSION

Moderate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence.