Mood and anxiety disorders in very preterm/very low-birth weight individuals from 6 to 26 years

Romantic and sexual relationships of young adults born very preterm: An individual participant data meta-analysis

AIM

To compare romantic and sexual relationships between adults born very preterm (VP; <32 weeks of gestation) or with very low birth weight (VLBW; <1500 g) and at term, and to evaluate potential biological and environmental explanatory factors among VP/VLBW participants.

METHODS

This individual participant data (IPD) meta-analysis included longitudinal studies assessing romantic and sexual relationships in adults (mean sample age ≥ 18 years) born VP/VLBW compared with term-born controls. Following PRISMA-IPD guidelines, 11 of the 13 identified cohorts provided IPD from 1606 VP/VLBW adults and 1659 term-born controls. IPD meta-analyses were performed using one-stage approach.

RESULTS

Individuals born VP/VLBW were less likely to be in a romantic relationship (OR 0.49; 95% CI 0.31-0.76), to be married/cohabiting (OR 0.70, 95% CI 0.53-0.92), or to have had sexual intercourse (OR 0.21, 95% CI 0.09-0.36) than term-born adults. If sexually active, VP/VLBW participants were more likely to experience their first sexual intercourse after the age of 18 years (OR 1.93, 95% CI 1.24-3.01) than term-born adults. Among VP/VLBW adults, males, and those with neurosensory impairment were least likely to experience romantic relationships.

CONCLUSIONS

These findings reflect less optimal social functioning and may have implications for socioeconomic and health outcomes of adults born VP/VLBW.

Late effects of prematurity: Psychiatric outcomes of 17-year-olds born very preterm

AIM

Very preterm (VPT) birth is a known early vulnerability factor, impacting both physical and mental health over the life-span. The additional burden of psychiatric illness in VPT adolescents is likely to adversely affect critical developmental tasks and personal, social and academic/vocational trajectories. Our aim was to examine the magnitude and extent of the risk of psychological burden by determining the prevalence of psychiatric disorders in our prospectively followed-up VPT and full-term (FT) control cohorts, in this period of developmental transition at age 17 years.

METHODS

Rates of psychiatric disorder in the VPT and FT control cohorts were ascertained at clinical interview of the adolescents and their care giver(s) by an adolescent psychiatrist.

RESULTS

VPT birth was associated with a greater risk of generalised anxiety disorder (VPT vs. FT risk ratio (RR) 2.33; 95% confidence interval (CI): 1.16, 4.67, P = 0.02), as well as attentional problems (VPT vs. FT RR 3.46; 95% CI: 1.01, 11.88, P = 0.03). Although care givers of VPT adolescents reported many social and communication difficulties, and observation at clinical interview supported this, our data did not reach clinical threshold for group differences in autistic spectrum disorder. For all other psychiatric disorders, there was no difference between VPT and FT control adolescents.

CONCLUSION

Our longitudinal cohort follow-up study examining the late effects of VPT birth has demonstrated increased rates of clinically significant psychiatric disorder in this period of important developmental transition. Families and health professionals need to be aware of the increased risk so they can monitor for symptoms and seek effective mental health treatments and support.

Preterm birth, birthweight, and subsequent risk for depression

An individual's birthweight, a marker of in utero exposures, was recently associated with certain psychiatric conditions. However, studies investigating the relationship between an individual's preterm birth status and/or birthweight and risk for depression during adulthood are sparse; we used data from the Women's Health Initiative (WHI) to investigate these potential associations. At study entry, 86,925 postmenopausal women reported their birthweight by category (<6 lbs., 6-7 lbs. 15 oz., 8-9 lbs. 15 oz., or ≥10 lbs.) and their preterm birth status (full-term or ≥4 weeks premature). Women also completed the Burnham screen for depression and were asked to self-report if: (a) they had ever been diagnosed with depression, or (b) if they were taking antidepressant medications. Linear and logistic regression models were used to estimate unadjusted and adjusted effect estimates. Compared to those born weighing between 6 and 7 lbs. 15 oz., individuals born weighing <6 lbs. (βadj = 0.007, P < 0.0001) and ≥10 lbs. (βadj = 0.006, P = 0.02) had significantly higher Burnam scores. Individuals born weighing <6 lbs. were also more likely to have depression (adjOR 1.21, 95% CI 1.11-1.31). Individuals born preterm were also more likely to have depression (adjOR 1.18, 95% CI 1.02-1.35); while attenuated, this association remained in analyses limited to only those reportedly born weighing <6 lbs. Our research supports the role of early life exposures on health risks across the life course. Individuals born at low or high birthweights and those born preterm may benefit from early evaluation and long-term follow-up for the prevention and treatment of mental health outcomes.

Mental health in young adults born extremely preterm or extremely low birthweight with contemporary neonatal intensive care

BACKGROUND

For infants born in the contemporary era of neonatal care, little is known about adult mental health outcomes of extremely preterm birth (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g). This study aimed to compare attention deficit hyperactivity disorder (ADHD), anxiety, mood, and substance use disorder prevalence in young adults born EP/ELBW and normal birthweight (NBW; >2499 g) controls, and to compare change in prevalence of mental health symptoms and disorders from 18 to 25 years.

METHODS

Participants were a prospective geographical cohort of 297 consecutive survivors born EP/ELBW during 1991-1992 and 260 NBW controls. At age 25 years, 174 EP/ELBW and 139 NBW participants completed the Adult ADHD Rating Scale, Structured Clinical Interview for DSM-IV Disorders, Beck Anxiety Inventory, and Center for Epidemiologic Studies Depression Scale-Revised. Data from follow-up at 18 years were also utilized. Multiple imputation was used to account for attrition.

RESULTS

Mental health outcomes at 25 years were similar between groups: prevalence rates were ADHD 7% v. 5%; anxiety 32% v. 27%; mood 38% v. 35%; substance use 12% v. 14% in the EP/ELBW and NBW groups, respectively. In both groups, ADHD declined between 18 and 25 years [odds ratio (OR) per year = 0.87, 95% confidence interval (CI) 0.79-0.95], and generalized anxiety disorder and major depressive episode became more common (OR 1.22, 95% CI 1.10-1.35 per year; OR 1.20, 95% CI 1.10-1.30 respectively).

CONCLUSIONS

This contemporary EP/ELBW cohort has comparable young adult mental health outcomes to controls, and similar patterns of change in mental health from late adolescence.

Mood and anxiety spectrum disorders detected by neuropsychiatric interviews in young adults born preterm: A prospective cohort study

BACKGROUND

Psychopathology has not yet been studied beyond pediatric age for all degrees of prematurity, including late-preterm, particularly in those who grew up with no apparent neurodevelopmental sequelae. This study aimed to examine psychopathological outcome following preterm birth and admission to neonatal intensive care in young adults without major neurodevelopmental and psychopathological problems that emerged during childhood.

METHODS

An Italian single-center prospective cohort study. Eighty-nine young adults (40 admitted to neonatal intensive care unit with less than 37 weeks of gestation and no medical history of other neurological or psychiatric conditions in childhood and 49 healthy peers born at term, matched by age, sex, and education) underwent neuropsychiatric interviews at the age of 20 ± 1 years; MINI International Neuropsychiatric Interview, Beck Depression Inventory and Barratt Impulsive Scale, results were correlated to individual neonatal data and cognitive measures.

RESULTS

We found a significantly higher prevalence of psychopathology at MINI score (22.5% vs. 4.2%; χ2 = 6.7; p = 0,010) and prevalence of previous stressful life events in the preterm compared to at-term group. B.D.I. (testing depression) and BIS-11(testing impulsivity) did not highlight a statistically significant difference between the groups. All patients had average I.Q., a statistically significant difference (p < 0.001) was observed between groups with a better performance in controls than cases.

CONCLUSIONS

Preterm infants attaining young adult age with otherwise typical development during childhood are at risk of psychopathology and lower resilience to stressful life events. The MINI interview could be a useful tool to highlight the psychopathology of preterm infants attaining adult age.

Associations of crying, sleeping, and feeding problems in early childhood and perceived social support with emotional disorders in adulthood

BACKGROUND

Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems) are associated with increased internalizing symptoms in adulthood. Unknown is whether early regulatory problems are associated with emotional disorders in adulthood, and what psychosocial factors may provide protection. We tested whether early childhood multiple or persistent regulatory problems are associated with a higher risk of (a) any mood and anxiety disorder in adulthood; (b) perceiving no social support in adulthood; and (c) whether social support provides protection from mood and anxiety disorders among participants who had multiple/persistent regulatory problems and those who never had regulatory problems.

METHODS

Data from two prospective longitudinal studies in Germany (n = 297) and Finland (n = 342) was included (N = 639). Regulatory problems were assessed at 5, 20, and 56 months with the same standardized parental interviews and neurological examinations. In adulthood (24-30 years), emotional disorders were assessed with diagnostic interviews and social support with questionnaires.

RESULTS

Children with multiple/persistent regulatory problems (n = 132) had a higher risk of any mood disorder (odds ratio (OR) = 1.81 [95% confidence interval = 1.01-3.23]) and of not having any social support from peers and friends (OR = 1.67 [1.07-2.58]) in adulthood than children who never had regulatory problems. Social support from peers and friends provided protection from mood disorders, but only among adults who never had regulatory problems (OR = 4.03 [2.16-7.94]; p = .039 for regulatory problems x social support interaction).

CONCLUSIONS

Children with multiple/persistent regulatory problems are at increased risk of mood disorders in young adulthood. Social support from peers and friends may, however, only provide protection from mood disorders in individuals who never had regulatory problems.

Fiber-Specific Measures of White Matter Microstructure and Macrostructure Are Associated With Internalizing and Externalizing Symptoms in Children Born Very Preterm and Full-term

BACKGROUND

Tensor-based investigations suggest that delayed or disrupted white matter development may relate to adverse behavioral outcomes in individuals born very preterm (VP); however, metrics derived from such models lack specificity. Here, we applied a fixel-based analysis framework to examine white matter microstructural and macrostructural correlates of concurrent internalizing and externalizing problems in VP and full-term (FT) children at 7 and 13 years.

METHODS

Diffusion imaging data were collected in a longitudinal cohort of VP and FT individuals (130 VP and 29 FT at 7 years, 125 VP and 44 FT at 13 years). Fixel-based measures of fiber density, fiber-bundle cross-section, and fiber density and cross-section were extracted from 21 white matter tracts previously implicated in psychopathology. Internalizing and externalizing symptoms were assessed using the Strengths and Difficulties Questionnaire parent report at 7 and 13 years.

RESULTS

At age 7 years, widespread reductions in fiber-bundle cross-section and fiber density and cross-section and tract-specific reductions in fiber density were related to more internalizing and externalizing symptoms irrespective of birth group. At age 13 years, fixel-based measures were not related to internalizing symptoms, while tract-specific reductions in fiber density, fiber-bundle cross-section, and fiber density and cross-section measures were related to more externalizing symptoms in the FT group only.

CONCLUSIONS

Age-specific neurobiological markers of internalizing and externalizing problems identified in this study extend previous tensor-based findings to inform pathophysiological models of behavior problems and provide the foundation for investigations into novel preventative and therapeutic interventions to mitigate risk in VP and other high-risk infant populations.

Growth of prefrontal and limbic brain regions and anxiety disorders in children born very preterm

BACKGROUND

Children born very preterm (VP) display altered growth in corticolimbic structures compared with full-term peers. Given the association between the cortiocolimbic system and anxiety, this study aimed to compare developmental trajectories of corticolimbic regions in VP children with and without anxiety diagnosis at 13 years.

METHODS

MRI data from 124 VP children were used to calculate whole brain and corticolimbic region volumes at term-equivalent age (TEA), 7 and 13 years. The presence of an anxiety disorder was assessed at 13 years using a structured clinical interview.

RESULTS

VP children who met criteria for an anxiety disorder at 13 years (n = 16) displayed altered trajectories for intracranial volume (ICV, p < 0.0001), total brain volume (TBV, p = 0.029), the right amygdala (p = 0.0009) and left hippocampus (p = 0.029) compared with VP children without anxiety (n = 108), with trends in the right hippocampus (p = 0.062) and left medial orbitofrontal cortex (p = 0.079). Altered trajectories predominantly reflected slower growth in early childhood (0-7 years) for ICV (β = -0.461, p = 0.020), TBV (β = -0.503, p = 0.021), left (β = -0.518, p = 0.020) and right hippocampi (β = -0.469, p = 0.020) and left medial orbitofrontal cortex (β = -0.761, p = 0.020) and did not persist after adjusting for TBV and social risk.

CONCLUSIONS

Region- and time-specific alterations in the development of the corticolimbic system in children born VP may help to explain an increase in anxiety disorders observed in this population.

Anxiety, Depression, and Behavioral and/or Conduct Disorder in Adolescence Among Former Preterm and Term Infants of Different Race and Ethnicities

OBJECTIVE

To compare parental reports of recent diagnoses of anxiety, depression, and/or behavioral/conduct disorder among former preterm (PT) and term adolescents by race/ethnicity and evaluate receipt of mental healthcare within the past year among those adolescents with any of these conditions.

STUDY DESIGN

A total of 20,871 Non-Hispanic white (NHW), Non-Hispanic black (NHB), and Hispanic adolescents were evaluated using data from the 2017/2018 National Survey of Children's Health. PT birth and race/ethnicity disparity in the diagnosis of these emotional/behavioral problems and receipt of mental healthcare among adolescents with any of these diagnoses were analyzed using logistic regression.

RESULTS

The unadjusted prevalence (95% CI) of these diagnoses was significantly higher among former PT (0.19 [0.17-0.22]) compared to term (0.15 [0.14-0.16]) adolescents. Despite having higher rates of adverse socioeconomic measures, former PT and term NHBs and Hispanics had lower unadjusted prevalence of these diagnoses in comparison to NHWs. After adjusting for differences in demographic, clinical, and socioeconomic characteristics, NHBs (0.47 [0.36-0.64]) and Hispanics (0.40 [0.30-0.54]) remain at lower odds of the composite measure of the emotional and/or behavioral problems compared to NHWs, while PT birth did not have a significant impact on this outcome measure. Only 53% of adolescents with these diagnoses received recent mental healthcare. No significant differences in the adjusted odds of receipt of mental healthcare were noted across the groups based on PT birth or race/ethnicity.

CONCLUSIONS

In contrast to PT birth, race/ethnicity had a significant impact on the adjusted odds of emotional/behavioral disorders during adolescence. Among adolescents with these diagnoses, PT birth and race/ethnicity did not significantly influence the adjusted odds of receipt of mental healthcare.

Psychiatric disorders in individuals born very preterm / very low-birth weight: An individual participant data (IPD) meta-analysis

BACKGROUND

Data on psychiatric disorders in survivors born very preterm (VP; <32 weeks) or very low birthweight (VLBW; <1500 g) are sparse. We compared rates of psychiatric diagnoses between VP/VLBW and term-born, normal birthweight (term/NBW) control participants.

METHODS

This individual participant data (IPD) meta-analysis pooled data from eligible groups in the Adults born Preterm International Collaboration (APIC). Inclusion criteria included: 1) VP/VLBW group (birth weight <1500 g and/or gestational age <32 weeks), 2) normal birth weight/term-born control group (birth weight >2499 g and/or gestational age ≥37 weeks), and 3) structured measure of psychiatric diagnoses using DSM or ICD criteria. Diagnoses of interest were Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), Anxiety Disorder, Mood Disorder, Disruptive Behaviour Disorder (DBD), Eating Disorder, and Psychotic Disorder. A systematic search for eligible studies was conducted (PROSPERO Registration Number 47555).

FINDINGS

Data were obtained from 10 studies (1385 VP/VLBW participants, 1780 controls), using a range of instruments and approaches to assigning diagnoses. Those born VP/VLBW had ten times higher odds of meeting criteria for ASD (odds ratio [OR] 10·6, 95% confidence interval [CI] 2·50, 44·7), five times higher odds of meeting criteria for ADHD (OR 5·42, 95% CI 3·10, 9·46), twice the odds of meeting criteria for Anxiety Disorder (OR 1·91, 95% CI 1·36, 2·69), and 1·5 times the odds of meeting criteria for Mood Disorder (OR 1·51, 95% CI 1·08, 2·12) than controls. This pattern of findings was consistent within age (<18 years vs. ≥18 years) and sex subgroups.

INTERPRETATION

Our data suggests that individuals born VP/VLBW might have higher odds of meeting criteria for certain psychiatric disorders through childhood and into adulthood than term/NBW controls. Further research is needed to corroborate our results and identify factors associated with psychiatric disorders in individuals born VP/VLBW.

FUNDING

Australia's National Health & Medical Research Council; CAPES (Coordenação de Aperfeiçoamento de Pessoal deNível Superior) - International Cooperation General Program; Canadian Institutes of Health Research Team Grant; National Council for Scientific and Technological Development (CNPq); Academy of Finland; Sigrid Juselius Foundation; Signe and Ane Gyllenberg Foundation; European Union's Horizon 2020 research and innovation programme: Project RECAP-Preterm; European Commission Dynamics of Inequality Across the Life-course: structures and processes (DIAL); Neurologic Foundation of New Zealand; MRC programme grant; Health Research Council of New Zealand; National Institutes of Health, USA; The Research Council of Norway; Joint Research Committee between St. Olavs Hospital and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU); Liaison Committee between Central Norway Regional Health Authority and NTNU.

Mental health, neurodevelopmental, and family psychosocial profiles of children born very preterm at risk of an early-onset anxiety disorder

AIM

To compare the mental health and neurodevelopmental profiles of school-age children born very preterm, with and without an anxiety disorder, and to identify neonatal medical, psychosocial, and concurrent neurodevelopmental correlates.

METHOD

A regional cohort of 102 (51 males, 51 females) children born very preterm (mean [SD] gestation at birth=28wks [2], range=23-31wks) was studied from birth to age 9 years alongside a comparison group of 109 (58 males, 51 females) children born at term (mean [SD] gestation at birth=40wks [1], range=38-41wks). At age 9 years, all children underwent a neurodevelopmental evaluation while parents were interviewed using the Development and Well-Being Assessment to diagnose a range of DSM-IV childhood psychiatric disorders. Detailed information was also available about the children's neonatal medical course and postnatal psychosocial environment, including maternal mental health and parenting.

RESULTS

At age 9 years, 21% (n=21) of very preterm and 13% (n=14) of term-born children met diagnostic criteria for an anxiety disorder. Clinically-anxious children born very preterm were characterized by higher rates of comorbid mental health (odds ratio [OR]=11.5, 95% confidence interval [CI]=3.8-34.7), social (OR=6.2, 95% CI=2.1-18.4), motor (OR=4.4, 95% CI=1.6-12.2), and cognitive (OR=2.6, 95% CI=1.0-7.0) problems than those without an anxiety disorder. Concurrent maternal mental health and child social difficulties were the strongest independent correlates of early-onset child anxiety disorders.

INTERPRETATION

Children born very preterm who developed an early-onset anxiety disorder were subject to high rates of comorbid problems. Findings highlight the importance of addressing both maternal and child mental health issues to optimize outcomes in this high-risk population. What this paper adds One out of five school-age children born very preterm are likely to meet DSM-IV diagnostic criteria for an anxiety disorder. Half of these children born very preterm with an early-onset anxiety disorder have comorbid attention-deficit/hyperactivity disorder. Other neurodevelopmental correlates of early-onset anxiety disorders include lower cognitive ability, motor problems, and peer social difficulties. Concurrent maternal mental health and child social adjustment problems were the strongest correlates of early-onset anxiety disorder risk among children born very preterm.

Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely

Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire‐9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers’ family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.

Common Core Assessments in follow-up studies of adults born preterm-Recommendation of the Adults Born Preterm International Collaboration

BACKGROUND

Of all newborns, 1%-2% are born very preterm (VP; <32 weeks) or with very low birthweight (VLBW; ≤1500 g). Advances in prenatal and neonatal care have substantially improved their survival, and the first generations who have benefited from these advances are now entering middle age. While most lead healthy lives, on average these adults are characterised by a number of adversities. These include cardiometabolic risk factors, airway obstruction, less physical activity, poorer visual function, lower cognitive performance, and a behavioural phenotype that includes inattention and internalising and socially withdrawn behaviour that may affect life chances and quality of life. Outcomes in later adulthood are largely unknown, and identifying trajectories of risk or resilience is essential in developing targeted interventions. Joint analyses of data and maintenance of follow-up of cohorts entering adulthood are essential. Such analyses are ongoing within the Adults Born Preterm International Collaboration (APIC; www.apic-preterm.org). Joint analyses require data harmonisation, highlighting the importance of consistent assessment methodologies.

OBJECTIVE

To present an expert recommendation on Common Core Assessments to be used in follow-up assessments of adults born preterm.

METHODS

Principles of Common Core Assessments were discussed at APIC meetings. Experts for each specific outcome domain wrote the first draft on assessments pertaining to that outcome. These drafts were combined and reviewed by all authors. Consensus was reached by discussion at APIC meetings.

RESULTS

We present a recommendation by APIC experts on consistent measures to be used in adult follow-up assessments.

CONCLUSIONS

The recommendation encompasses both "core" measures which we recommend to use in all assessments of adults born preterm that include the particular outcome. This will allow comparability between time and location. The recommendation also lists optional measures, focusing on current gaps in knowledge. It includes sections on study design, cardiometabolic and related biomarkers, biological samples, life style, respiratory, ophthalmic, cognitive, mental health, personality, quality of life, sociodemographics, social relationships, and reproduction.

Association of Preterm Birth With Prescription of Psychotropic Drugs in Adolescence and Young Adulthood

IMPORTANCE

Individuals born preterm have increased risk of mental health impairment compared with individuals born at term. The associations between preterm birth and attention-deficit/hyperactivity disorder and autism are well established; for depression, anxiety, psychotic and bipolar disorder, studies show divergent results.

OBJECTIVE

To compare the prescription of psychotropic drugs in adolescence and young adulthood between those born preterm and those born at term.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used registry data to identify all Norwegians born after 23 weeks of completed gestation between 1989 and 1998. Included individuals were those without registered birth defects, alive at age 10 years, and with available maternal data. Individuals were followed up from 2004 to 2016. Psychotropic drug prescriptions received from age 10 to 23 years were compared between preterm groups and peers born at term. Individuals were compared with their siblings to control for shared family confounding. Data analyses were performed from August 2018 through February 2020.

EXPOSURES

Gestational age at birth (GA) was categorized in 4 groups: extremely preterm (GA, 23 weeks and 0 days to 27 weeks and 6 days), very preterm (GA, 28 weeks and 0 days to 31 weeks and 6 days), moderately or late preterm (GA, 32 weeks and 0 days to 36 weeks and 6 days), and full term (GA, 37 weeks and 0 days to 44 weeks and 6 days).

MAIN OUTCOMES AND MEASURES

Prescriptions of psychotropic drugs (ie, prescriptions specifically of psychostimulants, antidepressants, anxiolytics, hypnotics or sedatives, or antipsychotics or prescriptions of any of these 5 drugs) among preterm groups were compared with prescriptions among peers born at term and among siblings.

RESULTS

Among 505 030 individuals (259 545 [51.4%] males; mean [SD] birth weight, 3533 [580] g), 762 individuals (0.2%) were extremely preterm, 2907 individuals (0.6%) were very preterm, 25 988 individuals (5.1%) were moderately or late preterm, and 475 373 individuals (94.1%) were full term. Individuals born preterm had increased risk of psychotropic drug prescription, with a dose-response association between GA and prescription. The extremely preterm group had higher rates of prescription for all drug types compared with peers born at term, with odds ratios from 1.7 (95% CI, 1.4-2.1) for antidepressants to 2.7 (95% CI, 2.1-3.4) for psychostimulants. The elevated odds of prescription of all types were less pronounced in the moderately to late preterm group, including odds ratios of 1.1 (95% CI, 1.0-1.1) for antidepressants and 1.2 (95% CI, 1.1-1.2) for psychostimulants. The increases in odds were smaller in the sibling comparison, and increases were not significant for several groups. For example, the OR for any prescription in the sibling analysis was 1.8 (95% CI, 1.2-2.8) in the very preterm group and 1.0 (95% CI, 0.9-1.1) in the moderately or late preterm group.

CONCLUSIONS AND RELEVANCE

This cohort study found higher rates of prescription of psychotropic drugs throughout adolescence and young adulthood among individuals with all degrees of preterm birth compared with those born at term. These results provide further evidence for an increased risk of mental health impairment among individuals born preterm and suggest that this is not restricted to the most preterm groups.

Testing the neurodevelopmental, trauma and developmental risk factor models of psychosis using a naturalistic experiment

BACKGROUND

The neurodevelopmental and trauma theories are two widely cited models of psychosis. A third - the developmental risk factor model (DRFM) - recognises the combined role of neurodevelopmental risks and trauma. Our objective was to test these theories using preterm populations as a natural experiment, given the high prevalence of neurodevelopmental deficits and exposure to trauma.

METHODS

Two population-based preterm birth cohorts, the Bavarian Longitudinal Study (BLS; N = 399) and EPICure Study (N = 184), were included with term-born controls. Peer victimisation in childhood was assessed by parent and child report and psychotic experiences (PE) were assessed in early adulthood. Different models of psychosis were tested using regression and mediation analyses.

RESULTS

There was support for the trauma and DRFM in the BLS. Peer victimisation increased the risk of PE for preterm and term-born participants equally [odds ratio = 4.87, 95% confidence interval (CI) 1.96-12.08]. There was an indirect effect where preterm children were more likely to be victimised, which subsequently increased risk of PE [β = 1.12 (s.e. = 0.61), 95% CI 0.11-2.48]. The results were replicated in EPICure.

CONCLUSIONS

Exposure to trauma which is experienced more often by neurodevelopmental risk children rather than neurodevelopmental risk per se increases the risk of PE. The findings are consistent with the trauma model and DRFM. Interventions focused on reducing trauma may reduce the development of PE.

Anxiety and Depressive Disorders in Children Born Preterm: A Meta-Analysis

OBJECTIVE

Preterm birth is associated with a high prevalence of psychiatric disorders including internalizing problems. However, there is a lack of consensus on the risk for depression and on specific diagnostic profiles. This meta-analysis investigates the independent pooled odds of Diagnostic and Statistical Manual of Mental Disorders Fourth Edition anxiety and depressive disorders in children between 3 and 19 years of age born preterm compared with their term-born peers.

METHOD

PubMed/MEDLINE, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature electronic databases were searched (last updated in September 2019) using population ("child"), exposure ("preterm birth"), and outcome ("anxiety") terms for English peer-reviewed publications. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed with the risk of bias assessed using the Newcastle-Ottawa Quality Assessment Scale. Pooled odds ratio (OR) with 95% confidence intervals (CIs) was estimated using fixed-effects models.

RESULTS

Eleven independent studies met the inclusion criteria. The pooled sample comprised 1294 preterm and 1274 term-born children with anxiety outcomes and 777 preterm and 784 term-born children with depressive outcomes between 3 and 19 years of age. Children born preterm had significantly greater odds for anxiety (OR: 2.17; 95% CI, 1.43-3.29), generalized anxiety (OR: 2.20; 95% CI, 1.26-3.84), and specific phobia (OR: 1.93; 95% CI, 1.05-3.52) relative to their term-born peers. There were no significant between-group differences for reported depressive disorders.

CONCLUSION

Preterm birth is associated with a higher prevalence of anxiety, but not depressive disorders, from 3 to 19 years of age, suggesting distinct etiological pathways in this high-risk population. The findings support variation in the rates of specific anxiety diagnoses, indicating the need to extend neurodevelopmental surveillance to encompass a holistic emotional screening approach.

Frühgeburtlichkeit und langfristige Folgen bis ins Schulalter

Zusammenfassung. Theoretischer Hintergrund: Frühgeborene (FG) haben ein erhöhtes langfristiges Entwicklungsrisiko. Dennoch gibt es in Deutschland kein konzertiertes Vorgehen zur Nachsorge bis ins Schulalter. Die heutigen Erkenntnisse zu Entwicklungsstörungen sind Grundlage einer qualifizierten Förderung. Fragestellung: Wie hoch sind Schulrückstellungsraten bei FG? Wie wird den schulischen Bedürfnissen FG Rechnung getragen? Methode: Evaluation der Schulrückstellung in einer aktuellen Kohorte sehr kleiner FG und qualitative Befragung von Lehrer_innen. Ergebnisse: Das Risiko für Schulrückstellungen ist bei FG erhöht. Lehrer_innen haben ein limitiertes Wissen zu Bedürfnissen FG und gleichzeitig hilfreiche Vorschläge für spezifische Förderung im Unterricht. Diskussion und Schlussfolgerung: Langfristige entwicklungsneurologische Nachsorge für FG ist dringend empfohlen, um potenzielle Probleme früh zu identifizieren, Interventionen zu initiieren und eine optimale Entfaltung des Entwicklungspotentials zu fördern.

Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review

BACKGROUND

Prenatal and perinatal risk factors for anxiety disorders have rarely been studied, even though they are highly prevalent in children and adolescents. It is important to identify the common risk factors, so that targeted preventive care and early interventions can be provided.

METHODS

A systematic review of the PubMed and PsycInfo databases was conducted to 25 October 2019, according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines. The protocol was registered on the Prospective Register of Systematic Reviews and the quality assessment was carried out using the Joanna Briggs tools.

RESULTS

The review identified 31 studies from eight countries, including three register studies. Cohort sizes ranged from 69 to 89,404 and diagnoses cases ranged from 4 to 7867. Although various risk factors had been researched, only few of them had been repeatedly studied and the findings were highly inconsistent. The associations between the different risk factors and anxiety disorders seemed weak compared to many other psychiatric disorders, but preterm birth and maternal somatic illnesses may increase the risk for anxiety disorders in offspring.

LIMITATIONS

The studies varied considerably by study design, risk factors and anxiety disorders studied, sample sizes and follow up periods.

CONCLUSIONS

Prenatal and perinatal risk factors for anxiety disorders have been under-researched, compared to other psychiatric disorders. Our systematic review found weak links to prenatal events, but flagged up preterm birth and maternal somatic illnesses as possible avenues for future research.

Personality, emotional and cognitive functions in young adults born preterm

BACKGROUND

Survival of preterm very low birthweight infants resulted in high risk for developmental cognitive deficits, poor academic achievement, and behaviour disorders. While numerous studies evaluated the prevalence of neurodevelopmental disability in early childhood, poor literature is available for infants born very low birthweight in adulthood.

MATERIALS AND METHODS

Fifty-five young adults born preterm (mean age: 18 ± 2.42 years; <33 weeks of gestational age and/or with birth weight <1500 g) were enrolled. The Verbal Intelligence Quotient (vIQ), Performance Intelligence Quotient (pIQ) and Total Intelligence Quotient (tIQ) were assessed through the Wechsler Adult Intelligence Scale - Revised (WAIS-R). Personality profiles were investigated using Rorschach test. Both WAIS-R and Rorschach scores were subsequently compared to 13 matched controls born at term. Data were analysed with the SPSS v20 for Windows statistical package.

RESULTS

Young adults born preterm showed lower IQ scores than young adults born at term: tIQ 90.95 ± 22.46 versus 108.77 ± 16.14, p = 0.006; vIQ 89.85 ± 21.85 versus 107.69 ± 18.33, p = 0.009, and pIQ 92.40 ± 22.90 versus 108.31 ± 14.52, p = 0.011. No differences emerged in personality profile as most subjects showed adequate internal resources in both groups, but a trend towards anxiety and insecurity were identified in young adult born preterm.

CONCLUSIONS

Young adults born preterm show psychological fragility and lower cognitive pattern than young adults born at term. Data support the need of an early psychological intervention that could help these individuals at greater risk to face a young society that is changing and that necessarily requires stronger internal resources.

Quality of life of adults born very preterm or very low birth weight: A systematic review

Aim

To establish differences in health‐related quality of life (HRQoL) in adults born term and those born very preterm (VPT) and/or with a very low birth weight (VLBW).

Methods

Our systematic review is preregistered under PROSPERO‐ID CRD42018084005. Studies were eligible for inclusion if their authors had stated the HRQoL of adults (18 years or older) born VPT (<32 weeks of gestation) or VLBW (<1500 g of birth weight) had been measured, if written in English, and if they reported a comparison with a control group or valid norms. We searched Pubmed, Scopus, Psycinfo, Web of Science, Embase and contacted experts in this field. Non‐response and other bias‐related problems were evaluated.

Results

We included 18 studies of 15 unique cohorts from 11 countries. In 11 studies, no differences in HRQoL between VPT or VLBW and term‐born adults were found; four studies found lower HRQoL in VPT/VLB adults; and evidence from three studies was inconclusive. Disability, sex and age were associated with HRQoL.

Conclusion

There is no conclusive evidence that HRQoL differs between term‐born adults and those born VPT or with a VLBW. The comparability of studies was restricted by differences between HRQoL measurements, age ranges at assessment and definition of disability.

Obstetric complications and subsequent risk of mood disorders for offspring in adulthood: a comprehensive overview

Background: A number of studies reported obstetric complications (OCs) to be a risk factor for the development of psychiatric conditions in the adulthood, including mood disorders.Aim: The aim of this study was to review the literature about the link between OCs during the perinatal period (items of Lewis-Murray scale) and the future risk of developing a mood disorder in adulthood, such as the major depressive disorder (MDD) or the bipolar disorder (BD).Methods: A research in the main database sources has been conducted to obtain an overview of the association mentioned above.Results: Few studies have investigated the role of OCs in the development of mood disorders in adulthood. The most robust evidence is that low birth weight (LBW) and preterm birth may be risk factors for the development of MDD in the future, even if some of the available data come from studies with small sample sizes or a retrospective design.Conclusion: OCs may confer a risk of developing mood disorders in adulthood. Future research should confirm these preliminary findings and clarify if other obstetric or neonatal complications (e.g. cyanosis or newborn epileptic seizures) may have a role in the future onset of mood disorders.

Emerging atypical connectivity networks for processing angry and fearful faces in very preterm born children

Very preterm born (VPT) children are those born before 32/40 weeks' gestational age and comprise 10% of the 15 million babies born prematurely worldwide each year. Due to advancements in neonatal medicine, the survival rate of VPT birth has increased, but few studies have investigated the nonmedical, social-cognitive morbidities that affect these children. In this study, we examined emotional face processing networks in VPT compared to age and sex matched full-term born (FT) children. Magnetoencephalography (MEG) was used to test VPT and FT born children at 6 years (n = 78) and 8 years (n = 83). Children were assessed using an implicit emotion face-processing task. Happy, fearful, and angry faces were presented for 150 ms, but children were asked to respond by button press to the location of a control pixelated image of the face displayed on the side of the screen opposite to the face. Children rated the valence of the images on a five-point scale. Group differences showed that VPT children rated angry faces more positively than their FT peers. VPT children had reduced connectivity for angry and fearful faces at 8 years in networks including regions such as the bilateral amygdala, superior temporal sulci, and anterior cingulate gyrus. Interventions should target both emotion recognition, as well as higher cognitive processes related to emotional control and thinking about one's own emotions.

Sex-dependent associations of low birth weight and suicidal ideation in adulthood: a community-based cohort study

Low birth weight (LBW; < 2,500 g) has been identified as a risk factor for adverse mental health outcomes over the life span. However, little is known about the association of LBW and suicidal ideation in middle and late adulthood. We investigated N = 8,278 participants of a representative community cohort: 3,849 men (46.5%) and 4,429 women (53.5%) (35-74 years of age). We assessed standardized measures of mental distress, sociodemographics, health behavior, and somatic factors (based on an extensive medical assessment). Controlling for these confounders, we examined the relationship of birth weight and suicidal ideation in logistic regression models. As men and women differ with regard to their susceptibility to suicidal ideation and behavior, we tested sex-dependent effects. LBW was reported by 458 participants (5.5%). In men, LBW was associated with a higher likelihood of reporting suicidal ideation (OR 2.92, 95% CI 1.58-5.12). In women, there was no such relationship. The findings underscore the interrelatedness of the physical and psychological domain, the role of early adversity in suicidal ideation, and they identify a vulnerable group whose numbers are expected to grow. They also indicate other risk factors for suicidal ideation in the community (mental distress, lack of social support, and health risk behavior).

The influence of pre and postnatal adversity on depression and anxiety over two decades

INTRODUCTION

Perinatal and later postnatal adversity (e.g., child sexual abuse) are predictors of psychopathology across the lifespan. However, little is known about the impact of the joint effects of perinatal and postnatal adversity on the longitudinal trajectories of mental health problems from adolescence through adulthood.

METHOD

We utilized data from a prospective, longitudinal birth cohort of extremely low birth weight (ELBW; < 1000 g) survivors and normal birth weight (NBW; > 2500 g) control participants. Self-report data on internalizing (depression, anxiety) and externalizing (antisocial) problems were collected at 12-16, 22-26, and 30-35 years of age.

RESULTS

A birth weight by child sexual abuse (CSA) interaction was observed such that ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than NBW participants exposed to CSA. Differences remained significant after adjustment for covariates. Likewise, ELBW survivors exposed to CSA had higher levels of internalizing problems from adolescence through adulthood than ELBW participants who were not exposed to CSA.

LIMITATIONS

Findings are limited by sample attrition due to the longitudinal nature of the study spanning over 30 years as well as the retrospective nature of child sexual abuse reporting.

CONCLUSIONS

Exposure to both perinatal and later postnatal adversity leads to persistently higher internalizing problems than exposure to either adversity alone over more than two decades. These findings suggest that individuals exposed to perinatal adversity may be especially vulnerable to, and persistently affected by, childhood adversity, particularly in the form of depression and anxiety.

Mental health outcomes of adults born very preterm or with very low birth weight: A systematic review

Preterm birth research is poised to explore the mental health of adults born very preterm(VP; <32⁺⁰ weeks gestational age) and/or very low birth weight(VLBW; <1500g) through individual participant data meta-analyses, but first the previous evidence needs to be understood. We systematically reviewed and assessed the quality of the evidence from VP/VLBW studies with mental health symptoms or disorders appearing in adulthood, excluding childhood onset disorders. Participants (≥18 years, born >1970) included VP/VLBW individuals with controls born at term(≥37⁺⁰ weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed.

The Life Course Consequences of Very Preterm Birth

Around 15 million children are born preterm (<37 weeks of gestation) every year. Of these, 15% or 2.25 million are born very preterm (VP; <32 weeks of gestation). Here, the developmental outcomes of VP babies in diverse domains from motor, cognitive, and social function to mental health and well-being throughout childhood and adolescence are reviewed. Their life course adaptation in terms of romantic relationships, employment, and quality of life into adulthood is also considered. Some adverse effects reduce as individuals age, and others remain remarkably stable from childhood into adulthood. We argue that to advance understanding of developmental mechanisms and direct resources for intervention more effectively, social factors need to be assessed more comprehensively, and genetically sensitive designs should be considered with neuroimaging integrated to test alternative developmental models. As current evidence is based almost exclusively on studies from high-income countries, research from low- and middle-income countries is urgently needed.

Psychiatric Symptoms and Disorders in Extremely Preterm Young Adults at 19 Years of Age and Longitudinal Findings From Middle Childhood

Since the 1980s, the long-term outcomes of extremely preterm birth (before 28 weeks of gestation) have garnered considerable interest as a result of significant improvements in neonatal care and the consequent increase in survival rates. Compared with birth at full term, extremely preterm birth places infants at increased risk for neurodevelopmental disorders, intellectual impairments, and psychiatric sequelae that persist throughout childhood and adolescence.¹ There is increasing interest in the longer-term outcomes for these babies; in particular, whether adverse outcomes persist or increase in adulthood or whether survivors can outgrow earlier problems.

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.

Effects of Gestational Age and Early Parenting on Children's Social Inhibition at 6 Years

Preterm birth (<37 weeks' gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent-infant relationships on social inhibition, 1314 children born at 26-41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent-infant relationship quality was assessed postnatally with the parent-infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17-1.40], verbal: OR = 1.23 [95% CI 1.13-1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11-1.32], verbal: OR = 1.11 [95% CI = 1.01-1.21]) responses. Good early parent-infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52-0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent-infant relationships may reduce preterm children's risk for social difficulties.

General cognitive but not mathematic abilities predict very preterm and healthy term born adults' wealth

Objective

Very preterm (<32 weeks gestation; VP) and/or very low birth weight (<1500g; VLBW) children often have cognitive and mathematic difficulties. It is unknown whether VP/VLBW children’s frequent mathematic problems significantly add to the burden of negative life-course consequences over and above effects of more general cognitive deficits. Our aim was to determine whether negative consequences of VP/VLBW versus healthy term birth on adult wealth are mediated by mathematic abilities in childhood, or rather explained by more general cognitive abilities.

Methods

193 VP/VLBW and 217 healthy term comparison participants were studied prospectively from birth to adulthood as part of a geographically defined study in Bavaria (South Germany). Mathematic and general cognitive abilities were assessed at 8 years with standardized tests; wealth information was assessed at 26 years with a structured interview and summarized into a comprehensive index score. All scores were z-standardized.

Results

At 8 years, VP/VLBW (n = 193, 52.3% male) had lower mathematic and general cognitive abilities than healthy term comparison children (n = 217, 47.0% male). At 26 years, VP/VLBW had accumulated significantly lower overall wealth than term born comparison adults (-0.57 (1.08) versus -0.01 (1.00), mean difference 0.56 [0.36–0.77], p < .001). Structural equation modeling confirmed that VP/VLBW birth (β = -.13, p = .022) and childhood IQ (β = .24, p < .001) both directly predicted adult wealth, but math did not (β = .05, p = .413). Analyses were controlled for small-for-gestational-age (SGA) birth, child sex, and family socioeconomic status.

Conclusion

This longitudinal study from birth to adulthood shows that VP/VLBW survivors’ general cognitive rather than specific mathematic problems explain their diminished life-course success. These findings are important in order to design effective interventions at school age that reduce the burden of prematurity for those individuals who were born at highest neonatal risk.

Influence of Low Protein Diet-Induced Fetal Growth Restriction on the Neuroplacental Corticosterone Axis in the Rat

Objectives: Placental steroid metabolism is linked to the fetal hypothalamus-pituitary-adrenal axis. Intrauterine growth restriction (IUGR) might alter this cross-talk and lead to maternal stress, in turn contributing to the pathogenesis of anxiety-related disorders of the offspring, which might be mediated by fetal overexposure to, or a reduced local enzymatic protection against maternal glucocorticoids. So far, direct evidence of altered levels of circulating/local glucocorticoids is scarce. Liquid chromatography tandem-mass spectrometry (LC-MS/MS) allows quantitative endocrine assessment of blood and tissue. Using a rat model of maternal protein restriction (low protein [LP] vs. normal protein [NP]) to induce IUGR, we analyzed fetal and maternal steroid levels via LC-MS/MS along with the local expression of 11beta-hydroxysteroid-dehydrogenase (Hsd11b). Methods: Pregnant Wistar dams were fed a low protein (8%, LP; IUGR) or an isocaloric normal protein diet (17%, NP; controls). At E18.5, the expression of Hsd11b1 and 2 was determined by RT-PCR in fetal placenta and brain. Steroid profiling of maternal and fetal whole blood, fetal brain, and placenta was performed via LC-MS/MS. Results: In animals with LP-induced reduced body (p < 0.001) and placental weights (p < 0.05) we did not observe any difference in the expressional Hsd11b1/2-ratio in brain or placenta. Moreover, LP diet did not alter corticosterone (Cort) or 11-dehydrocorticosterone (DH-Cort) levels in dams, while fetal whole blood levels of Cort were significantly lower in the LP group (p < 0.001) and concomitantly in LP brain (p = 0.003) and LP placenta (p = 0.002). Maternal and fetal progesterone levels (whole blood and tissue) were not influenced by LP diet. Conclusion: Various rat models of intrauterine stress show profound alterations in placental Hsd11b2 gatekeeper function and fetal overexposure to corticosterone. In contrast, LP diet in our model induced IUGR without altering maternal steroid levels or placental enzymatic glucocorticoid barrier function. In fact, IUGR offspring showed significantly reduced levels of circulating and local corticosterone. Thus, our LP model might not represent a genuine model of intrauterine stress. Hypothetically, the observed changes might reflect a fetal attempt to maintain anabolic conditions in the light of protein restriction to sustain regular brain development. This may contribute to fetal origins of later neurodevelopmental sequelae.

Trajectories of psychopathology in extremely low birth weight survivors from early adolescence to adulthood: a 20-year longitudinal study

BACKGROUND

Individuals born extremely preterm are exposed to significant perinatal stresses that are associated with an increased risk of psychopathology. However, a paucity of longitudinal studies has prevented the empirical examination of long-term, dynamic effects of perinatal adversity on mental health. Here, internalizing and externalizing problems from adolescence through adulthood were compared in individuals born at extremely low birth weight (ELBW; <1,000 g) and normal birth weight (NBW; >2,500 g).

METHODS

Internalizing and externalizing data were collected over 20 years in three waves, during adolescence, young adulthood, and adulthood. Growth models were used to compare longitudinal trajectories in a geographically based sample of 151 ELBW survivors and 137 NBW control participants born between 1977 and 1982 matched for age, sex, and socioeconomic status at age 8.

RESULTS

After adjusting for sex, socioeconomic and immigrant status, and family functioning, ELBW survivors failed to show the normative, age-related decline in internalizing problems over time relative to their NBW peers (β = .21; p < .01). Both groups exhibited small declines in externalizing problems over the same period. Self-esteem (but not physical health, IQ, or maternal mood) partially mediated the association between ELBW status and internalizing problems.

CONCLUSIONS

Extremely low birth weight survivors experienced a blunting of the expected improvement in depression and anxiety from adolescence to adulthood. These findings suggest that altered physiological regulatory systems supporting emotional and cognitive processing may contribute to the maintenance of internalizing problems in this population.

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.