Personality in Adults Who Were Born Very Preterm

Socioeconomic outcomes beyond 30 years of age in a cohort born with very low birth weight

AIM

As survival of infants born prematurely has increased dramatically, questions on long-term consequences have emerged. Our aim was to investigate long-term effects of very low birth weight on socioeconomic outcomes.

METHODS

One hundred and fifty very low birth weight infants (VLBW) born from 1980 to 1982 at Rigshospitalet, Denmark, who had previously been followed up at age 2, 4 and 18 years, were compared to cohorts of low birth weight, normal birth weight (NBW) and a national population-based reference cohort. From the Danish national registers we obtained data regarding educational level, financial independence and living arrangements. In addition, we used the previously published results from the three cohorts.

RESULTS

The VLBW cohort had lower intelligence quotient and higher risk of significant school difficulties evaluated at age 4 and 18 years. When compared to the NBW cohort, at 30-36 years of age the VLBW cohort tended to have lower educational level, OR 1.7, 95% CI 0.8-3.9, were not financially independent OR 1.5, 95% CI 0.6-3.7, lived alone OR 2.0, 95% CI 1.0-3.8 and had higher rates of the combination of all three outcomes, OR 3.2, 95% CI 0.7-15.8.

CONCLUSIONS

We found trends towards poor socioeconomic outcomes in young adults born with VLBW. The relative disadvantages appeared smaller than that in childhood.

OUP accepted manuscript

Very preterm children are more likely to exhibit difficulties in socio-emotional processing than their term-born peers. Emerging socio-emotional problems may be partly due to alterations in limbic system development associated with infants’ early transition to extrauterine life. The amygdala is a key structure in this system and plays a critical role in various aspects of socio-emotional development, including emotion regulation. The current study tested the hypothesis that amygdala resting-state functional connectivity at term-equivalent age would be associated with socio-emotional outcomes in childhood. Participants were 129 very preterm infants (<33 weeks' gestation) who underwent resting-state functional MRI at term and received a neurodevelopmental assessment at 4–7 years (median = 4.64). Using the left and right amygdalae as seed regions, we investigated associations between whole-brain seed-based functional connectivity and three socio-emotional outcome factors which were derived using exploratory factor analysis (Emotion Moderation, Social Function and Empathy), controlling for sex, neonatal sickness, post-menstrual age at scan and social risk. Childhood Emotion Moderation scores were significantly associated with neonatal resting-state functional connectivity of the right amygdala with right parahippocampal gyrus and right middle occipital gyrus, as well as with functional connectivity of the left amygdala with the right thalamus. No significant associations were found between amygdalar resting-state functional connectivity and either Social Function or Empathy scores. The current findings show that amygdalar functional connectivity assessed at term is associated with later socio-emotional outcomes in very preterm 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.

Contrasting multilevel relationships between behavior and body mass in blue tit nestlings

Repeatable behaviors (i.e., animal personality) are pervasive in the animal kingdom and various mechanisms have been proposed to explain their existence. Genetic and nongenetic mechanisms, which can be equally important, predict correlations between behavior and body mass on different levels (e.g., genetic and environmental) of variation. We investigated multilevel relationships between body mass measured on weeks 1, 2, and 3 and three behavioral responses to handling, measured on week 3, which form a behavioral syndrome in wild blue tit nestlings. Using 7 years of data and quantitative genetic models, we find that all behaviors and body mass on week 3 are heritable (h2 = 0.18–0.23) and genetically correlated, whereas earlier body masses are not heritable. We also find evidence for environmental correlations between body masses and behaviors. Interestingly, these environmental correlations have different signs for early and late body masses. Altogether, these findings indicate genetic integration between body mass and behavior and illustrate the impacts of early environmental factors and environmentally mediated growth trajectory on behaviors expressed later in life. This study, therefore, suggests that the relationship between personality and body mass in developing individuals is due to various underlying mechanisms, which can have opposing effects. Future research on the link between behavior and body mass would benefit from considering these multiple mechanisms simultaneously.

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.

Developmental programming of shyness: A longitudinal, prospective study across four decades

Although shyness is a ubiquitous phenomenon with early developmental origins, little research has examined the influence of prenatal exposures on the developmental trajectory of shyness. Here, we examined trajectories of shyness from childhood to adulthood in three groups (N = 254), with varying degrees of prenatal adversity as indicated by the number of stressful exposures: extremely low birth weight (ELBW; <1000 g) survivors prenatally exposed to exogenous corticosteroids (ELBW+S, n = 56); ELBW survivors not prenatally exposed to exogenous corticosteroids (ELBW+NS, n = 56); and normal birth weight (NBW, n = 142) controls. Multilevel modeling revealed that the ELBW+S individuals exhibited the highest levels of childhood shyness, which remained stable into adulthood. The ELBW+NS and NBW controls had comparably low levels of childhood shyness; however, the ELBW+NS individuals experienced patterns of increasing shyness, while NBW controls displayed decreases in shyness into adulthood. We speculate that individuals exposed to multiple prenatal stressors (i.e., ELBW+S) may be developmentally programmed to be more sensitive to detecting social threat, with one manifestation being early developing, stable shyness, while increasing shyness among ELBW+NS individuals may reflect a later developing shyness influenced by postnatal context. We discuss the implications of these findings for understanding the developmental origins and developmental course of human shyness from childhood through adulthood.

Trajectories of self-esteem in extremely low birth weight survivors through adulthood

Although the developmental course of self-esteem has been examined in general population samples, there is a lack of research examining the trajectory of self-esteem in populations who experience unique developmental challenges. We compared the trajectory of self-esteem in extremely low birth weight (ELBW; <1000 grams) survivors and normal birth weight (NBW) controls from mid-adolescence through their early 30s. Self-esteem was reported during three follow-up periods (age 12-16, age 22-26, age 30-35). Adjusting for sex, chronic health problems, socioeconomic status, and social support, no difference was noted in self-esteem in the two groups in adolescence, but birth weight status predicted rate of change of self-esteem from adolescence to adulthood. The NBW controls showed the expected, normative increases in self-esteem from mid-adolescence to young adulthood, while ELBW individuals displayed stable, low levels of self-esteem into young adulthood. Our findings highlight that ELBW survivors may not experience the normative trajectory of self-esteem into young adulthood.

Origins and Predictors of Friendships in 6- to 8-Year-Old Children Born at Neonatal Risk

OBJECTIVE

To test effects of gestational age (GA), early social experiences, and child characteristics on children's friendships and perceived peer acceptance.

STUDY DESIGN

As part of the prospective Bavarian Longitudinal Study (1147 children, 25-41 weeks GA), children's friendships (eg, number of friends, frequency of meeting friends) and perceived peer acceptance were assessed before school entry (6 years of age) and in second grade (8 years of age) using child and parent reports. The parent-infant relationship was evaluated during the 5 months after birth. Child characteristics (ie, height, motor impairment, cognitive ability, behavioral problems) were measured at 6 years of age. Multiple regressions estimated effects of GA, parent-infant relationship, and child characteristics.

RESULTS

Overall, children with higher GA had more friends, spent more time with friends, and were more accepted by peers at 6 years of age. Better parent-infant relationships, higher cognitive abilities, and fewer motor and behavioral problems predicted more friendships and higher peer acceptance after adjusting for sex, socioeconomic status, multiples, siblings, and special schooling. Across all GA groups, number of friends (child report: mean change, 1.77; 95% CI, 1.57-1.96) and peer acceptance (child report: mean change, 0.14; 95% CI, 0.09-0.19; parent report: mean change, 0.14; 95% CI, 0.11-0.17) increased with age, but the increase in number of friends was higher among preterm children (ie, interaction effect age*GA group: P = .034).

CONCLUSIONS

Our results provide evidence of a dose-response effect of low GA on children's friendships and perceived peer acceptance. Improvements in early parenting and motor, cognitive, and behavioral development may facilitate friendships and peer acceptance for all children across the gestation spectrum.

Self-Reported Mental Health Problems Among Adults Born Preterm: A Meta-analysis

CONTEXT

Preterm birth increases the risk for mental disorders in adulthood, yet findings on self-reported or subclinical mental health problems are mixed.

OBJECTIVE

To study self-reported mental health problems among adults born preterm at very low birth weight (VLBW; ≤1500 g) compared with term controls in an individual participant data meta-analysis.

DATA SOURCES

Adults Born Preterm International Collaboration.

STUDY SELECTION

Studies that compared self-reported mental health problems using the Achenbach Young Adult Self Report or Adult Self Report between adults born preterm at VLBW (n = 747) and at term (n = 1512).

DATA EXTRACTION

We obtained individual participant data from 6 study cohorts and compared preterm and control groups by mixed random coefficient linear and Tobit regression.

RESULTS

Adults born preterm reported more internalizing (pooled β = .06; 95% confidence interval .01 to .11) and avoidant personality problems (.11; .05 to .17), and less externalizing (-.10; -.15 to -.06), rule breaking (-.10; -.15 to -.05), intrusive behavior (-.14; -.19 to -.09), and antisocial personality problems (-.09; -.14 to -.04) than controls. Group differences did not systematically vary by sex, intrauterine growth pattern, neurosensory impairments, or study cohort.

LIMITATIONS

Exclusively self-reported data are not confirmed by alternative data sources.

CONCLUSIONS

Self-reports of adults born preterm at VLBW reveal a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered risk for externalizing problem types. Our findings support the view that preterm birth constitutes an early vulnerability factor with long-term consequences on the individual into adulthood.

Socio-Emotional Development Following Very Preterm Birth: Pathways to Psychopathology

Very preterm birth (VPT; < 32 weeks of gestation) has been associated with an increased risk to develop cognitive and socio-emotional problems, as well as with increased vulnerability to psychiatric disorder, both with childhood and adult onset. Socio-emotional impairments that have been described in VPT individuals include diminished social competence and self-esteem, emotional dysregulation, shyness and timidity. However, the etiology of socio-emotional problems in VPT samples and their underlying mechanisms are far from understood. To date, research has focused on the investigation of both biological and environmental risk factors associated with socio-emotional problems, including structural and functional alterations in brain areas involved in processing emotions and social stimuli, perinatal stress and pain and parenting strategies. Considering the complex interplay of the aforementioned variables, the review attempts to elucidate the mechanisms underlying the association between very preterm birth, socio-emotional vulnerability and psychopathology. After a comprehensive overview of the socio-emotional impairments associated with VPT birth, three main models of socio-emotional development are presented and discussed. These focus on biological vulnerability, early life adversities and parenting, respectively. To conclude, a developmental framework is used to consider different pathways linking VPT birth to psychopathology, taking into account the interaction between medical, biological, and psychosocial factors.

An association of adult personality with prenatal and early postnatal growth: the EPQ lie-scale

Background

Recent studies have noted differences in social acquiescence and interpersonal relations among adults born preterm or with very low birth weight compared to full term adults. In addition, birth weight has been observed to be negatively correlated with lie-scale scores in two studies. We attempted to replicate and extend these studies by examining young adult lie-scale scores in a Danish birth cohort.

Method

Weight, length and head circumference of 9125 children from the Copenhagen Perinatal Cohort were measured at birth and at 1, 3 and 6 years. A subsample comprising 1182 individuals participated in a follow-up at 20–34 years and was administered the Eysenck Personality Questionnaire (EPQ) which includes a lie-scale (indicating social acquiescence or self-insight). Associations between lie-scale scores and weight, length and head circumference respectively were analysed by multiple linear regression adjusting for single-mother status, parity, mother’s age, father’s age, parental social status, age at EPQ measurement, intelligence, and adult size.

Results

Male infants with lower weight, length, and head-circumference at birth and the following three years grew up to have higher scores on the lie-scale as young adults. Most of these associations remained significant after adjustment for the included covariates. No associations were found for females. Analyses were also conducted with neuroticism, extraversion and psychoticism as outcome variables, but no significant associations were found for these traits after adjustment.

Conclusions

The findings replicate and extend findings from previous studies suggesting that size at birth and during the first three years of life is significantly associated with social acquiescence in adult men. They highlight the potential influence of prenatal and early postnatal development on personality growth and development.