Young adults with very low birth weight: leaving the parental home and sexual relationships--Helsinki Study of Very Low Birth Weight Adults

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.

Body composition in adults born preterm with very low birth weight

BACKGROUND

Studies on body composition in preterm very low birth weight (VLBW < 1500 g) survivors are inconsistent and trajectories later in life unknown. We assessed body composition and its change from young to mid-adulthood in VLBW adults.

METHODS

We studied 137 VLBW adults and 158 term-born controls from two birth cohorts in Finland and Norway at mean age 36 years. Body composition was assessed by 8-polar bioelectrical impedance. We compared results with dual-energy x-ray absorptiometry measurements at 24 years.

RESULTS

In mid-adulthood, VLBW women and men were shorter than controls. Fat percentage (mean difference in women 1.1%; 95% CI, -1.5% to 3.5%, men 0.8%; -2.0% to 3.6%) and BMI were similar. VLBW women had 2.9 (0.9 to 4.8) kg and VLBW men 5.3 (2.7 to 8.1) kg lower lean body mass than controls, mostly attributable to shorter height. Between young and mid-adulthood, both groups gained fat and lean body mass (p for interaction VLBW x age>0.3).

CONCLUSION

Compared with term-born controls, VLBW adults had similar body fat percentage but lower lean body mass, largely explained by their shorter height. This could contribute to lower insulin sensitivity and muscular fitness previously found in VLBW survivors and predispose to functional limitations with increasing age.

IMPACT

In mid-adulthood, individuals born preterm with very low birth weight had similar body fat percentage but lower lean body mass than those born at term. This was largely explained by their shorter height. First study to report longitudinal assessments of body size and composition from young to mid-adulthood in very low birth weight adults. Lower lean body mass in very low birth weight adults could contribute to lower insulin sensitivity and muscular fitness and lead to earlier functional limitations with increasing age.

Problems in peer relationships and low engagement in romantic relationships in preterm born adolescents: effects of maternal warmth in early childhood

This study examined whether maternal warmth in early childhood moderates the association between preterm birth and problems in peer relationships and low engagement in romantic relationships in adolescence. We studied 9193 individuals from the Millennium Cohort Study in the United Kingdom, 99 (1.1%) of whom were born very preterm (VPT; < 32 weeks of gestation) and 629 (6.8%) moderate-to-late preterm (MLPT; 32-36 weeks gestation). Maternal warmth was reported by the mothers when their children were 3 years old. Peer relationship problems were reported by both the participants and their mothers at 14 and 17 years. Further, participants reported their engagement in romantic relationships at 14 and 17 years. All outcome variables were z-standardized, and the moderation effect was examined via hierarchical linear regressions. Compared to full-term birth, both MLPT and VPT birth were associated with lower engagement in romantic relationships at 17 years of age (b = .04, p = .02; b = .11, p = .02, respectively), and VPT birth was associated with increased peer relationship problems at 14 (b = .29, p = .01) and 17 years of age (b = .22, p = .046). Maternal warmth in early childhood was similarly associated with lower peer relationship problems in MLPT, VPT and full-term born adolescents. However, there was no influence of maternal warmth on engagement in romantic relationships at 17 years of age. There is no major modifying effect of maternal warmth in early childhood on the association between PT birth and peer relationship problems and low engagement in romantic relationships at 14 and 17 years of ages.

Transition to Adulthood for Extremely Preterm Survivors

OBJECTIVE

To compare transition into adulthood of survivors born extremely preterm (EP; <28 weeks' gestation) or extremely low birth weight (ELBW; <1000 g) in the postsurfactant era with term-born controls.

METHODS

Prospective longitudinal cohort study of all EP/ELBW survivors born in the State of Victoria, Australia between January 1, 1991 and December 31, 1992 and matched term-born controls. Outcomes include educational attainment, employment, financial status, romantic partnering, living arrangements, parenthood, physical health and mental health, risk-taking behaviors, life satisfaction, and interpersonal relationships at 25 years.

RESULTS

Data were available from 165 EP/ELBW and 127 control participants. Overall, there was little evidence for differences between the EP/ELBW and control groups on most comparisons after adjustment for social risk and multiple births. However, compared with controls, the EP/ELBW group was more likely to have their main source of income from government (adjusted odds ratio [aOR] 2.49, 95% confidence interval [CI] 1.21-5.13; P = .01) and to have never moved out of the parental home (aOR 2.13, 95% CI 1.27-3.58; P = .01), and fewer had ever engaged in smoking (aOR 0.52, 95% CI 0.28-0.98; P = .04), binge drinking (aOR 0.41, 95% CI 0.18-0.93; P = .03), or street drugs (aOR 0.56, 95% CI 0.32-0.98; P = .04).

CONCLUSIONS

Aside from clinically important differences in main income source, leaving the parental home, and reduced risk-taking behavior, survivors born EP/ELBW in the era since surfactant was introduced are transitioning into adulthood similarly to term-born controls in some areas assessed but not all.

ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study

BACKGROUND

This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns.

METHODS

(1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and term-born adults published in PubMed, Web of Science, and PROQUEST until April 2021; (2) a one-stage Individual Participant Data(IPD) meta-analysis (n = 1385 preterm, n = 1633 term; born 1978-1995) examined differences in self-reported ADHD symptoms[age 18-36 years]; and (3) a population-based register-linkage study of all live births in Finland (01/01/1987-31/12/1998; n = 37538 preterm, n = 691,616 term) examined ADHD diagnosis risk in adulthood (≥18 years) until 31/12/2016.

RESULTS

Systematic review results were conflicting. In the IPD meta-analysis, ADHD symptoms levels were similar across groups (mean z-score difference 0.00;95% confidence interval [95% CI] -0.07, 0.07). Whereas in the register-linkage study, adults born preterm had a higher relative risk (RR) for ADHD diagnosis compared to term controls (RR = 1.26, 95% CI 1.12, 1.41, p < 0.001). Among preterms, as gestation length (RR = 0.93, 95% CI 0.89, 0.97, p < 0.001) and SD birth weight z-score (RR = 0.88, 95% CI 0.80, 0.97, p < 0.001) increased, ADHD risk decreased.

CONCLUSIONS

While preterm adults may not report higher levels of ADHD symptoms, their risk of ADHD diagnosis in adulthood is higher.

IMPACT

Preterm-born adults do not self-report higher levels of ADHD symptoms, yet are more likely to receive an ADHD diagnosis in adulthood compared to term-borns. Previous evidence has consisted of limited sample sizes of adults and used different methods with inconsistent findings. This study assessed adult self-reported symptoms across 8 harmonized cohorts and contrasted the findings with diagnosed ADHD in a population-based register-linkage study. Preterm-born adults may not self-report increased ADHD symptoms. However, they have a higher risk of ADHD diagnosis, warranting preventive strategies and interventions to reduce the presentation of more severe ADHD symptomatology in adulthood.

Risk-Taking Behavior of Adolescents and Young Adults Born Preterm

OBJECTIVES

To study sexually transmitted Chlamydia trachomatis infections (STCTs), teenage pregnancies, and payment defaults in individuals born preterm as proxies for engaging in risk-taking behavior.

STUDY DESIGN

Our population-based register-linkage study included all 191 705 children alive at 10 years (8492 preterm [4.4%]) born without malformations in Finland between January 1987 and September 1990 as each mother's first child within the cohort. They were followed until young adulthood. We used Cox regression to assess the hazards of STCTs, teenage pregnancies, payment defaults, criminal offending, and substance abuse by gestational age. Gestational age was considered both as a continuous and categorical (extremely, very, moderately, late preterm, early term, post term, and full term as reference) exposure.

RESULTS

A linear dose-response relationship existed between gestational age and STCT and teenage pregnancy; adjusted hazard for STCT decreased by 1.6% (95% CI, 0.7%-2.6%), and for teenage pregnancy by 3.3% (95% CI, 1.9%-4.8%) per each week decrease in gestational age. Those born extremely preterm (23-27 completed weeks) had a 51% (95% CI, 31%-83%) lower risk for criminal offending than their full-term born counterparts, and those born very preterm (range, 28-31 weeks) had a 28% (95% CI, 7%-53%) higher hazard for payment defaults than those born at full term. Gestational age was not associated with substance abuse.

CONCLUSIONS

The lower risk-taking that characterizes people born preterm seems to generalize to sexual and to some extent criminal behavior. Those born very preterm are, however, more likely to experience payment defaults.

Health-related quality of life from 20 to 32 years of age in very low birth weight individuals: a longitudinal study

BACKGROUND

Preterm birth with very low birth weight (VLBW, birth weight < 1500 g) is associated with health problems later in life. How VLBW individuals perceive their physical and mental health-related quality of life (HRQoL) is important to understand their putative burden of disease. Previous studies have shown mixed results, and longitudinal studies into adulthood have been requested. This study aimed to investigate differences in HRQoL between preterm VLBW and term born individuals at 32 years of age, and to study changes in HRQoL from 20 to 32 years.

METHODS

In a geographically based longitudinal study, 45 VLBW and 68 term born control participants completed the Short Form 36 Health Survey (SF-36) at 32 years of age. Data from three previous timepoints was also available (20, 23 and 28 years of age). The SF-36 yields eight domain scores as well as a physical and a mental component summary. Between-group differences in these variables were investigated. We also performed subgroup analyses excluding individuals with disabilities, i.e., cerebral palsy and/or low estimated intelligence quotient.

RESULTS

At 32 years of age, the physical component summary was 5.1 points lower (95% confidence interval (CI): 8.6 to 1.6), and the mental component summary 4.1 points lower (95% CI: 8.4 to - 0.3) in the VLBW group compared with the control group. For both physical and mental component summaries there was an overall decline in HRQoL from 20 to 32 years of age in the VLBW group. When we excluded individuals with disabilities (n = 10), group differences in domain scores at 32 years were reduced, but physical functioning, bodily pain, general health, and role-emotional scores remained lower in the VLBW subgroup without disabilities compared with the control group.

CONCLUSION

We found that VLBW individuals reported lower HRQoL than term born controls at 32 years of age, and that HRQoL declined in the VLBW group from 20 to 32 years of age. This was in part, but not exclusively explained by VLBW individuals with disabilities.

Adult outcome of preterm birth: Implications for neurodevelopmental theories of psychosis

Preterm birth is associated with an elevated risk of developmental and adult psychiatric disorders, including psychosis. In this review, we evaluate the implications of neurodevelopmental, cognitive, motor, and social sequelae of preterm birth for developing psychosis, with an emphasis on outcomes observed in adulthood. Abnormal brain development precipitated by early exposure to the extra-uterine environment, and exacerbated by neuroinflammation, neonatal brain injury, and genetic vulnerability, can result in alterations of brain structure and function persisting into adulthood. These alterations, including abnormal regional brain volumes and white matter macro- and micro-structure, can critically impair functional (e.g. frontoparietal and thalamocortical) network connectivity in a manner characteristic of psychotic illness. The resulting executive, social, and motor dysfunctions may constitute the basis for behavioural vulnerability ultimately giving rise to psychotic symptomatology. There are many pathways to psychosis, but elucidating more precisely the mechanisms whereby preterm birth increases risk may shed light on that route consequent upon early neurodevelopmental insult.

The extremely preterm young adult - State of the art

Recently several studies have reported adult outcomes for individuals born at extremely low gestations, although they tend to be included as part of slightly more mature populations. The growth in collaborative studies allows greater confidence in the identification of persisting risk and allows us to have confidence in the likely outcomes in more contemporary cohorts. This review shows the persistence of adverse outcomes through to adult life and includes a range of outcomes including all body systems evaluated. Nonetheless adult outcomes demonstrate that most survivors appear to be free of major disabling conditions and demonstrate good participation in society. Several studies have reported outcomes in the third decade, but subsequent ageing trajectories have not yet been defined. The stability of many of the outcomes evaluated over childhood into adult life and the lack of improvement in prevalence of childhood impairments found in contemporary cohorts indicates persisting levels of risk.

Optimism in adults born preterm: Systematic review and individual-participant-data meta-analysis

AIM

Preterm birth(<37 gestational weeks) is associated with numerous adversities, however, data on positive developmental outcomes remain limited. We examined if preterm and term born(≥37 gestational weeks) adults differ in dispositional optimism/pessimism, a personality trait associated with health and wellbeing. We assessed if birth weight z-score, neurosensory impairments and parental education modified the outcome.

METHODS

We systematically searched PubMed and Web of Science for cohort or case-control studies(born ≥ 1970) with data on gestational age and optimism/pessimism reported using the Life-Orientation-Test-Revised in adulthood(≥18 years). The three identified studies(Helsinki Study of Very Low Birth Weight Adults; Arvo Ylppö Longitudinal Study; Avon Longitudinal Study of Parents and Children) provided data for the two-step random-effects linear regression Individual-Participant-Data meta-analysis.

RESULTS

Preterm and term borns did not differ on optimism(p = 0.76). Preterms scored higher on pessimism than term borns(Mean difference = 0.35, 95%Confidence Interval 0.36, 0.60, p = 0.007), although not after full adjustment. Preterm born participants, but not term born participants, with higher birth weight z-score, had higher optimism scores (0.30 raw score units per standard deviation increase, 95% CI 0.10, 0.49, p = 0.003); preterm vs term x birth weight z-score interaction p = 0.004).

CONCLUSIONS

Preterm and term born adults display similar optimism. In preterms, higher birth weight may foster developmental trajectories promoting more optimistic life orientations.

Social Functioning in Adults Born Very Preterm: Individual Participant Meta-analysis

CONTEXT

There is a lack of research on individual perceptions of social experiences and social relationships among very preterm (VP) adults compared with term-born peers.

OBJECTIVE

To investigate self-perceived social functioning in adults born VP (<32 weeks' gestation) and/or with very low birth weight (VLBW) (<1500g) compared with term-born adults (≥37 weeks' gestation) using an individual participant data (IPD) meta-analysis.

DATA SOURCES

Two international consortia: Research on European Children and Adults born Preterm and Adults Born Preterm International Collaboration.

STUDY SELECTION

Cohorts with outcomes assessed by using the Adult Self-Report Adaptive Functioning scales (friends, spouse/partner, family, job, and education) in both groups.

DATA EXTRACTION

IPD from 5 eligible cohorts were collected. Raw-sum scores for each scale were standardized as z scores by using mean and SD of controls for each cohort. Pooled effect size was measured by difference (Δ) in means between groups.

RESULTS

One-stage analyses (1285 participants) revealed significantly lower scores for relationships with friends in VP/VLBW adults compared with controls (Δ -0.37, 95% confidence interval [CI]: -0.61 to -0.13). Differences were similar after adjusting for sex, age, and socioeconomic status (Δ -0.39, 95% CI: -0.63 to -0.15) and after excluding participants with neurosensory impairment (Δ -0.34, 95% CI: -0.61 to -0.07). No significant differences were found in other domains.

LIMITATIONS

Generalizability of research findings to VP survivors born in recent decades.

CONCLUSIONS

VP/VLBW adults scored their relationship with friends lower but perceived their family and partner relationships, as well as work and educational experiences, as comparable to those of controls.

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.

Sex-typical behavior in children born preterm at very low birth weight

BACKGROUND

Perinatal events may alter psychosexual development. We aimed to assess whether a preterm birth at very low birth weight (VLBW; <1500 g) or antenatal synthetic glucocorticoids (sGC) given to the mother are associated with altered sex-typical behavior in childhood.

METHODS

Sex-typical behavior was assessed using the Pre-school Activities Inventory (PSAI) at the mean age of 4.9 years (SD 1.6) in 879 children, of whom 143 were preterm with VLBW (PT <1500 g, all exposed to sGC), 282 were preterm with birth weight ≥1500 g (PT ≥1500 g, 171 exposed to sGC), and 454 were full term (FT, 166 exposed to sGC).

RESULTS

Antenatal sGC was not associated with PSAI scores in either sex. PT <1500 g boys had less male-typical PSAI scores than other boys, even in multivariate model adjusting for age, maternal age, antenatal sGC, number of brothers and sisters, and motor or cognitive impairment. PT <1500 g girls had less female-typical PSAI scores than other girls in the multivariate model. The effect size was small (d = 0.03) for both sexes.

CONCLUSIONS

Preterm birth with VLBW is associated with reduced sex-typical behavior in childhood, which is in line with the previous data indicating altered psychosexual development in adults born preterm. Mechanisms underlying these observations are not fully understood.

IMPACT

Preterm birth is associated with reduced rates of marriage and reproduction in adulthood, but sex-typical behavior in children born preterm has not been studied before. The results of this study indicate that preterm birth with very low birth weight <1500 g is associated with reduced sex-typical behavior in childhood in both sexes. These observations are in line with the previous data indicating altered psychosexual development in adults born preterm. Mechanisms underlying these observations are not fully understood and require further studies.

Reproductive risks in 35-year-old adults born very preterm and/or with very low birth weight: an observational study

Evidence suggests that increased survival over the last decades of very preterm (VPT; gestational age < 32 weeks)- and very low birth weight (VLBW; birth weight < 1500 g)-born infants is not matched by improved outcomes. The objective of our study was to evaluate the reproductive rate, fertility, and pregnancy complications in 35-year-old VPT/VLBW subjects. All Dutch VPT/VLBW infants born alive in 1983 and surviving until age 35 (n = 955) were eligible for a POPS-35 study. A total of 370 (39%) subjects completed a survey on reproductive rate, fertility problems, pregnancy complications, and perinatal outcomes of their offspring. We tested differences in these parameters between the VPT/VLBW subjects and their peers from Dutch national registries. POPS-35 participants had less children than their peers in the CBS registry. They reported more problems in conception and pregnancy complications, including a three times increased risk of hypertension during pregnancy.Conclusion: Reproduction is more problematic in 35-year olds born VPT/VLBW than in the general population, possibly mediated by an increased risk for hypertension, but their offspring have no elevated risk for preterm birth. What is known: At age 28, the Dutch national POPS cohort, born very preterm or with a very low birth in 1983, had lower reproductive rates than the general Dutch population (female 23% versus 32% and male 7% versus 22%). What is new: At age 35, the Dutch POPS cohort still had fewer children than the general Dutch population (female 56% versus 74% and male 40% versus 56%). Females in the POPS cohort had a higher risk of fertility problems and pregnancy complications than their peers in the Dutch national registries, but their offspring had no elevated risk for preterm birth.

"Health, wealth and achievements of former very premature infants in adult life"

Very preterm survivors born in the early neonatal intensive care era are now in their middle adulthood. The literature from cohort studies and population-linked registries indicate that extreme prematurity is associated with lower educational attainment and income, higher need for social assistance, and lower rates of marriage/partnership and reproduction. In addition, with increasing age, many general and system-specific adverse health outcomes, such as psychiatric problems, hypertension, and cardio-metabolic disorders have emerged, resulting in high cumulative health care costs across the life-span. Yet, a significant majority of adults born preterm are leading productive lives and contributing to society. Although this information may not be directly applicable to survivors of modern neonatal intensive care, there is much to learn from these findings to inform and guide us into designing effective strategies to improve the health and well-being of future very premature infants. The longer-term outcome of more recent survivors remains to be determined.

Chronotype in very low birth weight adults - a sibling study

Chronotype is the temporal preference for activity and sleep during the 24 h day and is linked to mental and physical health, quality of life, and mortality. Later chronotypes, so-called "night owls", consistently display poorer health outcomes than "larks". Previous studies have suggested that preterm birth (<37 weeks of gestation) is associated with an earlier chronotype in children, adolescents, and young adults, but studies beyond this age are absent. Our aim was to determine if adults born preterm at very low birth weight (VLBW, ≤1500 g) display different chronotypes than their siblings. We studied VLBW adults, aged 29.9 years (SD 2.8), matched with same-sex term-born siblings as controls. A total of 123 participants, consisting of 53 sibling pairs and 17 unmatched participants, provided actigraphy-derived data on the timing, duration, and quality of sleep from 1640 nights (mean 13.3 per participant, SD 2.7). Mixed effects models provided estimates and significance tests. Compared to their siblings, VLBW adults displayed 27 min earlier sleep midpoint during free days (95% CI: 3 to 51 min, p =.029). This was also reflected in the timing of falling asleep, waking up, and sleep-debt corrected sleep midpoint. The findings were emphasized in VLBW participants born small for gestational age. VLBW adults displayed an earlier chronotype than their siblings still at age 30, which suggests that the earlier chronotype is an enduring individual trait not explained by shared family factors. This preference could provide protection from risks associated with preterm birth.

ABBREVIATIONS

AGA: Appropriate for gestational age; ELBW: Extremely low birth weight, ≤ 1000 grams; FMBR: Finnish Medical Birth Registry; HeSVA: Helsinki Study of Very low birth weight Adults; MSFsc: Midsleep on free days, corrected for sleep debt; SGA: Small for gestational age, ≤ -2 SD; VLBW: Very low birth weight, ≤ 1500 grams; WASO: Wake after sleep onset.

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.

Association of Preterm Birth With Risk of Ischemic Heart Disease in Adulthood

IMPORTANCE

Preterm birth has previously been associated with increased risks of hypertension and diabetes, but not ischemic heart disease (IHD), in adulthood. The reasons for this lack of association with IHD despite associations with its risk factors have been elusive, but may be associated with methodologic issues, such as survivor bias, in prior studies.

OBJECTIVE

To determine whether preterm birth is associated with an increased risk of IHD in adulthood in a large population-based cohort.

DESIGN, SETTING, AND PARTICIPANTS

This national, population-based cohort study included all 2 141 709 persons who were born as singleton live births in Sweden during 1973 to 1994. The data were analyzed in September 2018.

EXPOSURES

Gestational age at birth, identified from nationwide birth records in the Swedish Birth Registry.

MAIN OUTCOMES AND MEASURES

Ischemic heart disease that was identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age, 43 years). A Cox regression was used to examine gestational age at birth in association with IHD in adulthood while adjusting for other perinatal and maternal factors. Cosibling analyses assessed for potential confounding by unmeasured shared familial factors.

RESULTS

Of 2 141 709 participants, 1 041 906 (48.6%) were female and there were 1921 persons (0.09%) who received a diagnosis of IHD in 30.9 million person-years of follow-up. Gestational age at birth was inversely associated with IHD risk in adulthood. At ages 30 to 43 years, adjusted hazard ratios for IHD associated with preterm (gestational age <37 weeks) and early-term birth (37-38 weeks) were 1.53 (95% CI, 1.20-1.94) and 1.19 (1.01-1.40), respectively, compared with full-term birth (39-41 weeks). Preterm-born women had lower IHD incidence than preterm-born men (15.16 vs 22.00 per 100 000 person-years) but had a higher adjusted hazard ratio (1.93; 95% CI, 1.28-2.90 vs 1.37; 95% CI, 1.01-1.84). These associations did not appear to be explained by shared genetic or environmental factors in families.

CONCLUSIONS AND RELEVANCE

In this large national cohort, preterm and early-term birth were associated with an increased IHD risk in adulthood. Persons born prematurely need early evaluation and preventive actions to reduce the risk of IHD.

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.

Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

AIM

To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006.

METHODS

A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011.

RESULTS

There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7).

CONCLUSION

Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

Harsh times: do stressors lead to labor market losses?

This paper examines the links between stressful life events and labor market outcomes. We use twin data for Finnish men and women combined with register-based individual information on earnings, employment and social income transfers. The twin data allow us to account for shared environmental and genetic confounders. We measure the exposure to stressful life events in 1990. The labor market outcomes are measured during a 20-year follow-up over the period 1990-2009. Three findings stand out. First, stressors lead to worse labor market outcomes. Second, both men and women are distressed by labor market shocks, but they respond differently to marital problems and health shocks within the family. For example, women respond to marital problems by working more, whereas men respond similarly after facing a random health shock within the family. Third, the relationship between health shocks and labor market outcomes diminishes as time passes, whereas the consequences of labor market shocks are more permanent.

Psychosocial developmental trajectory of a cohort of young adults born very preterm and/or with a very low birth weight in the Netherlands

Background

The achievement of age-specific developmental milestones in youth is of great importance to the adjustment in adult life. Young adults who were born preterm, might go through a different developmental trajectory and transition into adulthood than their peers. This study aimed to compare the psychosocial developmental trajectory of young adults who were born preterm with peers from the general population. Young adults from the POPS (Project On Preterm and Small for gestational age infants) cohort study, born in 1983 in the Netherlands, completed online the Course of Life Questionnaire (CoLQ - achievement of psychosocial developmental milestones) at 28 years of age. Analysis of variance by group, age and gender was performed to test differences on the CoLQ scale scores between the POPS-group and 211 peers (25–30 years) from the general population (Ref-group). Differences on item level, representing the achievement of individual milestones, were analyzed with logistic regression analyses by group, age and gender.

Results

The POPS-group (n = 300, 32,3% biased response) scored significantly lower than the Ref-group on the scales Psychosexual Development (effect size − 0.26, p < 0.01), Antisocial Behavior (ES − 0.44, p < 0.001) and Substance Use & Gambling (ES − 0.35, p < .001). A further exploration on item-level revealed, among others, that the POPS-group had their first boyfriend/girlfriend at later age, were more often single, misbehaved less at school and smoked, drank and gambled less than the Ref-group. On the scales Autonomy Development and Social Development no differences were found between the POPS-group and the Ref-group.

Conclusions

A relatively less vulnerable respondent group of young adults born preterm showed some psychosocial developmental trajectory delays and might benefit from support at teenage age. Because of the non-response bias, we hypothesize that the total group of young adults born preterm will show more severe psychosocial developmental problems.

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.

Extremely prematurely born adolescents self-report of anxiety symptoms, and the mothers' reports on their offspring

AIM

To compare anxiety symptoms in adolescents born extremely prematurely to term-born controls.

METHODS

We had 96 preterm-born adolescents and 40 term-born controls from Denmark, and their mothers score the adolescents on the Revised Children Anxiety and Depression scale. We analysed group differences, cross-informant correlations and relative risks for elevated anxiety symptoms.

RESULTS

Self-reported anxiety symptoms did not significantly differ, although the upper confidence limit (95% CI: -3.3 to 5.1) supported an odds ratio of 2 for the preterm-born participants. Mothers of the preterm-born participants reported higher social anxiety symptoms than did mothers of controls (51.7 versus 46.8, p = 0.001). The relative risk for being above a threshold indicating distressing anxiety was small from self-reports (1.39; p = 0.60). From mother-reports, the relative risk was noticeable but not significant (4.58; p = 0.14). Cross-informant scores correlated significant for total anxiety and social anxiety for the preterm-born (rτ = 0.2, p = 0.001; rτ = 0.3, p ≤ 0.001).

CONCLUSIONS

Self-reports did not clearly indicate more anxiety in the preterm group, although confidence intervals supported a possible twofold increase. Mother- and self-reports correlated only for the preterm group, which may indicate increased sensitivity for their children's symptoms.

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.

In their own words: Life at adulthood after very premature birth

Very premature infants born in the last century following the early days of post-neonatal intensive care have demonstrated an array of physical, emotional, and mental health problems as they approach their third and fourth decades. These outcomes have been well documented by several international investigators. However, there is a paucity of information on the personal perspectives of these individuals with regard to their own quality of life, their hopes and their fears. This article will focus on the objective information from the published literature and how it differs from the personal perspectives of former very premature infants.

Multivariate Analysis of the Factors Associated With Sexual Intercourse, Marriage, and Paternity of Hypospadias Patients

INTRODUCTION

Patients with hypospadias are treated surgically during childhood, which has the intention of enabling a satisfactory sexual life in adulthood. However, it is unclear whether patients with corrected hypospadias can lead a satisfactory sexual life and sustain a marital relationship and produce offspring.

AIM

To evaluate factors associated with achievement of sexual intercourse, marriage, and paternity in patients with hypospadias who have reached adulthood.

METHODS

Self-completion questionnaires were mailed in April 2012 to patients with hypospadias at least 18 years old who had been treated at our institution during childhood from 1973 through 1998 by a single surgeon and the same surgical policy. Assessments included the International Prostate Symptom Score, the International Index for Erectile Function-5, and non-validated questions related to current social and physical status and sexual, marital, and paternity experiences. Candidate factors were extracted from patients' neonatal data, surgical findings and results, and current physical and social status obtained by the questionnaires.

MAIN OUTCOME MEASURES

Candidate factors associated with heterosexual intercourse, marriage, and paternity experiences were analyzed using univariate and multivariate proportional hazard models and log-rank test of Kaplan-Meier curves.

RESULTS

Of the 518 patients contacted, 108 (age = 18-50 years, median = 28 years) met the inclusion criteria. Two- and one-stage repairs were performed as the initial treatment in 79 and 12, respectively, and 17 of the analyzed cases were reoperations for patients initially treated elsewhere. Fifty-seven patients had the milder type (31 glandular, 26 penile), 36 had the proximal type (13 penoscrotal, 23 scrotal-perineal), and 15 had an unknown type. Multivariate analyses by Cox proportional hazard model and log-rank tests confirmed that experience of sexual intercourse was associated with the milder type of hypospadias (P = .025 and .0076 respectively), marriage was associated with stable employment (P = .020 and .026, respectively), and paternity was associated with the absence of additional surgery after completion of the initial repair (P = .013 by multivariate analysis).

CONCLUSION

There was scant overlap of factors associated with the three events. The present findings provide reference information for surgeons and parents regarding future sexual and marriage experiences of children treated for hypospadias.

Determinants of underage induced abortion--the 1987 Finnish Birth Cohort study

INTRODUCTION

Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth.

MATERIAL AND METHODS

All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at <18 years of age and girls with no underage pregnancies (n = 27 605, 95.0%).

RESULTS

Shared risk factors of underage induced abortion and childbirth included early onset behavioral and emotional disorders [adjusted OR 1.9 (1.4-2.5) and 2.7 (95% CI 1.8-3.9)], a history of foster care [1.5 [1.1-1.9] and 3.0 [2.3-4.1)], and socioeconomic factors, including living in a family receiving income support [1.8 (1.5-2.1) and 3.4 (2.7-4.4)], respectively. Specific risk factors of underage induced abortion were psychoactive substance use disorders [2.2 (1.3-3.5)], having a mother who smoked during pregnancy [1.5 (1.3-1.8)] or had undergone induced abortion [1.8 (1.5-2.2)]. Coping with a chronic physical illness [0.7 (0.5-0.9)], and perinatal problems [0.6 (0.4-0.7)] were inversely associated with underage induced abortion.

CONCLUSIONS

The traditionally acknowledged determinants of underage childbirth played a less prominent role in induced abortion. Novel risk factors of underage induced abortion were found, including severe substance abuse and adverse maternal reproductive history, and should be addressed at all levels offering youth healthcare and social welfare services.

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.

Birth Weight and Social Trust in Adulthood: Evidence for Early Calibration of Social Cognition

Social trust forms the fundamental basis for social interaction within societies. Understanding the cognitive architecture of trust and the roots of individual differences in trust is of key importance. We predicted that one of the factors calibrating individual levels of trust is the intrauterine flow of nutrients from mother to child as indexed by birth weight. Birth weight forecasts both the future external environment and the internal condition of the individual in multiple ways relevant for social cognition. Specifically, we predicted that low birth weight is utilized as a forecast of a harsh environment, vulnerable condition, or both and, consequently, reduces social trust. The results of the study reported here are consistent with this prediction. Controlling for many confounds through sibling and panel designs, we found that lower birth weight reduced social trust in adulthood. Furthermore, we obtained tentative evidence that this effect is mitigated if adult environments do not induce stress.

Long-Term Outcomes of Very Preterm Birth

Very preterm birth has become more frequent during the past decades due to progress in reproductive medicine, more frequent indicated preterm births due to maternal illnesses, and increasing maternal age. Moreover, survival rates of very preterm children have increased due to improved neonatal management. However, very preterm-born children, adolescents, and young adults are at increased risk for poor cognitive function and socio-emotional problems, which is of growing public health concern. Very premature birth has been studied to unravel consequences of a nonoptimal environment during a developmental period which under normal circumstances would be the last trimester of fetal development. For very preterm children, this developmental period partly occurs outside the womb, which leads to major distress for the immature newborn. For the cerebral cortex, the last trimester of pregnancy is a particularly sensitive period during which cortical folding takes place and the volume increases 4fold. During this period, even minor insults may cascade into disturbances of brain development. The most frequent complication after very preterm birth is related to insufficient functioning of the lungs, which may lead to hypoxic-ischemic incidences and damage to nervous tissue. This review presents evidence for long-term sequels of very premature birth regarding neurocognitive, academic, socio-emotional, and mental health development. Then it discusses possible underlying mechanisms including alterations in brain development, programming of the hypothalamic-pituitary-adrenal axis and circadian rhythmicity, as well as affected parent-child interaction patterns in families with very preterm children. Finally, intervention approaches to improve outcomes after very preterm birth are discussed and directions for future research presented.

Independent living and romantic relations among young adults born preterm

BACKGROUND

Young adults born preterm at very low birth weight start families later. Whether less severe immaturity affects adult social outcomes is poorly known.

METHODS

The study "Preterm birth and early life programming of adult health and disease" (ESTER, 2009-2011) identified adults born early preterm (<34 weeks' gestation, N = 149), late preterm (≥ 34 to <37 weeks' gestation, N = 248), and at term (≥ 37 weeks' gestation, N = 356) from the Northern Finland Birth Cohort 1986 and the Finnish Medical Birth Register (1987-1989), with perinatal data, medical and family history, socioeconomic status, and lifestyle from routine visits or questionnaires. Cox, logistic, and ordinal regressions estimated the hazard and odds ratios (HR and OR) with 95% confidence intervals of outcomes related to preterm birth.

RESULTS

Compared with term-born subjects, those born early and late preterm were less likely to have cohabited with a romantic partner (HR, 0.79; [0.61-1.03] and HR, 0.80; [0.65-0.99], respectively) or experienced sexual intercourse (HR, 0.83; [0.66-1.05] and HR, 0.76; [0.63-0.92], respectively) by young adulthood. They also had higher odds of obtaining a 1-point lower score in a visual analog scale of self-perceived sexual attractiveness (OR, 1.45; [1.09-1.98] and OR, 1.44; [1.06-1.97] for early and late preterm birth, respectively). No difference was observed in the likelihood of departing from childhood home and number of individuals having their own families.

CONCLUSIONS

Young adults born preterm experience more social challenges, which may affect their romantic relationships and future family planning.

Very low birth weight, infant growth, and autism-spectrum traits in adulthood

OBJECTIVES

We examined whether adults born preterm at very low birth weight (VLBW; <1500 g) differ from term-born adults in autism-spectrum traits, and whether among VLBW adults, growth in infancy is associated with these traits.

METHODS

A total of 110 VLBW and 104 term-born adults of the Helsinki Study of Very Low Birth Weight Adults completed the Autism-Spectrum Quotient yielding total, social interaction, and attention to detail sum scores. Growth in weight, length, and head circumference from birth to term and from term to 1 year of corrected age was determined as standardized residuals reflecting growth conditional on previous history.

RESULTS

VLBW adults scored higher than term-born controls on social interaction sum score, indicating higher autism-spectrum traits. In contrast, they scored lower on attention to detail sum score, indicating lower autism-spectrum traits. Within the VLBW group, faster growth in weight, length, and head circumference from birth to term was associated with lower total and social interaction sum scores. In this group, growth from term to 1 year was not associated with autism-spectrum traits.

CONCLUSIONS

Among those born preterm at VLBW, the risk for higher levels of autism-spectrum traits, particularly related to social interaction, may persist into adulthood. Faster growth from birth to term may ameliorate these effects, suggesting that targeted interventions could aid long-term neurodevelopment.

Functional outcomes of very premature infants into adulthood

The outcomes of very low birth weight survivors born in the early post-neonatal intensive care era have now been reported to young adulthood in several longitudinal cohort studies, and more recently from large Scandinavian national databases. The latter reports corroborate the findings that despite disabilities, a significant majority of very low birth weight survivors are leading productive lives, and are functioning better than expected. This is reassuring, but there are still concerns about future psychopathology, cardiovascular and metabolic problems as they approach middle age. Although these findings may not be directly applicable to the current survivors of modern neonatal intensive care, they do provide a yardstick by which to project the outcomes of future survivors until more contemporaneous data are available.

Hospice support and the transition to adult services and adulthood for young people with life-limiting conditions and their families: a qualitative study

BACKGROUND

Transition to adult services and adulthood is now a prospect for young people with life-limiting conditions requiring palliative care. Little is known about their transition experiences or how children's hospices can support a young adult population during/following transition.

AIMS

(1) To examine how young people with life-limiting conditions and their parents experience transition. (2) To identify families' and hospice staff's perceptions of family support needs during transition. (3) To identify the implications for children's hospices.

DESIGN

Qualitative study using in-depth, semi-structured interviews. Analysis used a grounded theory approach.

SETTING/PARTICIPANTS

A total of 39 participants recruited from one children's hospice in the United Kingdom.

RESULTS

Transition planning was absent or poorly coordinated; for most families, there were no equivalent adult health/social services. Consequently, it was a time of uncertainty and anxiety for families. Moving to a young adult unit was a positive experience for young people as the building/support model recognised their adult status. However, they had unmet needs for emotional support and accessing information/services to realise their aspirations. Parents had unmet emotional needs and were unclear of support available once their children reached adulthood. Staff identified training needs in relation to working with adults, providing emotional support and acting as an advocate/key worker.

CONCLUSIONS

Providing an appropriate building is only one aspect of developing support for young adults. A different model of support is needed, one which promotes young people's independence and provides emotional support while continuing to support parents and siblings. Hospices could play a role in transition support and coordination.

Self- and parent-rated executive functioning in young adults with very low birth weight

BACKGROUND AND OBJECTIVE

Adults born preterm score lower on performance-based tests of executive functioning (EF) than their term-born peers. These test scores do not necessarily translate to application of these skills in an everyday environment. The objective of the study was to test differences between very low birth weight (VLBW; <1500 g) adults and their term-born peers in self- and parent-rated EF and examine concordance between self- and parent-rated EF and performance-based tests of EF.

METHODS

A longitudinal study of 90 VLBW adults and 93 term-born controls (aged 21-30 years) was performed. The young adults and their parents filled in the Behavioral Rating Inventory of Executive Functioning-Adult Version, and the adults underwent performance-based tests of EF.

RESULTS

VLBW young adults and especially those born appropriate for gestational age reported fewer problems in behavioral regulation and global EF than term-born controls; however, parents of VLBW adults born small for gestational age reported more problems for their children in all EF scales than parents of the controls. Compared with their parents, VLBW young adults reported fewer problems in behavioral regulation. Adults' ratings and their parents' ratings correlated significantly among VLBW and control groups. In the VLBW and VLBW/small-for-gestational-age groups, parent ratings of EF were correlated to performance-based tests, whereas among term-born adults, self-reports correlated.

CONCLUSIONS

These findings reveal that VLBW adults may have learned to compensate in the everyday environment for their EF deficits apparent in performance-based tests. Alternatively, VLBW adults may have positively skewed views of their abilities.

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.

Early determinants of mental health

Environmental adversities in pre- and early postnatal life may have life-long consequences. Based upon a series of epidemiological and clinical studies and natural experiments, this review describes how the early life environment may affect psychological functions and mental disorders later in life. We focus on studies that have examined the associations of small body size at birth and prematurity as proxies of prenatal environmental adversity. We also review literature on materno-fetal malnutrition, maternal prenatal glycyrrhizin in licorice consumption and hypertension-spectrum pregnancy disorders as factors that may compromise the fetal developmental milieu and hence provide insight into some of the mechanisms that may underlie prenatal programming. While effects of programming mostly take place during the first 1000 days after conception, we finally present evidence from prospective studies suggesting that programming can occur also during later critical periods of development or 'windows of plasticity'. The studies may bear relevance for future prevention and intervention programs targeting the potentially modifiable environmental factors that will aid at promoting mental well-being and health of an individual.

Adult psychiatric outcomes of very low birth weight survivors

BACKGROUND

Childhood studies have identified relationships between low birth weight and a variety of psychological disorders. However, very few studies have prospectively followed VLBW survivors into adulthood and none have examined adult psychiatric disorders in this population.

OBJECTIVE

This exploratory study sought to determine the rates and nature of psychiatric disorders in very low birth weight (VLBW, birth weight < 1500 g) adults.

METHOD

117 VLBW participants and 32 normal birth weight (NBW, birth weight > 2499 g) controls, born 1977-1982, were assessed in early adulthood (24-29 years). Participants were first screened for psychopathology using the Symptoms Checklist (SCL-90-R). Participants who were elevated on this measure were eligible for a Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) to determine a formal psychiatric diagnosis.

RESULTS

VLBW adults were more likely than controls to be elevated on the Global Severity Index (odds ratio (OR) = 4.29, 95% confidence interval (CI) = 0.96, 19.14) and the depression (OR = 5.17, 95%CI = 1.17, 23.00), paranoid ideation (OR = 4.08, 95%CI = 0.91, 18.23), hostility (relative risk (RR) = 1.34, 95%CI = 1.21, 1.49), and interpersonal sensitivity (OR = 3.80, 95%CI = 1.08, 13.32) subscales of the SCL-90-R. VLBW adults were also more likely to be diagnosed with a current mood disorder than NBW adults (RR = 1.36, 95%CI = 1.22, 1.51).

CONCLUSIONS

VLBW adults are at greater risk of psychopathology than NBW peers.

Premenstrual symptoms in young adults born preterm at very low birth weight - from the Helsinki Study of Very Low Birth Weight Adults

Background

Clinically significant premenstrual symptoms are common among young women. Premenstrual syndrome (PMS) is characterized by emotional, behavioural and physical symptoms that consistently occur during the luteal phase of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS. Individual variation in stress responsiveness may be involved in the pathophysiology of premenstrual symptoms. Preterm birth at very low birth weight (VLBW, < 1500g) has a multitude of consequences that extend to adult life, including altered stress responsiveness which could affect the prevalence of premenstrual symptoms.

Methods

In this cohort study, we compared 75 VLBW women with 95 women born at term (mean age 22.5). We used a standardized retrospective questionnaire assessing the presence and severity of a variety of symptoms before and after menses. The symptom scores were used both as continuous and as dichotomized variables, with cutoffs based on DSM-IV criteria for PMDD and ACOG criteria for PMS, except prospective daily ratings could not be used. We used multiple linear and logistic regression to adjust for confounders.

Results

There was no difference in the continuous symptom score before menses (mean difference VLBW-term -18.3%, 95% confidence interval -37.9 to 7.5%) or after menses. The prevalence of premenstrual symptoms causing severe impairment to daily life was 13.3% for VLBW women and 14.7% for control women. For PMDD, it was 8.0% and 4.2%, and for PMS, 12.0% and 11.6%, respectively. These differences were not statistically significant (p > 0.1).

Conclusion

Our findings suggest that the severity of premenstrual symptoms and the prevalence of PMDD and PMS among young women born preterm at VLBW is not higher than among those born at term.

The quality of life of young children and infants with chronic medical problems: review of the literature

The question "what makes a good quality of life?" is a philosophical one which could be thought immune to scientific investigations. However, over the last few decades there has been great progress in developing tools to quantify quality of life (QoL) to make comparisons between different health states, evaluate the effectiveness of medical interventions, and describe the life trajectories of individuals or groups. Using a series of vignettes, we explore and review the biomedical literature to demonstrate how QoL is affected by chronic health conditions in childhood, and how it evolves as individuals pass into adulthood. Individuals experiencing serious chronic illnesses generally have reduced health-related QoL: their health status has significant repercussions of their everyday life, but scores are usually much better than healthy individuals expect, and better than physicians predict. Global QoL is more than a health status concept. QoL is a complex relationship between objectivity and subjectivity; it requires substantial and valid facts, and it defines itself by an interpretation of health within different schemes of values: societal, medical, and those of the subject themselves. QoL is dynamic; purely physical influences diminish as individuals age, and psychosocial factors become much more important. Resilience frequently allows adaptation to adverse health states, leading to acceptable QoL for most children with disabilities.

Resting energy expenditure in young adults born preterm--the Helsinki study of very low birth weight adults

Background

Adults born preterm with very low birth weight (VLBW; <1500g) have higher levels of cardiovascular and metabolic risk factors than their counterparts born at term. Resting energy expenditure (REE) could be one factor contributing to, or protecting from, these risks. We studied the effects of premature birth with VLBW on REE.

Methodology/Principal Findings

We used indirect calorimetry to measure REE and dual x-ray absorptiometry (DXA) to measure lean body mass (LBM) in 116 VLBW and in 118 term-born control individuals (mean age: 22.5 years, SD 2.2) participating in a cohort study. Compared with controls VLBW adults had 6.3% lower REE (95% CI 3.2, 9.3) adjusted for age and sex, but 6.1% higher REE/LBM ratio (95% CI 3.4, 8.6). These differences remained similar when further adjusted for parental education, daily smoking, body fat percentage and self-reported leisure time exercise intensity, duration and frequency.

Conclusions/Significance

Adults born prematurely with very low birth weight have higher resting energy expenditure per unit lean body mass than their peers born at term. This is not explained by differences in childhood socio-economic status, current fat percentage, smoking or leisure time physical activity. Presence of metabolically more active tissue could protect people with very low birth weight from obesity and subsequent risk of chronic disease.

Parental bonding after preterm birth: child and parent perspectives in the Helsinki study of very low birth weight adults

OBJECTIVE

To examine whether parenting behavior recalled by very low birth weight (VLBW) adults or their parents differs from that of term-born control subjects or their parents.

STUDY DESIGN

A total of 164 VLBW and 172 control adults (mean age 22.5 years, SD 2.2) assessed retrospectively the parenting behavior of their parents by the Parental Bonding Instrument, which includes dimensions of care, protectiveness, and authoritarianism. A subgroup of 190 mothers and 154 fathers assessed their own parenting behavior by the Parent Behavior Inventory, which includes dimensions of supportive and hostile parenting.

RESULTS

The VLBW women assessed their mothers as more protective and authoritarian than the control women. The VLBW and control men did not differ from each other. Both mothers and fathers of the VLBW adults assessed their own parenting as more supportive than those of the control subjects.

CONCLUSIONS

Preterm birth at VLBW may promote a more protective, as well as more supportive, parenting style.

Intima-media thickness and flow-mediated dilatation in the Helsinki study of very low birth weight adults

BACKGROUND

Adults born at a very low birth weight (VLBW) (< 1500 g), compared with those born at term, bear risk factors for cardiovascular disease, including higher blood pressure and insulin resistance.

OBJECTIVE

We studied, in young adults born at a VLBW, early signs of an accelerated atherosclerotic process and the relationship of these signs with postnatal growth.

METHODS

We compared 92 with a VLBW with 68 who were born at term. At age 18 to 27, we measured stiffness and intima-media thickness (IMT) of the right carotid artery and flow-mediated dilatation (FMD) of the right brachial artery.

RESULTS

Those with a VLBW had 1.1% units higher FMD (95% confidence interval [CI]: 0.0-2.2) (P = .06) and 0.5% units higher IMT relative to lumen size (95% CI: 0.1-0.9). IMT or FMD, when analyzed as the absolute change in millimeters, and carotid stiffness in the groups were similar. Among those with a VLBW, each 100-g-greater weight gain during the first 2 postnatal weeks predicted 1.1% units higher FMD (95% CI: 0.2-2.0) in adulthood.

CONCLUSIONS

Although young adults born at VLBWs, compared with those born at term, have higher levels of risk factors for cardiovascular disease, we found no clear evidence for elevated early markers of atherosclerosis. However, in relation to artery lumen diameter, IMT in the participants who had a VLBW was higher than in those who were born at term. In our study, weight gain during the first postnatal weeks had no harmful effect on the arteries in young adulthood.

Adults born at very low birth weight exercise less than their peers born at term

OBJECTIVE

To study the effects of very low birth weight (VLBW, <1500 g) birth on physical activity, an important protective and modifiable factor.

STUDY DESIGN

VLBW participants (n=163) with no major disability and 188 individuals born at term (mean age, 22.3 years; range, 18.5-27.1) completed a standardized questionnaire of physical activity.

RESULTS

VLBW participants reported less leisure-time conditioning physical activity. They were 1.61-fold more likely to "not exercise much," 1.61-fold more likely to exercise infrequently (once a week or less), 2.75-fold more likely to exercise with low intensity (walking), and 3.11-fold more likely to have short exercise sessions (<30 minutes). The differences were present even in subjects with no history of bronchopulmonary dysplasia or asthma and were only slightly attenuated when adjusted for height, parental education, lean body mass, and percent body fat.

CONCLUSIONS

Unimpaired adults who were VLBW exercise less during their leisure time than adults born at term. Promoting physical activity may be particularly important in the VLBW population to counteract the risks of chronic disease in adult life.

Reduced body size and shape-related symptoms in young adults born preterm with very low birth weight: Helsinki study of very low birth weight adults

OBJECTIVE

To test the hypothesis that being born prematurely with very low birth weight (VLBW) (birth weight<or=1500 g) is associated with subphenotypes of eating disorders (dissatisfaction with body shape and pursuit of thinness) in young adulthood.

STUDY DESIGN

Preterm-born VLBW subjects (n=163) and controls (n=189) born at term completed 3 subscales of Eating Disorder Inventory-2 questionnaire (EDI): Drive for Thinness, Body Dissatisfaction, and Bulimia. Data were analyzed with multiple linear regression adjusted for confounders.

RESULTS

Among both sexes, EDI total scores were lower in VLBW subjects than in controls. The fully adjusted difference was -11.0% (95% CI, -18.4%, -2.2%) for women and -11.2% (95% CI, -20.2%, -1.3%) for men. Among women the lower scores in VLBW adults were observed in each EDI subscale. Results were similar when adjusted also for fat percentage, measured by dual-energy x-ray absorptiometry. Of the covariates, higher body mass index and higher score in Beck Depression Inventory contributed significantly to a higher EDI total score.

CONCLUSIONS

Young adults, particularly women, born prematurely with VLBW have fewer body size and shape-related symptoms and possibly lower risk for eating disorders than their term-born peers.

Adult outcome of extremely preterm infants

Survival rates for extremely preterm (<28 weeks' gestational age) infants have increased and are approaching 3 in 4 with the advent of modern perinatal and neonatal intensive care. In contrast with some children with chronic diseases such as cystic fibrosis, most survivors of extreme prematurity have no ongoing health issues. However, as a group, they do have higher rates of adverse health outcomes, and more of them will present to pediatricians over time and, ultimately, to adult physicians as they grow older. Pediatricians can aid the transition to adult health care by being aware of the nutritional, cardiovascular, respiratory, motor, cognitive, psychiatric, and functional outcomes into adulthood of survivors of extreme prematurity.