June 30, 2022
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Babies with a very low birth weight may be at a much higher risk of depression, ADHD, or other psychiatric conditions in adulthood, compared with those born a healthy weight, and steroid use just before birth may increase this risk even further. This is according to a study published in the journal Pediatrics.
But it is not all bad news for very-low-birth-weight babies; the research team – led by Dr. Ryan Van Lieshout, professor of psychiatry and neurosciences in the Michael G. DeGroote School of Medicine at McMaster University in Canada – also found they are at lower risk of alcohol or substance abuse.
The most common driver behind low birth weight is premature birth; approximately 7 in 10 low-birth-weight babies in the US are born preterm. Other causes include fetal growth restriction and infection during pregnancy.
Past studies have established that babies with a low birth weight are at increased risk of numerous health problems later in life, including obesity, hypertension, diabetes, and heart disease. But how does low birth weight affect mental health in adulthood?
To find out, Dr. Van Lieshout and his team analyzed the presence of psychiatric disorders among 84 adults who were born with an extremely low birth weight (less than 1,000 g) and 90 adults who were born a normal birth weight.
All participants were born between 1977 and 1982 in Ontario, Canada, and were in their early 30s at the time of assessment.
The researchers found that the participants with extremely low birth weight were three times less likely to develop a substance or alcohol use disorder than those with normal birth weight.
However, low-birth-weight participants were 2.5 times more likely to develop a psychiatric disorder in adulthood – such as depression, ADHD (attention deficit hyperactivity disorder), and anxiety than those born normal weight, according to the team.
In addition, low-birth-weight participants whose mothers received full antenatal steroid treatment just before birth were found to be almost 4.5 times more likely than normal-birth-weight participants to develop psychiatric problems, and they also had no reduced risk for substance or alcohol use disorders.
Commenting on their findings, Dr. Van Lieshout says: “Importantly, we have identified psychiatric risks that may develop for extremely low-birth-weight survivors as they become adults, and this understanding will help us better predict, detect and treat mental disorders in this population.”
Analysis of another research conducted over nearly 30 years showed the same thing. The study appears in the journal Psychological Bulletin®, which is published by the American Psychological Association.
“Our findings provide evidence that individuals born at extremely low birth weight are at higher overall risk for psychological difficulties than their normal birth weight peers. These difficulties most frequently involve attention, anxiety-related and social problems,” said lead author Karen Mathewson, Ph.D., McMaster University.
Mathewson and her colleagues conducted meta-analyses using 41 studies that followed 2,712 individuals who were extremely low birth weight babies and 11,127 who were normal birth weight babies. The studies took place over a 26-year period (1990 – 2016) in 12 different countries, including the United States and Canada.
Extremely low birth weight babies were found to be at increased risk for particular mental health problems, beginning in childhood and extending at least into their 30s. As children, they were significantly more likely to have attention deficit hyperactivity disorder in almost every study included in the review. Adolescents were also at greater risk for ADHD and social problems. Adults born with extremely low birth weight reported significantly higher levels of anxiety, depression, and shyness, as well as significantly lower levels of social functioning.
These risks did not seem to vary according to where or when extremely low birth weight survivors were born, or whether they had significant neurosensory impairments, such as cerebral palsy or blindness. All of the studies were from developed countries from North America, Europe, or Australia.
Mathewson believes these findings may stem from the biological responses of the infant to difficult prenatal conditions and postnatal stresses following early birth.
“The consistency of the findings across geographical regions suggests that these attentional, behavioral and social outcomes may be contributed to by developmentally programmed, biological factors,” she said.
Even though the risk for mental health problems in extremely low birth weight survivors is increased compared to normal birth weight individuals, many will not develop mental disorders at all, Mathewson noted. But the effect sizes for ADHD, social problems, and internalizing disorders were moderate-to-large in extremely low birth weight children and remained moderate in extremely low birth weight adolescents. (A moderate effect is generally apparent to an unaided, careful observer). Moderate effects of birth weight status suggest that group differences in the risk for these mental health problems can be significant. The findings point to the need to continue to provide services to these individuals throughout their lives, according to Mathewson. “It is important that families and health care providers be aware of the potential for early-emerging mental health problems in extremely low birth weight survivors, and that some of these individuals may not grow out of these problems as they get older,” she said. “As a result, it is essential that appropriate treatment be made available to those who require it as early in life as possible.”
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