Psychological and psychophysiological functioning of young adults born preterm : The Helsinki Study of Very Low Birth Weight Adults

Improvements in neonatal intensive care during the last few decades have led to a remarkable improvement in the survival rates of preterm infants born with very low birth weight (< 1500 g; VLBW). However, VLBW may have a cost for the physical, psychosocial and cognitive development of the survivors. Nevertheless, there has been little research into the long-term consequences of VLBW that last till or emerge in adulthood. In addition, there have been relatively few studies on whether the adult outcomes of VLBW depend on sex or fetal growth. Within the Helsinki Study of Very Low Birth Weight Adults, we studied whether young adults with VLBW differ from term-born adults in psychological and psychophysiological functioning as well as in recollections of parenting, and whether potential group differences are modified by sex or intrauterine growth. The original cohort comprised 335 VLBW infants born between 1978 and 1985, treated at the Children s Hospital of Helsinki University Central Hospital, and discharged alive. A total of 373 infants born at term at the same birth hospitals were identified to form a control group. At the first follow-up visit in young adulthood (mean age 22.5 years), 166 VLBW (42.8% men) and 172 term-born control adults (40.1% men) participated. Of the VLBW participants, 33.1% were born small for gestational age (SGA; birth weight for gestational age < -2 SD), which was used as a crude indicator of poorer intrauterine growth. In conjunction with the first visit, the participants filled in questionnaires on personality, romantic attachment and the parenting behavior of their parents. In addition, blood pressure reactivity to psychosocial stress was measured in a subsample of 44 VLBW and 37 control adults. At the second follow-up visit, three years later (mean age 25.0 years), 113 VLBW (44.2% men; 37.2% SGA) and 105 control adults (42.9% men) participated, and their academic achievement was self-reported and neurocognitive abilities were tested. In addition, the parents of the participants filled in questionnaires on their own parenting behaviors. In comparison to the term-born adults, the VLBW adults scored lower in all the neurocognitive tests, and they had more often received remedial education, although they did not differ in years of education or in their grade point averages (Study I). The VLBW adults also showed a higher diastolic blood pressure reactivity to psychosocial stress (Study II). Sex and being born SGA modified the results concerning personality, romantic attachment and parenting. In the personality assessment, all the VLBW adults reported less fun seeking indicating less spontaneous eagerness for new, potentially rewarding actions, but only the VLBW-SGA women reported more behavioral inhibition than the term-born women (Study III). In relation to their romantic attachment style, the VLBW adults, with the exception of the VLBW-SGA women, reported less anxiety than the controls, indicating less concerns over being rejected by their partner. In contrast, the VLBW-SGA women reported increased attachment-related avoidance behavior (Study IV). In relation to parenting, the VLBW women reported that their mothers had been more protective and authoritarian than did women in the term-born group, but there were no group differences in parental care. The parents of the VLBW adults reported more supportive parenting than the parents of the term-born adults (Study V). In conclusion, we found that the VLBW adults differed from those born at term in all the areas of functioning included in the thesis. Of the VLBW adults, more alterations were found in women and in those with poor intrauterine growth. Overall, according to the results in young adulthood, VLBW may be related to vulnerabilities such as lower neurocognitive abilities and increased blood pressure reactivity; however, it may also give rise to potentially protective factors, such as higher parental involvement. Knowledge of the different vulnerabilities and protective factors could be utilized in planning interventions and optimal measures of support among preterm children and their families.Pikkukeskosena syntyminen ennustaa myöhempää psykologista ja psykofysiologista kehitystä Väitöstutkimuksessa verrattiin pikkukeskosina (syntymäpaino alle 1500 g) syntyneitä nuoria aikuisia täysiaikaisina syntyneisiin verrokkeihin psykologisissa ja psykofysiologisissa toiminnoissa. Ryhmät erosivat toisistaan kaikilla tutkituilla osa-alueilla. Pikkukeskosina syntyneet suoriutuivat verrokkeja heikommin kognitiivisissa testeissä ja olivat saaneet peruskoulussa enemmän tukiopetusta, mutta eivät eronneet verrokeistaan opiskeluvuosien tai peruskoulun päättötodistuksen keskiarvon suhteen. Lisäksi pikkukeskosina syntyneiden verenpainereaktiivisuus psykososiaaliseen stressiin oli suurempi kuin verrokeilla. Persoonallisuuden piirteiden osalta pikkukeskosena syntyneet raportoivat vähemmän taipumusta hauskuuden tavoitteluun. Kiintymystyyliä koskevassa parisuhdekyselyssä pikkukeskosena syntyneet raportoivat vähemmän huolta torjutuksi tulemisesta kuin verrokit. Sikiöaikanaan hitaasti kasvaneet pikkukeskosnaiset erottuivat kuitenkin muusta keskosryhmästä raportoimalla verrokkinaisiin verrattuna voimakkaampaa välttämiskäyttäytymistä sekä yleisenä persoonallisuuden piirteenään että erityisesti parisuhteessaan. Vanhemmuuskyselyssä pikkukeskosnaiset raportoivat äitiensä olleen suojelevampia ja kontrolloivampia kuin verrokkinaiset. Pikkukeskosena syntyneiden vanhemmat itse raportoivat enemmän lasta tukevaa vanhemmuutta kuin verrokkien vanhemmat. Kaiken kaikkiaan tulosten mukaan pikkukeskosena syntyminen on yhteydessä riskitekijöihin kuten heikompiin kognitiivisiin taitoihin, kohonneeseen stressiverenpaineeseen ja voimakkaampaan välttämiskäyttäytymiseen, mutta myös mahdollisiin suojaaviin tekijöihin kuten vanhempien osallistuvaan vanhemmuuteen. Tietoa keskosten riskitekijöistä ja vahvuuksista voidaan hyödyntää keskoslasten ja heidän perheidensä parissa tehtävien tukitoimien suunnittelussa. Koska keskosten tehohoidon kehittymisen myötä pikkukeskosten selviytymisennuste on parantunut huomattavasti vasta viime vuosikymmenien aikana, pikkukeskosuuden aikuisuuteen ulottuvia tai aikuisuudessa ilmaantuvia pitkäaikaisseurauksia ei ole riittävästi voitu tutkia. Tämä väitöstutkimus valottaa osaltaan pikkukeskosuuden yhteyksiä myöhempään psykologiseen ja psykofysiologiseen kehitykseen. Tutkimus toteutettiin osana kohorttitukimusta 'Pikkukeskosen terveys aikuisiässä'. Alkuperäinen kohortti koostui vuosina 1978 1985 Helsingin ja Uudenmaan sairaanhoitopiirin alueella syntyneistä pikkukeskosista sekä heidän täysiaikaisista verrokeistaan. Ensimmäiselle tutkimuskäynnille varhaisaikuisuudessa (keski-ikä 22.5 vuotta) osallistui 166 pikkukeskosena (42.8% miehiä; 33.1% hidas sikiöajan kasvu) ja 172 täysiaikaisena (40.1% miehiä) syntynyttä tutkittavaa. Toiselle tutkimuskäynnille (keski-ikä 25.0 vuotta) osallistui 113 pikkukeskosena (44.2% miehiä; 37.2% hidas sikiöajan kasvu) ja 105 täysiaikaisena (42.9% miehiä) syntynyttä tutkittavaa. Koulusuoriutumista, persoonallisuutta, parisuhdekiintymystä ja vanhemmuutta tutkittiin kyselylomakkeilla ja kognitiivisia taitoja selvitettiin neuropsykologisilla testeillä. Verenpainereaktiivisuutta mitattiin 44 pikkukeskosena ja 37 täysiaikaisena syntyneen tutkittavan osajoukossa psykososiaalisen stressikokeen aikana

Cardiovascular Responses to Psychosocial Stress Reflect Motivation State in Adults Born at Extremely Low Birth Weight

Background. Adults born extremely preterm appear to have more difficulty managing the stresses of early adulthood than their term-born peers. Objective. To examine the effects of being born at extremely low birth weight (ELBW; birth weight < 1000 g) versus at full term on cardiovascular responses to stress. Method. Cardiovascular responses were elicited during administration of a widely used laboratory stressor, the Trier Social Stress Test (TSST). Results. Term-born adults exhibited a larger decrease in total peripheral resistance and larger increase in cardiac output for TSST performance, reflecting greater resilience, than did ELBW adults. Furthermore, in ELBW participants but not controls, cardiovascular responses were correlated with anxiety, suggesting that their responses reflected feelings of stress. Conclusions. Skills-training and practice with relevant stressors may be necessary to increase the personal resources of ELBW participants for managing stress as they transition to adulthood.Peer reviewe

Nutrition after preterm birth and adult neurocognitive outcomes

Background Preterm birth ( Methods In 86 participants of the Helsinki Study of Very Low Birth Weight Adults (birthweight <1500g), we examined if higher intakes of energy, macronutrients, and human milk during the first nine weeks after preterm birth predict performance in tests of cognitive ability at 25.1 years of age (SD = 2.1). Results 10 kcal/kg/day higher total energy intake at 3 to 6 weeks of age was associated with 0.21 SD higher adult IQ (95% Confidence Interval [CI] 0.07-0.35). Higher carbohydrate and fat intake at 3-6 weeks, and higher energy intake from human milk at 3-6 and at 6-9 weeks were also associated with higher adult IQ: these effect sizes ranged from 0.09 SD (95% CI 0.01-0.18) to 0.34 SD (0.14-0.54) higher IQ, per one gram/kg/day more carbohydrate and fat, and per 10 kcal/kg/day more energy from human milk. Adjustment for neonatal complications attenuated the associations: intraventricular hemorrhage, in particular, was associated with both poorer nutrition and poorer IQ. Conclusion In preterm neonates with very low birth weight, higher energy and human milk intake predict better neurocognitive abilities in adulthood. To understand the determinants of these infants' neurocognitive outcome, it seems important to take into account the role of postnatal nutrition, not just as an isolated exposure, but as a potential mediator between neonatal illness and long-term neurodevelopment.Peer reviewe

Diurnal Cortisol Patterns and Dexamethasone Suppression Test Responses in Healthy Young Adults Born Preterm at Very Low Birth Weight

BACKGROUND: Early life stress, such as painful and stressful procedures during neonatal intensive care after preterm birth, can permanently affect physiological, hormonal and neurobiological systems. This may contribute to altered programming of the hypothalamic-pituitary-adrenal axis (HPAA) and provoke changes in HPAA function with long-term health impacts. Previous studies suggest a lower HPAA response to stress in young adults born preterm compared with controls born at term. We assessed whether these differences in HPAA stress responsiveness are reflected in everyday life HPAA functioning, i.e. in diurnal salivary cortisol patterns, and reactivity to a low-dose dexamethasone suppression test (DST), in unimpaired young adults born preterm at very low birth weight (VLBW; <1500 g). METHODS: The participants were recruited from the Helsinki Study of Very Low Birth Weight Adults cohort study. At mean age 23.3 years (2.1 SD), 49 VLBW and 36 controls born at term participated in the study. For cortisol analyzes, saliva samples were collected on two consecutive days at 0, 15, 30 and 60 min after wake-up, at 12:00 h, 17:00 h and 22:00 h. After the last salivary sample of the first study day the participants were instructed to take a 0.5 mg dexamethasone tablet. RESULTS: With mixed-effects model no difference was seen in overall diurnal salivary cortisol between VLBW and control groups [13.9% (95% CI: -11.6, 47.0), P = 0.31]. Salivary cortisol increased similarly after awakening in both VLBW and control participants [mean difference -2.9% (29.2, 33.0), P = 0.85]. Also reactivity to the low-dose DST (awakening cortisol ratio day2/day1) was similar between VLBW and control groups [-1.1% (-53.5, 103.8), P = 0.97)]. CONCLUSIONS: Diurnal cortisol patterns and reactivity to a low-dose DST in young adulthood were not associated with preterm birth.Peer reviewe

Early life origins cognitive decline: findings in elderly men in the helsinki birth cohort study.

OBJECTIVES: To examine whether the adverse effects of slow prenatal and postnatal growth on cognitive function persist to old age and predict age related cognitive decline. DESIGN AND SETTING: A longitudinal birth cohort study of men born in Helsinki, Finland 1934-44. PARTICIPANTS: Nine-hundred-thirty-one men of the Helsinki Birth Cohort Study, with detailed data on growth from birth to adulthood, aged 20.1 (SD = 1.4) at the first and 67.9 (SD = 2.5) years at the second cognitive testing. MAIN OUTCOME MEASURES: The Finnish Defense Forces Basic Intellectual Ability Test assessed twice over nearly five decades apart. RESULTS: Lower weight, length and head circumference at birth were associated with lower cognitive ability at 67.9 years (1.04-1.55 points lower ability per each standard deviation [SD] unit decrease in body size, 95% Confidence Interval [95%CI]: 0.05 to 2.72) and with cognitive decline after 20.1 years (0.07-0.11 SD decline over time per each SD decrease in body size, 95%CI:0.00 to 0.19). Men who were born larger were more likely to perform better in the cognitive ability test over time (1.22-1.43 increase in odds to remain in the top relative to the lower two thirds in ability over time per each SD increase in body size, 95%CI:1.04 to 1.79) and were more resilient to cognitive decline after 20.1 years (0.69 to 0.76 decrease in odds to decline from than remain in the top third of ability over time per each SD increase in body size, 95%CI:0.49 to 0.99). Slower growth between birth and two years in weight, height and body mass index was associated with lower cognitive ability at 67.9 years, but not with cognitive decline. CONCLUSIONS: Poorer lifetime cognitive ability is predicted by slower growth before and after birth. In predicting resilience to age related cognitive decline, the period before birth seems to be more critical.Peer reviewe

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

Abstract Background Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems) are associated with increased internalizing symptoms in adulthood. Unknown is whether early regulatory problems are associated with emotional disorders in adulthood, and what psychosocial factors may provide protection. We tested whether early childhood multiple or persistent regulatory problems are associated with a higher risk of (a) any mood and anxiety disorder in adulthood; (b) perceiving no social support in adulthood; and (c) whether social support provides protection from mood and anxiety disorders among participants who had multiple/persistent regulatory problems and those who never had regulatory problems. Methods Data from two prospective longitudinal studies in Germany (n = 297) and Finland (n = 342) was included (N = 639). Regulatory problems were assessed at 5, 20, and 56 months with the same standardized parental interviews and neurological examinations. In adulthood (24–30 years), emotional disorders were assessed with diagnostic interviews and social support with questionnaires. Results Children with multiple/persistent regulatory problems (n = 132) had a higher risk of any mood disorder (odds ratio (OR) = 1.81 [95% confidence interval = 1.01–3.23]) and of not having any social support from peers and friends (OR = 1.67 [1.07–2.58]) in adulthood than children who never had regulatory problems. Social support from peers and friends provided protection from mood disorders, but only among adults who never had regulatory problems (OR = 4.03 [2.16–7.94]; p = .039 for regulatory problems x social support interaction). Conclusions Children with multiple/persistent regulatory problems are at increased risk of mood disorders in young adulthood. Social support from peers and friends may, however, only provide protection from mood disorders in individuals who never had regulatory problems

The association of early regulatory problems with behavioral problems and cognitive functioning in adulthood : two cohorts in two countries

Peer reviewe

Positive maternal mental health during pregnancy and psychiatric problems in children from early childhood to late childhood

Negative maternal mental health during pregnancy increases the risk of psychiatric problems in children, but research on the potential benefits of positive maternal mental health during pregnancy is scarce. We investigated associations between positive maternal mental health composite score, based on reports of maternal positive affect, curiosity, and social support during pregnancy, and children's psychiatric problems (Child Behavior Checklist) at ages 1.9-5.9 and 7.1-12.1 years among 2636 mother-child dyads of the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction study. For each standard deviation higher positive maternal mental health score during pregnancy, total psychiatric problems were 1.37 (95% confidence interval (CI) -1.79,-0.95) t-scores lower in early childhood and 1.75 (95% CI -2.24,-1.26) t-scores lower in late childhood. These associations were independent of covariates and of negative maternal mental health. Total psychiatric problems remained stably lower from early childhood to late childhood in children of mothers with higher positive mental health during pregnancy, whereas they increased in children of mothers with lower positive mental health. Positive maternal mental health in child's late childhood partially mediated the effects of positive maternal mental health during pregnancy on children's psychiatric problems. Supporting positive maternal mental health may benefit mothers and children.Peer reviewe

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

Abstract Background: Multiple or persistent crying, sleeping, or feeding problems in early childhood (regulatory problems) are associated with increased internalizing symptoms in adulthood. Unknown is whether early regulatory problems are associated with emotional disorders in adulthood, and what psychosocial factors may provide protection. We tested whether early childhood multiple or persistent regulatory problems are associated with a higher risk of (a) any mood and anxiety disorder in adulthood; (b) perceiving no social support in adulthood; and (c) whether social support provides protection from mood and anxiety disorders among participants who had multiple/persistent regulatory problems and those who never had regulatory problems. Methods: Data from two prospective longitudinal studies in Germany (n = 297) and Finland (n = 342) was included (N = 639). Regulatory problems were assessed at 5, 20, and 56 months with the same standardized parental interviews and neurological examinations. In adulthood (24–30 years), emotional disorders were assessed with diagnostic interviews and social support with questionnaires. Results: Children with multiple/persistent regulatory problems (n = 132) had a higher risk of any mood disorder (odds ratio (OR) = 1.81 [95% confidence interval = 1.01–3.23]) and of not having any social support from peers and friends (OR = 1.67 [1.07–2.58]) in adulthood than children who never had regulatory problems. Social support from peers and friends provided protection from mood disorders, but only among adults who never had regulatory problems (OR = 4.03 [2.16–7.94]; p = .039 for regulatory problems x social support interaction). Conclusions: Children with multiple/persistent regulatory problems are at increased risk of mood disorders in young adulthood. Social support from peers and friends may, however, only provide protection from mood disorders in individuals who never had regulatory problems

Poor Sleep and Cardiovascular Function in Children

We investigated whether sleep quantity and quality were related to 24-hour ambulatory blood pressure and cardiovascular reactivity in children. We studied term-born, healthy 8.0-year olds (SD: 1.4 years) without sleep-disordered breathing (231 and 265 children provided valid data for analyses of ambulatory blood pressure and cardiovascular reactivity, respectively). Sleep was registered with an actigraph for 6 nights on average (SD: 1.2; range: 3 to 13 nights). Ambulatory blood pressure was measured for 24-hours (41% nonschool days) with an oscillometric device. The children underwent the Trier Social Stress Test for Children, during which blood pressure, electrocardiography, and thoracic impedance were recorded and processed offline to give measures of cardiovascular and autonomic function. Neither quantity nor quality of sleep was related to 24-hour ambulatory blood pressure or cardiovascular reactivity after accounting for major covariates (sex, age, height, body mass index, and parental education). Although lower sympathetic nervous system activation and higher cardiac activation under stress were found in the group of children who slept for short duration when they were compared with the average sleep duration group, these associations were not significant after correction for multiple testing and were not seen in linear regression models of the effects of sleep duration. These findings do not support the mainstream of epidemiological findings, derived from samples more heterogeneous in age, sociodemographic characteristics, and health, suggesting that poor sleep is associated with an unhealthy cardiovascular phenotype. (Hypertension. 2011;58:16-21.) . Online Data Supplemen