Sture Andersson

Very Low Birth Weight and Behavioral Symptoms of Attention Deficit Hyperactivity Disorder in Young Adulthood: The Helsinki Study of Very-Low-Birth-Weight Adults

OBJECTIVEnChildren with very low birth weight (<1500 g) are at increased risk for attention deficit hyperactivity disorder (ADHD). Whether this increased risk continues into adulthood is unknown. The authors assessed behavioral symptoms of ADHD in a well-characterized cohort of very-low-birth-weight young adults who were either small for gestational age (less than two standard deviations below the Finnish mean) or appropriate for gestational age (within two standard deviations of the mean).nnnMETHODnA total of 162 very-low-birth-weight subjects (small for gestational age: N=52; appropriate for gestational age: N=110) and 172 term comparison subjects 18 to 27 years of age completed the Adult Problem Questionnaire, which yielded six exploratory factor analysis-derived subscales. Participants were also asked about substance use.nnnRESULTSnVery-low-birth-weight adults in the small for gestational age subgroup scored higher on the executive dysfunctioning and emotional instability subscales of the Adult Problem Questionnaire than did those in the appropriate for gestational age subgroup and the comparison group. The appropriate for gestational age and comparison groups had similar scores on these subscales. On the alcohol use subscale of the Adult Problem Questionnaire, both the appropriate and small for gestational age subgroups scored lower than comparison subjects and also reported fewer risk-taking behaviors (alcohol, smoking, and use of recreational drugs) than did comparison subjects.nnnCONCLUSIONSnRather than very low birth weight per se, intrauterine growth retardation, as reflected by small for gestational age status in the very-low-birth-weight subjects, confers a risk for behavioral and emotional adversity related to ADHD in young adulthood.

Depression in Young Adults With Very Low Birth Weight: The Helsinki Study of Very Low-Birth-Weight Adults

CONTEXTnLittle is known about the mental health outcomes of very low-birth-weight (VLBW) (< 1500 g) infants in young adulthood.nnnOBJECTIVEnTo test whether young adults aged 18 to 27 years with VLBW differ from term control subjects in depressive symptoms, current use of antidepressant medication, and the rate of depression diagnosed by a physician.nnnDESIGNnRetrospective longitudinal study.nnnSETTINGnAcademic research.nnnPARTICIPANTSnA total of 162 VLBW young adults (response rate, 65.1%) and 172 term control subjects (response rate, 54.8%) born between February 22, 1978, and November 8, 1985, in Helsinki, Finland.nnnMAIN OUTCOME MEASURESnAntidepressant use, history of physician-diagnosed depression, Beck Depression Inventory score, and Center for Epidemiologic Studies Depression Scale score.nnnRESULTSnThe VLBW participants reported 20.1% (95% confidence interval [CI], -40.8% to -5.1%) lower CES-D scores than the controls (P =.02). However, this finding was confined to 110 VLBW participants who were born appropriate for gestational age (birth weight > or = -2 SDs according to Finnish birth weight charts), whose Center for Epidemiologic Studies Depression Scale scores were 29.1% (95% CI, -53.7% to -8.4%) lower than those of the controls (P =.004). Furthermore, VLBW participants born appropriate for gestational age were 4.8 (95% CI, 1.3-10.0) times less likely to report a depression diagnosis than controls (P =.02). In contrast, 52 VLBW participants born small for gestational age (birth weight < -2 SDs according to Finnish birth weight charts) reported 36.2% (95% CI, 1.1%-83.5%) higher Beck Depression Inventory scores (P =.04), were 4.0 (95% CI, 1.1-14.3) times more likely to use antidepressants (P =.03), and were 2.5 (95% CI, 1.0-6.3) times more likely to report a depression diagnosis (P =.04) compared with controls.nnnCONCLUSIONSnThis is the first study (to our knowledge) to show that intrauterine growth pattern may modify associations between VLBW and depression. Intrauterine growth retardation rather than VLBW per se may pose a risk of depression in young adulthood.

Decreased bone mineral density in adults born with very low birth weight: a cohort study.

Petteri Hovi and colleagues evaluate skeletal health in 144 adults born preterm with very low birth weight and show that as adults these individuals have significantly lower bone mineral density than do their term-born peers.

Very Low Birth Weight Increases Risk for Sleep-Disordered Breathing in Young Adulthood: The Helsinki Study of Very Low Birth Weight Adults

OBJECTIVE. We investigated whether very low birth weight (<1500 g) is associated with the risk of sleep-disordered breathing in young adulthood. METHODS. The study was a retrospective longitudinal study of 158 young adults born with very low birth weight and 169 term-born control subjects (aged 18.5–27.1 years). The principal outcome variable was sleep-disordered breathing defined as chronic snoring. RESULTS. The crude prevalence of chronic snoring was similar in both groups: 15.8% for the very low birth weight group versus 13.6% for the control group. However, after controlling for the confounding variables in multivariate logistic regression models (age, gender, current smoking, parental education, height, BMI, and depression), chronic snoring was 2.2 times more likely in the very low birth weight group compared with the control group. In addition, maternal smoking during pregnancy was significantly and independently of very low birth weight related to risk of sleep-disordered breathing. Maternal preeclampsia, standardized birth weight, and, for very low birth weight infants, small-for-gestational-age status were not related to sleep-disordered breathing. CONCLUSIONS. Premature infants with very low birth weight have a twofold risk of sleep-disordered breathing as young adults. In addition, maternal smoking during pregnancy increases the risk of sleep-disordered breathing by more than twofold.

Ambulatory Blood Pressure in Young Adults with Very Low Birth Weight

OBJECTIVEnWe hypothesized that, as compared with a matched control group born at term, young adults with very low birth weight (VLBW <1.5 kg) would have higher 24-hour ambulatory blood pressure.nnnSTUDY DESIGNnWe studied 118 18- to 27-year-old subjects born with VLBW within the greater Helsinki area and 120 term-born control subjects with similar age, sex, and birth hospital. The mean birth weight for VLBW subjects was 1.1 kg (standard deviation [SD], 0.2) and for controls, 3.6 kg (SD, 0.5). Gestational ages were 29.2 (SD, 2.3) and 40.1 (SD, 1.0) weeks. Current education of higher-educated parents served as an indicator of childhood socioeconomic status. Ambulatory blood pressure was measured during a 24-hour period with an oscillometric device (Spacelabs 90207).nnnRESULTSnVLBW subjects had, with sex, age, and body mass index adjustment, a 2.4 mm Hg (95% confidence interval, 0.2 to 4.6) higher 24-hour systolic pressure. We found hypertension in 11 VLBW subjects and in 3 term-born subjects, giving an adjusted odds ratio of 4.0 (1.1 to 14.8). When socioeconomic status was taken into account, results remained unchanged.nnnCONCLUSIONSnHigher rates of hypertension and higher 24-hour blood pressure among young adults with VLBW may indicate higher risk for adverse cardiovascular outcomes.

Adults Born at Very Low Birth Weight Exercise Less than Their Peers Born at Term

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

Personality of young adults born prematurely: the Helsinki study of very low birth weight adults

BACKGROUNDnToday, the first generations of very low birth weight (VLBW <or= 1500 g) infants are entering adulthood but very little is known of their personality traits, associated with both psychopathological vulnerability and resilience.nnnMETHODSnIn this cohort study we compared personality traits among young adults (age range 18 to 27 years, mean 21.4, SD 2.19) with VLBW (n = 158) with those of term-born controls (n = 168) of same gender, age, and maternity hospital. The participants completed the Neo-Personality Inventory.nnnRESULTSnOf the five main traits, the VLBW participants scored significantly higher in conscientiousness (MD .1, 95% CI .0 to .3; p < .03), agreeableness (MD .2, 95% CI .0 to .3; p < .001), and lower in openness to experience (MD -.1, 95% CI -.2 to .0; p < .02). In addition, the VLBW group differed from the controls with regard to facets of neuroticism (lower hostility and impulsivity, ps < .05) and extraversion (less assertiveness p < .01). Furthermore, there were fewer undercontrolled personality profiles among the VLBW subjects (p < .01). All differences were independent of gender, age at assessment, parental education, individual school grade average, and maternal pre-eclampsia and smoking during pregnancy.nnnCONCLUSIONSnYoung adults born with VLBW showed markedly different personality traits compared with their controls. The VLBW group displayed less negative emotions, were more dutiful and cautious, and displayed more warmth in their social relationships than their term-born peers. We present two potential mechanisms underlying these findings. The first relates to parental influences and the other to evidence linking biological mechanisms associated with prematurity with personality characteristics in adulthood.

Young Adults With Very Low Birth Weight: Leaving the Parental Home and Sexual Relationships—Helsinki Study of Very Low Birth Weight Adults

OBJECTIVE. Although most children and adults who are born very preterm live healthy lives, they have, on average, lower cognitive scores, more internalizing behaviors, and deficits in social skills. This could well affect their transition to adulthood. We studied the tempo of first leaving the parental home and starting cohabitation with an intimate partner and sexual experience of young adults with very low birth weight (<1500 g). METHODS. In conjunction with the Helsinki Study of Very Low Birth Weight Adults, 162 very low birth weight individuals and 188 individuals who were born at term (mean age: 22.3 years [range: 18.5–27.1]) and did not have any major disability filled out a questionnaire. For analysis of their ages at events which had not occurred in all subjects, we used survival analysis (Cox regression), adjusted for gender, current height, parents ages at the birth, maternal smoking during pregnancy, parental educational attainment, number of siblings, and parental divorce/death. RESULTS. During their late teens and early adulthood, these very low birth weight adults were less likely to leave the parental home and to start cohabiting with an intimate partner. In gender-stratified analyses, these hazard ratios were similar between genders, but the latter was statistically significant for women only. These very low birth weight adults were also less likely to experience sexual intercourse. This relationship was statistically significant for women but not for men; however, very low birth weight women and men both reported a smaller lifetime number of sex partners than did control subjects. CONCLUSIONS. Healthy young adults with very low birth weight show a delay in leaving the parental home and starting sexual activity and partnerships.

Advanced Pubertal Growth Spurt in Subjects Born Preterm: The Helsinki Study of Very Low Birth Weight Adults

CONTEXTnAmong people born at term, low birth weight is associated with early puberty. Early maturation may be on the pathway linking low birth weight with cardiovascular disease and type 2 diabetes. Subjects born preterm with very low birth weight (VLBW; <1500 g) have as adults increased risk factors for cardiovascular disease. Little is known about their pubertal timing.nnnOBJECTIVEnThe objective of the investigation was to study the timing of pubertal growth in subjects born preterm with VLBW as compared with controls.nnnDESIGN, SETTING, AND PARTICIPANTSnA follow-up study of subjects born preterm including 188 VLBW and 190 term-born control subjects. Growth data were available for 128 VLBW and 147 control subjects, of whom we excluded 15 and 1, respectively, because of neurological impairment.nnnMAIN OUTCOME MEASUREnTiming of pubertal growth spurt was estimated by assessing the ages, corrected for gestational age at birth, at acceleration (take-off) and peak height velocity of pubertal growth, and age at attaining adult height.nnnRESULTSnAll components of pubertal growth occurred earlier in VLBW subjects than in controls. Age at take-off was 0.8 yr earlier [95% confidence interval (CI) 0.4-1.3] in VLBW subjects born appropriate and 0.9 yr earlier (95% CI 0.4-1.5) in those born small for gestational age. VLBW subjects were more likely to have a pubertal growth spurt that was at least 2 yr earlier than population average [odds ratio 3.8 (95% CI: 1.5-9.6)].nnnCONCLUSIONSnPrematurity per se is associated with advanced pubertal growth. Advanced puberty may be among the factors mediating adult metabolic outcomes in subjects born preterm with VLBW.

Blood pressure responses to psychosocial stress in young adults with very low birth weight: Helsinki study of very low birth weight adults.

Young adults born prematurely with very low birth weight (≤1500 g) have higher blood pressure than do their counterparts born at term. We tested whether they also have higher blood pressure reactivity to psychosocial stress, which may be a more-specific predictor of long-term cardiovascular morbidity. Systolic and diastolic blood pressure levels for 44 very low birth weight adults (mean age: 23.1 years; SD: 2.3 years) and 37 control subjects (mean age: 23.6 years; SD: 2.0 years) were measured through noninvasive finger photoplethysmography during a standardized psychosocial stress challenge (Trier Social Stress Test). Baseline and task values and their difference (ie, reactivity) served as outcome variables. In comparison with the control group, the very low birth weight group had 7.9 mm Hg higher diastolic blood pressure during the task and 4.8 mm Hg higher diastolic reactivity, with adjustment for gender and age, height, and BMI at testing. A similar trend was seen for systolic blood pressure during the baseline period and the task, but the group differences were not statistically significant. Our results indicate that very low birth weight is associated with elevated blood pressure reactivity to psychosocial stress and, therefore, may increase the risk of cardiovascular morbidity.