Elsevier

Biological Psychiatry

Volume 47, Issue 11, June 2000, Pages 1005-1011
Biological Psychiatry

Original articles
Psychiatric sequelae of low birth weight at 11 years of age

https://doi.org/10.1016/S0006-3223(99)00312-1Get rights and content

Abstract

Background: We examined the relationship between low birth weight (LBW) and psychiatric problems at age 11 years.

Methods: Random samples of 6-year-old LBW and normal birth weight (NBW) children from two socioeconomically disparate communities were identified, traced, and assessed. We targeted the 1983–1985 cohort of newborns who reached age 6 in 1990–1992, the scheduled period of fieldwork. Of the 1,095 in the target sample, 823 (75%) were assessed. Five years later, the sample was reassessed. Behavior problems were evaluated by standardized behavior problems scales rated by mothers and teachers. A multiple regression application that combines data from multiple informants was used. Prospective data were used to estimate the incidence of severe attention problems during the follow-up period.

Results: Information from mothers and teachers revealed that LBW was associated with an excess of attention problems at age 11 in the urban but not in the suburban children. In the urban setting, LBW children had a higher incidence of clinically significant attention problems than NBW children. Although LBW children scored higher than NBW children on externalizing problems, the effect was accounted for in large part by maternal smoking in pregnancy.

Conclusions: The LBW-attention problems association observed in the urban community suggests an interaction between biologic vulnerability associated with premature birth and environmental risk associated with social disadvantage. Further research and replication are called for.

Introduction

Low birth weight (LBW) serves as a marker for defining high-risk newborns, as it is correlated with prenatal risk factors, intrapartum complications, and neonatal disease, and is comprised primarily of premature births. The commonly used definition of 2500 g for LBW provides striking contrasts in mortality and morbidity, although a relationship with some outcomes can be observed up to 3500 to 4000 g (Kleinman 1992). The improved survival of LBW infants has provided a compelling rationale for continued research into later development of LBW children.

With few exceptions, recent studies on the long-term neuropsychiatric sequelae of LBW have focused on the extreme low end of the birth weight distribution, that is, very low birth weight (≤1500 g) or extremely low birth weight (≤1000 or even ≤750 g). Very low birth weight (VLBW) is associated with high rates of peri- or intraventricular hemorrhage, severe respiratory distress syndrome, and other neonatal diseases with severe neurologic and cognitive consequences. Follow-up studies of VLBW children at school age have documented increased rates of behavioral and cognitive problems, even in the absence of neurologic abnormalities identified in infancy or early childhood. A distinct pattern of behavior problems has been suggested, with high levels of activity and inattention Buka et al 1992, Hack et al 1992, McCormick et al 1990. An increased risk for attention-deficit/hyperactivity disorder (ADHD) was reported in VLBW children Botting et al 1997, Szatmari et al 1990. The few studies that included a wider range of the LBW distribution suggest that the increased prevalence of psychiatric problems is not confined to the VLBW range but applies also to LBW children with birth weight greater than 1500 g McCormick et al 1996, McCormick et al 1992.

We previously reported on the psychiatric sequelae of LBW (≤2500 g) at 6 years of age, based on data on LBW and normal birth weight (NBW) children randomly selected from an urban, largely disadvantaged community, and a suburban middle class community (Breslau et al 1996a). Based on mothers’ reports elicited by structured diagnostic interviews, a higher prevalence of DSM-III-R ADHD was observed in LBW versus NBW children, primarily in the urban setting. Data from teachers on a standardized behavior problem checklist revealed an excess in attention problems in LBW versus NBW children, and the magnitude of the excess was greater in urban than suburban children. Mothers’ ratings on a parallel behavior checklist yielded consistent findings with those from teachers’ ratings.

This report focuses on the psychiatric sequelae of LBW at 11 years of age, using both mothers’ and teachers’ ratings of attention, externalizing, and internalizing problems. The statistical method used in this study combines data from both informants for estimating the effects of LBW on behavior problems. The approach evaluates the extent to which the estimated effect of LBW on behavior problems varies between the two types of informants and across settings. We test whether the previously observed LBW effects on attention problems and their differential magnitude in the urban versus suburban setting are in evidence at 11 years of age, and whether LBW children have a higher incidence of clinically significant inattention during the 5-year follow-up interval. We also test the effects of LBW on externalizing and internalizing problems, areas on which the evidence at 6 years of age was less clear.

Section snippets

Sample and data

Random samples of 6-year-old LBW and NBW children from two socioeconomically disparate populations were identified, traced, and assessed. The 1983–1985 cohort of newborns who reached 6 years of age in 1990–1992, the scheduled period of fieldwork, were targeted. Two major hospitals in southeast Michigan were selected, one in the city of Detroit (urban) and the other in a nearby middle-class suburb (suburban). In each hospital, for each year from 1983 through 1985, random samples of LBW and

Description of sample

The urban and suburban subsets differed markedly in racial composition, maternal education, and maternal marital status (Table 1); however, differences between the LBW and NBW subsets within settings were small. The urban subset was predominantly black and had a higher proportion of single mothers and mothers with less than high school education, compared to the suburban subset. A comparison of the initial sample of 823 with the follow-up sample of 717 revealed only minor differences.

Mothers’ and teachers’ ratings of behavior problems: descriptive data

Table 2

Discussion

Information from mothers and teachers on children’s behavior problems at age 11 revealed that the effect of LBW on attention problems differed between the urban and suburban settings. Specifically, LBW signaled an excess in children’s attention problems in the urban disadvantaged community, but not in the suburban middle class community. This finding was not accounted for by history of maternal smoking during pregnancy or during the child’s early years. Furthermore, there was evidence to

Acknowledgements

Supported by Grants No. MH-44586 from the National Institute of Mental Health (NB) and No. DA R29 11952 from the National Institute of Drug Abuse (HDC).

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