Original articlesPsychiatric sequelae of low birth weight at 11 years of age
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).
References (34)
- et al.
Low birth weight and neurocognitive status at six years of age
Biol Psychiatry
(1996) - et al.
Neurologic soft signs and low birthweightTheir association and neuropsychiatric implications
Biol Psychiatry
(2000) - et al.
Sherlock Holmes and child psychopathology assessment approachesThe case of the false-positive
J Am Acad Child Adolesc Psychiatry
(1999) Child Behavior Checklist for Ages 4–18
(1991)Teacher’s Report Form
(1991)- et al.
Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birth weight children at 12 years
J Child Psychol Psychiatry
(1997) - et al.
Maternal smoking during pregnancy and adult male criminal outcomes
Arch Gen Psychiatry
(1999) Psychiatric sequelae of low birth weight
Epidemiol Rev
(1995)- et al.
Psychiatric sequelae of low birth weight at six years of age
J Abnorm Child Psychol
(1996) - et al.
A gradient relationship between low birth weight and IQ at 6 years of age
Arch Pediatr Adolesc Med
(1994)
Emotional and behavioral development of low-birthweight infants
Analysis of Longitudinal Data
Maternal smoking during pregnancy and psychiatric adjustment in late adolescence
Arch Gen Psychiatry
Bivariate logistic regression analysis of childhood psychopathology ratings using multiple informants
Am J Epidemiol
The effect of very low birth weight and social risk on neurocognitive abilities at school age
J Dev Behav Pediatr
Cited by (123)
Birth dimensions, severe mental illness and risk of type 2 diabetes in a cohort of Danish men born in 1953
2019, European PsychiatryCitation Excerpt :The “Developmental Origins of Health and Disease” hypothesis proposes that intrauterine adverse environments could affect the physiology of the offspring and hereby increase the later risk of somatic diseases, thought fetal programming models [18–20]. Hence, indicators of impaired fetal growth, such as low birth weight, low ponderal index (a weight-height parameter related with the fetal growth pattern) and small-for-gestational-age, have shown to be related with both, somatic diseases and mortality, in adult age [19,21–24] as well as with later psychopathology [25–31]. Several studies on sub-optimal environment in fetal life have already shown that birth dimensions related to fetal growth, such as low birth weight, are risk factors for both, severe mental illness [32,33] and type 2 diabetes [22,34,35], separately, even after accounting for potential confounding factors such as heritability, lifestyle and socioeconomic environment.
Antipsychotic-induced weight gain and birth weight in psychosis: A fetal programming model
2019, Journal of Psychiatric ResearchVery low birth weight is associated with brain structure abnormalities and cognitive function impairments: A systematic review
2017, Brain and CognitionCitation Excerpt :Attention deficit in the VLBW adolescents is possibly the result of impairments in the ability to resolve cognitive conflicts (Bless et al., 2013). Consistent with earlier reports (Botting, Powls, Cooke, & Marlow, 1997; Breslau & Chilcoat, 2000; Mccormick, Brooks-G, Workman-Daniels, Turner, & Peckham, 1992), Jaekel et al. showed that childhood attention in VLBW children predicted academic achievement 5–7 years later (Jaekel, Wolke, & Bartmann, 2012). Previous studies demonstrated that preterm VLBW children had poor performance in the planning ability in the executive function test (De Amorim et al., 2013; Kulseng et al., 2006).
Placental and fetal growth restriction, size at birth and neonatal growth alter cognitive function and behaviour in sheep in an age- and sex-specific manner
2015, Physiology and BehaviorCitation Excerpt :Unlike bleat frequency, neonatal growth was not correlated with arm entries for this task and was in fact positively correlated with arm entries for task L and M1 in 18 week-old males, suggesting that pre- and post-natal growth do not have consistent effects on this behavioural outcome. Consistent with adverse effects of restricted prenatal growth on behaviour, low birth weight and SGA children have higher incidences of behavioural disruption, ADHD and conduct disorders than AGA children [2,72], particularly in girls [53]. It appears likely, therefore, that while memory may be directly impaired by poor pre- and postnatal growth, behavioural disruption – including that linked to poor attention and altered stress responses – may also contribute to learning problems after IUGR.
Attention-Deficit/Hyperactivity Disorder
2013, Emery and Rimoin's Principles and Practice of Medical Genetics