Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context
Summary: Background: Existing research has shown that prematurity and low birth weight are associated with mental health in children and adolescents, but their impact on mental health in adulthood and the mechanisms involved have been less studied. This study investigated the impact of prematurity...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-07-01
|
| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537025002482 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849702919679508480 |
|---|---|
| author | Achim Fieß Alica Hartmann Mareike Ernst Alexander K. Schuster Eva Mildenberger Elmar Brähler Michael S. Urschitz Norbert Pfeiffer Manfred E. Beutel Sandra Gißler Jonas Tesarz |
| author_facet | Achim Fieß Alica Hartmann Mareike Ernst Alexander K. Schuster Eva Mildenberger Elmar Brähler Michael S. Urschitz Norbert Pfeiffer Manfred E. Beutel Sandra Gißler Jonas Tesarz |
| author_sort | Achim Fieß |
| collection | DOAJ |
| description | Summary: Background: Existing research has shown that prematurity and low birth weight are associated with mental health in children and adolescents, but their impact on mental health in adulthood and the mechanisms involved have been less studied. This study investigated the impact of prematurity and abnormal fetal growth, as a marker for fetal growth restriction, on mental health outcomes in adulthood. Methods: This retrospective cohort study examined adults aged 18–52 years, categorized by gestational age (extremely preterm: ≤28 weeks; very preterm: 29–32 weeks; moderately preterm: 33–36 weeks; term: ≥37 weeks). The cohort consists of individuals who were either born preterm or at term from 1969 to 2002. Data collection occurred between 2019 and 2021. This exploratory analysis used multivariable logistic regression to assess the impact of prematurity and fetal growth restriction on adult mental health outcomes (measured by the “Patient Health Questionnaire”), adjusting for age, gender, and socioeconomic status. The study also explored the relationship between childhood behavioral problems, retrospectively described by the mothers of the participants (2–4 years), and adult mental health, with separate analyses for preterm and term births. Findings: The multivariable logistic regression analysis of 606 participants (average age 28·96 ± 8·9 years, 326 females) indicated that a low gestational age of ≤28 weeks was independently associated with an increased prevalence of major depressive disorder (OR = 4·14, CI: 1·43–11·77, p = 0·01) and anxiety disorder (OR = 5·17, CI: 1·51–17·37, p = 0·01) in adulthood compared to a gestational age of ≥37 weeks. A low birth weight percentile was not associated with mental disorders. Further regression analysis revealed that peer problems and emotional problems in childhood were significantly associated with major depression in adulthood in participants born preterm. The sensitivity analysis revealed that the previously observed association between the gestational age group of ≤28 weeks and major depressive disorder was no longer statistically significant (OR = 2·84, CI: 0·85–9·07, p = 0·08) when the model was adjusted for maternal smoking and alcohol consumption during pregnancy. The association between the extreme preterm group and generalized anxiety disorder remained significant (OR = 4·63, CI: 1·27–16·22, p = 0·02). Interpretation: This study provides exploratory insights into the complex impact of prematurity on mental health in adulthood, highlighting the vulnerability of the extremely preterm group (≤28 weeks) from a multi-informant, lifespan perspective. It emphasizes the importance of continuous monitoring and psychosocial support for those born extremely preterm, from infancy through adulthood, to mitigate potential adverse mental health outcomes. Funding: The Gutenberg Prematurity Study was supported by the Ernst und Berta-Grimmke Stiftung, Stufe 1 support of the UM and the Else Kröner-Fresenius-Stiftung. |
| format | Article |
| id | doaj-art-4fd34eedb7f64035a2c3ee3c1aedbe7b |
| institution | DOAJ |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-4fd34eedb7f64035a2c3ee3c1aedbe7b2025-08-20T03:17:27ZengElsevierEClinicalMedicine2589-53702025-07-018510331610.1016/j.eclinm.2025.103316Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in contextAchim Fieß0Alica Hartmann1Mareike Ernst2Alexander K. Schuster3Eva Mildenberger4Elmar Brähler5Michael S. Urschitz6Norbert Pfeiffer7Manfred E. Beutel8Sandra Gißler9Jonas Tesarz10Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Corresponding author. Department of Ophthalmology, Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, AustriaDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDivision of Neonatology, Department of Pediatrics, University Medical Center of the Johannes Gutenberg-University Mainz, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, GermanyDivision of Paediatric Epidemiology, Institute of Medical Biostatistics, Epidemiology, and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, GermanyDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, GermanyDepartment of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, GermanySummary: Background: Existing research has shown that prematurity and low birth weight are associated with mental health in children and adolescents, but their impact on mental health in adulthood and the mechanisms involved have been less studied. This study investigated the impact of prematurity and abnormal fetal growth, as a marker for fetal growth restriction, on mental health outcomes in adulthood. Methods: This retrospective cohort study examined adults aged 18–52 years, categorized by gestational age (extremely preterm: ≤28 weeks; very preterm: 29–32 weeks; moderately preterm: 33–36 weeks; term: ≥37 weeks). The cohort consists of individuals who were either born preterm or at term from 1969 to 2002. Data collection occurred between 2019 and 2021. This exploratory analysis used multivariable logistic regression to assess the impact of prematurity and fetal growth restriction on adult mental health outcomes (measured by the “Patient Health Questionnaire”), adjusting for age, gender, and socioeconomic status. The study also explored the relationship between childhood behavioral problems, retrospectively described by the mothers of the participants (2–4 years), and adult mental health, with separate analyses for preterm and term births. Findings: The multivariable logistic regression analysis of 606 participants (average age 28·96 ± 8·9 years, 326 females) indicated that a low gestational age of ≤28 weeks was independently associated with an increased prevalence of major depressive disorder (OR = 4·14, CI: 1·43–11·77, p = 0·01) and anxiety disorder (OR = 5·17, CI: 1·51–17·37, p = 0·01) in adulthood compared to a gestational age of ≥37 weeks. A low birth weight percentile was not associated with mental disorders. Further regression analysis revealed that peer problems and emotional problems in childhood were significantly associated with major depression in adulthood in participants born preterm. The sensitivity analysis revealed that the previously observed association between the gestational age group of ≤28 weeks and major depressive disorder was no longer statistically significant (OR = 2·84, CI: 0·85–9·07, p = 0·08) when the model was adjusted for maternal smoking and alcohol consumption during pregnancy. The association between the extreme preterm group and generalized anxiety disorder remained significant (OR = 4·63, CI: 1·27–16·22, p = 0·02). Interpretation: This study provides exploratory insights into the complex impact of prematurity on mental health in adulthood, highlighting the vulnerability of the extremely preterm group (≤28 weeks) from a multi-informant, lifespan perspective. It emphasizes the importance of continuous monitoring and psychosocial support for those born extremely preterm, from infancy through adulthood, to mitigate potential adverse mental health outcomes. Funding: The Gutenberg Prematurity Study was supported by the Ernst und Berta-Grimmke Stiftung, Stufe 1 support of the UM and the Else Kröner-Fresenius-Stiftung.http://www.sciencedirect.com/science/article/pii/S2589537025002482PrematurityFetal growth restrictionMental healthAdult outcomesMaternal risk factors |
| spellingShingle | Achim Fieß Alica Hartmann Mareike Ernst Alexander K. Schuster Eva Mildenberger Elmar Brähler Michael S. Urschitz Norbert Pfeiffer Manfred E. Beutel Sandra Gißler Jonas Tesarz Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context EClinicalMedicine Prematurity Fetal growth restriction Mental health Adult outcomes Maternal risk factors |
| title | Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context |
| title_full | Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context |
| title_fullStr | Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context |
| title_full_unstemmed | Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context |
| title_short | Sequelae of preterm birth over the lifespan: an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyResearch in context |
| title_sort | sequelae of preterm birth over the lifespan an exploratory analysis of behavioral problems in childhood and increased risk of major depression and anxiety in adulthood from a cohort studyresearch in context |
| topic | Prematurity Fetal growth restriction Mental health Adult outcomes Maternal risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025002482 |
| work_keys_str_mv | AT achimfieß sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT alicahartmann sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT mareikeernst sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT alexanderkschuster sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT evamildenberger sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT elmarbrahler sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT michaelsurschitz sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT norbertpfeiffer sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT manfredebeutel sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT sandragißler sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext AT jonastesarz sequelaeofpretermbirthoverthelifespananexploratoryanalysisofbehavioralproblemsinchildhoodandincreasedriskofmajordepressionandanxietyinadulthoodfromacohortstudyresearchincontext |