Association between psychological symptoms in adults and growth in early life: longitudinal follow up study

Epidemiological and Psychopharmacological Study About Off-Label Treatment in Child and Adolescent Psychiatric Emergencies: A Tertiary/Single Center Experience

OBJECTIVE

The study used an epidemiological and pharmacological description of child and adolescent psychiatric emergencies (CAPEs), during which psychotropic medications are frequently administered as off-label therapies.

METHODS

We retrospectively describe CAPE in 190 patients (mean age, 14.7 years) referring in the emergency department of a single tertiary center, from June 2016 to June 2018, focusing on off-label administration rate, most of all in emergency setting.

RESULTS

An intrinsic fragility was observed in this population, where 28.4% of patients present a history of self-harm, 24.7% a concomitant neurodevelopmental disorder, and 17.3% a history of substance abuse. Psychomotor agitation was the most frequent referral reason, and it represents an unspecified clinical presentation of several conditions, while self-harm showed a stronger association with depressive disorders (55.2%).Globally, 811 medications were administered both as baseline therapy (67.8% of off-label rate) and/or in the emergency setting, where the off-label rate raised to 78.3%. Benzodiazepines had the highest rate of off-label use (98.2% as baseline therapy, 92.9% in acute context). Nevertheless, in 83.5% cases of acute administrations, a singular oral benzodiazepine (mostly lorazepam) guaranteed psychomotor agitation resolution, with a lower rate of adverse effects in contrast with atypical antipsychotics.

CONCLUSIONS

Off-label drug use in CAPEs is a recurrent clinical practice. An international agreement about off-label drugs is crucial to obtain standard long-term pharmacoepidemiological, safety, and efficacy data. Pharmacological pediatric trials and international guidelines are also required to regulate pharmacological treatments of CAPEs, most of all in emergency settings.

Cumulative risks predict epigenetic age in adult survivors of extremely low birth weight

Long-term sequelae of extremely low birth weight (ELBW; ≤1000 g) may contribute to accelerated biological aging. This hypothesis was examined by analyzing a range of risk factors with a molecular age marker in adults born at ELBW or normal birth weight (NBW; ≥2500 g). DNAm age-the weighted average of DNA methylation at 353 cytosine-phosphate-guanine (CpG) sites from across the genome-was derived from a sample of 45 ELBW (M_age  = 32.35 years) and 47 NBW control (M_age  = 32.44 years) adults, using the Illumina 850k BeadChip Array. At two assessments undertaken 9 years apart (at 23 and 32 years), cumulative risks were summed from six domains with potential to affect physiological and psychological health: resting respiratory sinus arrhythmia, blood pressure, basal cortisol, grip strength, body mass index, and self-esteem. At age 32 years, cumulative risks were differentially associated with epigenetic age in ELBW survivors (interaction, p < 0.01). For each additional risk factor they possessed, ELBW survivors (B = 1.43) were biologically 2.16 years older than NBW adults (B = -0.73), by the fourth decade of life. Developmental change, epigenetic maintenance, and intervention targets are discussed.

Early predictors of mental health in mid-adulthood

AIM

Substantial research has focused on the examination of factors that contribute to the development of psychiatric problems. However, much less is known about factors early in life that may protect from poor mental health outcomes in midlife. This study aimed to identify the extent to which a set of key perinatal demographic variables and adolescent academic performance were associated with good mental health in mid-adulthood.

METHODS

In a sample of 525 individuals (aged 34-44, 55.4% male) born and raised in Jerusalem, Israel (STREAM study) we attempted to differentiate those who did and did not report psychiatric symptoms in mid-adulthood. Using χ² and regression analysis, we explored birth factors (year of birth, sex, birth weight, and number of older siblings, data on parental immigration and socioeconomic status), academic achievement in eighth grade and contemporaneous measures of lifestyle factors, personality traits, and perceived resilience.

RESULTS

Participants with good mental health were more often male (P = .005) and had better academic performance already at adolescence than participants who reported psychiatric symptoms in midlife (P < .001). They reported fewer physical complaints (P = .008), were less likely to smoke (P = .001) and considered themselves to be more "resilient" (P < .001).

CONCLUSIONS

The results showed that better academic performance in adolescence may be associated with better stress-coping strategies, resulting in fewer psychiatric complaints, more perceived resilience, and less stress-related behaviours in mid-adulthood. Future studies confirming this hypothesis could inform public mental health interventions.

Socio-demographic determinants of low birth weight: Evidence from the Kassena-Nankana districts of the Upper East Region of Ghana

Objective

To examine the social, economic and demographic factors that determine low birth weight in the two Kassena Nankana districts of the Upper East region of Ghana.

Methods

Cross-sectional data was collected from January 2009 to December 2011 using the Navrongo Health and Demographic Surveillance System which monitors routine health and demographic outcomes in the study area. Data on foetal characteristics such as birth weight, and sex and maternal age, parity, maternal education, marital status, ethnicity, religious affiliation and socio-economic characteristics were collected and described. Tests of means, proportions and Chi-squares are employed in bivariate analysis, and adjusted logistic regression models fitted to control for potential confounding variables. All tests were two-sided and test of significance was set at p-value of < 0.05.

Results

There were 8,263 live births (44.9% females) with an overall average birth weight of 2.85 kg (2.9 kg for males and 2.8 kg for females). The average maternal age was 28 years, median parity 2, maternal literacy rate was about 70% and 83% of mothers were married. The prevalence of low birth weight was 13.8% 95%CI [13.10, 14.6] and more in female babies than in males (15.5% vs 12.2%; p<0.0001). Determinants of low birth-weight after controlling for confounding factors were sex of neonate (OR = 1.32, 95%CI [1.14,1.52]; p<0.0001), maternal age (p = 0.004), and mothers who are not married (OR = 1.44 [1.19, 1.74]; p<0.0001).

Conclusion

Female neonates in this population were likely to present with low birth weight and maternal factors such as younger age, lower socio-economic status and single parenthood were major determinants of low birth weight. Effective and adequate antenatal care should therefore target women with these risk factors.

Group psychological intervention for maternal depression: A nested qualitative study from Karachi, Pakistan

AIM

To understand the experience of maternal depression, the factors implicated in accessing health, and the acceptability of the psychosocial intervention.

METHODS

The participants were recruited from the paediatrics outpatient department of Civil Hospital Karachi, Pakistan. The study started in December 2009 and completed in December 2010. Women with maternal depression, aged 18-44 years with children aged 0-30 mo who had received nutritional supplements, and participated in the intervention programme [called Learning through Play (LTP) plus] were included in the study. Qualitative interviews were conducted with 8 participants before the intervention and 7 participants after the intervention. A semi structured topic guide was used to conduct the interviews.

RESULTS

Framework analysis procedures were used to analyse the qualitative data. Four themes emerged: (1) the women’s contextual environment: Interpersonal conflicts, lack of social support and financial issues being the major barriers in assessing healthcare; (2) women’s isolation and powerlessness within the environment: Sense of loneliness was identified as a restricting factor to access healthcare; (3) the impact of the intervention (LTP-Plus): Women felt “listened to” and seemed empowered; and (4) empowered transformed women within the same contextual environment: The facilitator provided a “gardening role” in nurturing the women resulting in a positive transformation within the same environment. The women’s homes seemed to be more happy homes and there was a positive change in their behaviour towards their children.

CONCLUSION

Findings informed the further development and testing of culturally-appropriate psychosocial intervention (LTP⁺) for addressing maternal depression.

Relation between maternal antenatal anxiety and infants' weight depends on infants' sex: A longitudinal study from late gestation to 1-month post birth

OBJECTIVE

To test for gender-differences in the relation between mothers' antenatal anxiety and infants' body weight during gestation, at birth, and at 1-month of age.

METHODS

Two hundred and twelve randomly-recruited women were divided into two groups: Controls (n=105) and Anxious Group (n=107) based on a standard cut-off of the Beck Anxiety Inventory. Outcome measures were Fetal Weight derived from biometrics obtained from an ultrasound scan in the 3rd trimester and infants' weight at birth and at 1-month of age, both obtained from medical records.

RESULTS

Multivariate analyses showed main effects of Gender on infants' birth weight (P=.001) and on infants' weight at 1-month of age (P=.004), but no main effects of Anxiety Group at any time-point. Gender x Anxiety Group interactions at all three time points (Fetal weight: P=.05; Birth weight: P=.03; 1-month of age: P=.10) reflected gender differences (males>females) among infants in the anxious group, but not among controls. Distinct trends regarding same sex comparisons across groups (Control vs. Anxiety) were in line with predictions (male controls<male anxious; female controls>females anxious). Controlling for Postpartum Anxiety and Antenatal and Postpartum Depression in the models did not affect primary results.

CONCLUSION

Gender differences in fetal and birth weight were more substantial among infants of anxious mothers than among controls due to the seemingly accelerated growth of "anxious" males and the diminution of weight among "anxious" females.

Behavioral epigenetics and the developmental origins of child mental health disorders

Advances in understanding the molecular basis of behavior through epigenetic mechanisms could help explain the developmental origins of child mental health disorders. However, the application of epigenetic principles to the study of human behavior is a relatively new endeavor. In this paper we discuss the 'Developmental Origins of Health and Disease' including the role of fetal programming. We then review epigenetic principles related to fetal programming and the recent application of epigenetics to behavior. We focus on the neuroendocrine system and develop a simple heuristic stress-related model to illustrate how epigenetic changes in placental genes could predispose the infant to neurobehavioral profiles that interact with postnatal environmental factors potentially leading to mental health disorders. We then discuss from an 'Evo-Devo' perspective how some of these behaviors could also be adaptive. We suggest how elucidation of these mechanisms can help to better define risk and protective factors and populations at risk.

Low birth weight, preterm birth and small for gestational age association with adult depression: systematic review and meta-analysis

BACKGROUND

There is no consensus on the effects that low birth weight, premature birth and intrauterine growth have on later depression.

AIMS

To review systematically the evidence on the relationship of low birth weight, smallness for gestational age (SGA) and premature birth with adult depression.

METHOD

We searched the literature for original studies assessing the effect of low birth weight, premature birth and SGA on adult depression. Separate meta-analyses were carried out for each exposure using random and fixed effects models. We evaluated the contribution of methodological covariates to heterogeneity using meta-regression.

RESULTS

We identified 14 studies evaluating low birth weight, 9 premature birth and 4 SGA. Low birth weight increased the odds of depression (OR = 1.39, 95% CI 1.21-1.60). Premature birth and SGA were not associated with depression, but publication bias might have underestimated the effect of the former and only four studies evaluated SGA.

CONCLUSIONS

Low birth weight was associated with depression. Future studies evaluating premature birth and SGA are needed.

Early development, stress and depression across the life course: pathways to depression in a national British birth cohort

BACKGROUND

The aetiology of depression is multifactorial, with biological, cognitive and environmental factors across the life course influencing risk of a depressive episode. There is inconsistent evidence linking early life development and later depression. The aim of this study was to investigate relationships between low birthweight (LBW), infant neurodevelopment, and acute and chronic stress as components in pathways to depression in adulthood.

METHOD

The sample included 4627 members of the National Survey of Health and Development (NSHD; the 1946 British birth cohort). Weight at birth, age of developmental milestones, economic deprivation in early childhood, acute stressors in childhood and adulthood, and socio-economic status (SES) in adulthood were assessed for their direct and indirect effects on adolescent (ages 13 and 15 years) and adult (ages 36, 43 and 53 years) measures of depressive symptoms in a structural equation modelling (SEM) framework. A structural equation model developed to incorporate all variables exhibited excellent model fit according to several indices.

RESULTS

The path of prediction from birthweight to age of developmental milestones to adolescent depression/anxiety to adult depression/anxiety was significant (p < 0.001). Notably, direct paths from birthweight (p = 0.25) and age of developmental milestones (p = 0.23) to adult depression were not significant. Childhood deprivation and stressors had important direct and indirect effects on depression. Stressors in adulthood were strongly associated with adult depression.

CONCLUSIONS

Depression in adulthood is influenced by an accumulation of stressors across the life course, including many that originate in the first years of life. Effects of early-life development on mental health appear by adolescence.

Self-rated mental health and socio-economic background: a study of adolescents in Sweden

BACKGROUND

Adolescents' mental health is a major public health issue. Previous research has shown that socio-economic factors contribute to the health status of adolescents. The present study explores the association between socio-economic status and self-rated mental health among adolescents.

METHODS

Cross sectional data from the Halmstad Youth Quality of Life cohort was collected in a town in Sweden. In all, 948 adolescents (11-13 younger age group and 14-16 older age group) participated. Information on self-rated mental health was collected from the subscale Psychological functioning in the Minneapolis Manchester Quality of Life instrument. The items were summarized into a total score and dichotomized by the mean. Indicators measuring socio-economic status (SES) were collected in a questionnaire using the Family Affluence Scale (FAS) and additional factors regarding parents' marital status and migration were added. Logistic models were used to analyze the data.

RESULTS

Girls were more likely to rate their mental health below the mean compared to boys. With regard to FAS (high, medium, low), there was a significantly increased risk of self-rated mental health below the mean among younger boys in the medium FAS score OR; 2.68 (95% CI 1.35;5.33) and among older boys in the low FAS score OR; 2.37 (1.02;5.52) compared to boys in the high FAS score. No such trend was seen among girls. For younger girls there was a significant protective association between having parents born abroad and self-rated mental health below mean OR: 0.47 (0.24;0.91).

CONCLUSIONS

A complex pattern of associations between SES and self-rated mental health, divergent between age and gender groups, was shown. The total FAS score was only associated with boys' self-rated mental health in both age groups, whereas parents' migratory status influenced only the girls' self-rated mental health. Because of the different association for girls' and boys' self-rated mental health and SES, other factors than SES should also be considered when investigating and exploring the mental health of adolescents in affluent communities.

An association of adult personality with prenatal and early postnatal growth: the EPQ lie-scale

Background

Recent studies have noted differences in social acquiescence and interpersonal relations among adults born preterm or with very low birth weight compared to full term adults. In addition, birth weight has been observed to be negatively correlated with lie-scale scores in two studies. We attempted to replicate and extend these studies by examining young adult lie-scale scores in a Danish birth cohort.

Method

Weight, length and head circumference of 9125 children from the Copenhagen Perinatal Cohort were measured at birth and at 1, 3 and 6 years. A subsample comprising 1182 individuals participated in a follow-up at 20–34 years and was administered the Eysenck Personality Questionnaire (EPQ) which includes a lie-scale (indicating social acquiescence or self-insight). Associations between lie-scale scores and weight, length and head circumference respectively were analysed by multiple linear regression adjusting for single-mother status, parity, mother’s age, father’s age, parental social status, age at EPQ measurement, intelligence, and adult size.

Results

Male infants with lower weight, length, and head-circumference at birth and the following three years grew up to have higher scores on the lie-scale as young adults. Most of these associations remained significant after adjustment for the included covariates. No associations were found for females. Analyses were also conducted with neuroticism, extraversion and psychoticism as outcome variables, but no significant associations were found for these traits after adjustment.

Conclusions

The findings replicate and extend findings from previous studies suggesting that size at birth and during the first three years of life is significantly associated with social acquiescence in adult men. They highlight the potential influence of prenatal and early postnatal development on personality growth and development.

Low birth-weight and risk for major depression: a community-based longitudinal study

The current study examines the association between low birth weight and risk for major depression from early adolescence to early adulthood. It accounts for eight documented confounders, and depression within families. Data were analyzed from the National Longitudinal Survey of Youth 1979 on mothers and offspring. Major depression was assessed with the Center for Epidemiologic Studies Depression Scale Short-Form (CES-D-SF) among offspring (N=3398) biannually, from 2000 to 2010 (aged 14-25). Competing models were examined with survival analysis and Generalized Estimated Equations (GEE). CES-D-SF based major depression was reported by 33.46% (n=1137) of participants. Among persons with very low birth weight (<1500 g), 47.5% (n=19/40) were classified with CES-D-SF depression (OR=1.81, 95% CI=0.97, 3.39). Similar results were found with survival analysis (HR=1.97, 95% CI=0.97, 4.01). Among multiple offspring families, GEE modeling showed a similar trend. On aggregate (unadjusted OR=2.46, 95% CI=1.07, 5.63; adjusted OR=2.43, 95% CI=0.94, 6.23), and within families of mothers with CES-D-SF depression (unadjusted OR=2.54, 95% CI=0.55, 11.66; adjusted OR=1.79, 95% CI=0.28, 11.42). Compelling evidence is lacking in favor of an association between very low birth weight (<1500 g), and suspected major depression from early adolescence to early adulthood after accounting for documented confounders.

An investigation of factors identified at birth in relation to anxiety and depression in old age: the Hordaland Health Study (HUSK)

BACKGROUND

Although life course influences have long been recognised in affective disorder, little is known about the influence of early life factors on late life anxiety and depression. The aim was to investigate the extent to which birth measures, maternal health and family circumstances were associated with symptoms of anxiety and depression in late life.

METHODS

A retrospective cohort study was constructed from a cross-sectional survey sample of community residents aged 72-74 years, 406 of whom had traceable birth records. Cases and controls for late life anxiety and depression were defined applying standard cut-offs to the Hospital Anxiety and Depression Scale. A range of measures and circumstances were extracted from birth records blind to survey data and compared in age- and gender-adjusted models.

RESULTS

There were no differences in any anthropometric measure in either case control comparison. Case-level anxiety and depression were both associated with significantly lower maternal age. Late-life anxiety was additionally associated with smaller maternal pelvic size and the mother's condition being rated as poor at birth/discharge. Late-life depression was associated with a lower status paternal occupation.

CONCLUSIONS

There was no evidence for a substantial influence of early life size on late life affective disorder. However, there was some evidence in secondary analyses for an enduring influence of the family's socioeconomic environment and maternal health.

The association between lower birth weight and comorbid generalised anxiety and major depressive disorder

OBJECTIVE

Studies testing the association between birth weight and depression or anxiety have found inconsistent results and there has been a lack of research on the possible relationship between birth weight and comorbid anxiety and depression. We tested for an association between lower birth weight and major depression, generalised anxiety and comorbid generalised anxiety and major depression.

METHOD

Data was taken from 2113 mothers and their offspring participating in the Mater University Study of Pregnancy (MUSP) birth cohort. Generalised anxiety, major depression and comorbid generalised anxiety and major depression at 21 years were tested for associations with birth weight using multinomial logistic regression.

RESULTS

Lower birth weight was found to predict comorbid generalised anxiety and major depression, but did not predict either generalised anxiety or major depression.

LIMITATIONS

We were unable to specify comorbidity by the primary disorder, or by the severity or recurrence of the depression.

CONCLUSION

Previous associations found between birth weight and mental health may reflect a specific link between lower birth weight and comorbid generalised anxiety and major depressive disorders. As neither disorder individually was associated with lower birth weight, this may suggest that this developmental origin represents a unique risk pathway to comorbidity not shared with either discrete disorder.

Birth weight and perceived stress reactivity in older age

Stress reactivity is a disposition that underlies individual differences in stress responses, thereby affecting vulnerability for the development of disease. Besides genetic and early postnatal environmental factors, stress reactivity has been shown to be influenced by an adverse prenatal developmental environment, but it is unclear if such effects persist into older age. We tested associations between fetal growth and perceived stress reactivity in 421 participants from the Hertfordshire Cohort at age 66-75 years. Regression analysis showed a U-shaped association between birth weight and perceived stress reactivity with increased levels of stress reactivity at the lower and upper end of the birth weight distribution. These effects were stable after adjustment for markers of early adversity and recent adversity and chronic stress. Although the effects were small, they are consistent with findings from studies in younger cohorts, and demonstrate that such effects can persist into older age.

Foetal origins of depression? A systematic review and meta-analysis of low birth weight and later depression

BACKGROUND

The foetal origins hypothesis suggests an association between low birth weight and later depression, yet evidence supporting this association has been inconsistent.

METHOD

We systematically reviewed evidence for an association between low birth weight and adult depression or psychological distress in the general population by meta-analysis. We searched EMBASE, Medline, PsycINFO and ISI Web of Science for studies reporting observational data with low birth weight as the exposure and self- or clinician-rated depression or psychological distress measures as an outcome. Selective studies of exposures such as famine or outcomes such as severe illness only were excluded. Altogether,1454 studies were screened for relevance, 26 were included in the qualitative synthesis, 18 were included in the meta-analysis. A random effects meta-analysis method was used to obtain a pooled estimate of effect size.

RESULTS

The odds of depression or psychological distress was greater for those of low birth weight (<2500 g) compared to those of normal birth weight (>2500 g) or greater [odds ratio (OR) 1.15, 95% confidence intervals (CI) 1.00-1.32]. However, this association became non-significant after trim-and-fill correction for publication bias (OR 1.08, 95% CI 0.92-1.27). Using meta-regression, no differences in effect size were observed by gender, outcome measure of depression or psychological distress, or whether the effect size was adjusted for possible confounders.

CONCLUSIONS

We found evidence to support a weak association between low birth weight and later depression or psychological distress, which may be due to publication bias. It remains possible that the association may vary according to severity of symptoms or other factors.

The association of fetal and early childhood growth with adult mental distress: evidence from the johns hopkins collaborative perinatal study birth cohort

OBJECTIVES

Early childhood physical growth may have an impact on the development of adult mental distress. The primary objectives were to (1) assess the association of early growth in weight (adjusted for height) with adult mental distress, and (2) determine if specific sub-types, or patterns, of early physical growth are associated with adult mental distress.

METHODS

Subjects were all Johns Hopkins Collaborative Perinatal Study cohort subjects with complete birth size information that successfully completed the Pathways to Adulthood follow-up in early adulthood. Variability in the timing of growth in weight adjusted for height from birth to age 7.5 years was taken into account using a non-hierarchical linear model. Two critical periods of growth were considered as tertiles of change in weight adjusted for height from birth to age 7 and birth to age 1 year. Mental distress in adulthood (ages 29-32) was measured using the General Health Questionnaire (GHQ-28).

RESULTS

Small for gestational age subjects were at increased risk of later mental distress, but not uniformly so. Those born with low weight and length for gestational age were a distinct subgroup of those born small for gestational age, and had unique patterns of risk for adult mental distress when early growth was considered.

CONCLUSION

Acceleration and deceleration in weight for height change is associated with mental distress over multiple periods of early life and acts differentially between those periods. Furthermore, the association of early childhood growth with the likelihood of adult mental distress is dependent on prenatal growth.

Early determinants of mental health

Environmental adversities in pre- and early postnatal life may have life-long consequences. Based upon a series of epidemiological and clinical studies and natural experiments, this review describes how the early life environment may affect psychological functions and mental disorders later in life. We focus on studies that have examined the associations of small body size at birth and prematurity as proxies of prenatal environmental adversity. We also review literature on materno-fetal malnutrition, maternal prenatal glycyrrhizin in licorice consumption and hypertension-spectrum pregnancy disorders as factors that may compromise the fetal developmental milieu and hence provide insight into some of the mechanisms that may underlie prenatal programming. While effects of programming mostly take place during the first 1000 days after conception, we finally present evidence from prospective studies suggesting that programming can occur also during later critical periods of development or 'windows of plasticity'. The studies may bear relevance for future prevention and intervention programs targeting the potentially modifiable environmental factors that will aid at promoting mental well-being and health of an individual.

A review of the reporting and handling of missing data in cohort studies with repeated assessment of exposure measures

BACKGROUND

Retaining participants in cohort studies with multiple follow-up waves is difficult. Commonly, researchers are faced with the problem of missing data, which may introduce biased results as well as a loss of statistical power and precision. The STROBE guidelines von Elm et al. (Lancet, 370:1453-1457, 2007); Vandenbroucke et al. (PLoS Med, 4:e297, 2007) and the guidelines proposed by Sterne et al. (BMJ, 338:b2393, 2009) recommend that cohort studies report on the amount of missing data, the reasons for non-participation and non-response, and the method used to handle missing data in the analyses. We have conducted a review of publications from cohort studies in order to document the reporting of missing data for exposure measures and to describe the statistical methods used to account for the missing data.

METHODS

A systematic search of English language papers published from January 2000 to December 2009 was carried out in PubMed. Prospective cohort studies with a sample size greater than 1,000 that analysed data using repeated measures of exposure were included.

RESULTS

Among the 82 papers meeting the inclusion criteria, only 35 (43%) reported the amount of missing data according to the suggested guidelines. Sixty-eight papers (83%) described how they dealt with missing data in the analysis. Most of the papers excluded participants with missing data and performed a complete-case analysis (n=54, 66%). Other papers used more sophisticated methods including multiple imputation (n=5) or fully Bayesian modeling (n=1). Methods known to produce biased results were also used, for example, Last Observation Carried Forward (n=7), the missing indicator method (n=1), and mean value substitution (n=3). For the remaining 14 papers, the method used to handle missing data in the analysis was not stated.

CONCLUSIONS

This review highlights the inconsistent reporting of missing data in cohort studies and the continuing use of inappropriate methods to handle missing data in the analysis. Epidemiological journals should invoke the STROBE guidelines as a framework for authors so that the amount of missing data and how this was accounted for in the analysis is transparent in the reporting of cohort studies.

Placental 11-beta hydroxysteroid dehydrogenase methylation is associated with newborn growth and a measure of neurobehavioral outcome

BACKGROUND

There is growing evidence that the intrauterine environment can impact the neurodevelopment of the fetus through alterations in the functional epigenome of the placenta. In the placenta, the HSD11B2 gene encoding the 11-beta hydroxysteroid dehydrogenase enzyme, which is responsible for the inactivation of maternal cortisol, is regulated by DNA methylation, and has been shown to be susceptible to stressors from the maternal environment.

METHODOLOGY/PRINCIPAL FINDINGS

We examined the association between DNA methylation of the HSD11B2 promoter region in the placenta of 185 healthy newborn infants and infant and maternal characteristics, as well as the association between this epigenetic variability and newborn neurobehavioral outcome assessed with the NICU Network Neurobehavioral Scales. Controlling for confounders, HSD11B2 methylation extent is greatest in infants with the lowest birthweights (P = 0.04), and this increasing methylation was associated with reduced scores of quality of movement (P = 0.04).

CONCLUSIONS/SIGNIFICANCE

These results suggest that factors in the intrauterine environment which contribute to birth outcome may be associated with placental methylation of the HSD11B2 gene and that this epigenetic alteration is in turn associated with a prospectively predictive early neurobehavioral outcome, suggesting in some part a mechanism for the developmental origins of infant neurological health.

The association between birth weight and anxiety disorders in young adults

Recent evidence has linked birth weight to later behaviour/mental disorders, yet studies have hitherto neglected to investigate the relationship between birth weight and adult anxiety disorders. Prospectively collected data from 2210 mother/offspring pairs of the Mater University Study of Pregnancy (MUSP) birth cohort was used to test for associations between birth weight z-score and four major groupings of DSM-IV anxiety disorders. Birth weight z-score was linearly and inversely associated with lifetime diagnosis of post-traumatic stress disorders at 21 years, with those falling within the smallest birth weight quintile group at almost two-fold increased odds (OR=1.96, 95% CI: 1.10, 3.52) of being diagnosed with the disorder compared to those falling within the largest group. The association remained when subsequent analysis restricted the sample to those exposed to trauma. This is the first study in which birth weight has been found to be associated with post-traumatic stress disorders in adults.

Tamanho ao nascer e problemas de saúde mental aos 11 anos em uma coorte brasileira de nascimentos

O objetivo foi avaliar a associação entre tamanho ao nascer e problemas de saúde mental aos 11 anos na Coorte de Nascimentos de Pelotas, Rio Grande do Sul, Brasil, de 1993. Foram pesados e medidos ao nascer 4.358 recém-nascidos. Avaliou-se problemas de saúde mental com o questionário de capacidades e dificuldades (Strengths and Difficulties Questionnaire - SDQ). A prevalência de problemas de saúde mental foi de 32% (IC95%: 31-33). Na análise ajustada, os 291 (6,7%) recém-nascidos com escorez de peso/idade e os 268 (6,2%) com índice de massa corporal (IMC)/idade < -2 DP tiveram, respectivamente, 27% (IC95%: 7-49) e 29% (IC95%: 10-51) maior risco de apresentar problemas de saúde mental aos 11 anos quando comparados com aqueles com escore normal. Os 102 (2,43%) recém-nascidos com escorez de IMC e os 279 (6,4%) com perímetro cefálico/idade > +2 DP tiveram, respectivamente, 34% (IC95%: 6-71) e 19% (IC95%: 1-40) maior risco de apresentar esses problemas se comparados com aqueles com escore normal. Os resultados sugerem que fatores ocorridos na gestação e refletidos nas medidas de tamanho ao nascer podem ocasionar problemas de saúde mental em etapas tardias.

Children who recover from early stunting and children who are not stunted demonstrate similar levels of cognition

Stunting is associated with adverse cognitive development in childhood and adolescence, fewer years of schooling, decreased productivity, and reduced adult stature. Recovery from early stunting is possible; however, few studies explore whether those who demonstrate linear catch-up growth experience long-term cognitive deficits. Using longitudinal data on 1674 Peruvian children from the Young Lives study, we identified factors associated with catch-up growth and assessed whether children who displayed catch-up growth have significantly lower cognition than children who were not stunted during infancy and childhood. Based on anthropometric data for children 6-18 mo of age and again for the same children when they were 4.5-6 y of age, we categorized participants as not stunted, stunted in infancy but not childhood (catch-up), stunted in childhood, and stunted in infancy and childhood. Children who had grandparents in the home, had less severe stunting in infancy, and had taller mothers were more likely to demonstrate catch-up growth by round 2. Children who experienced catch-up growth had verbal vocabulary and quantitative test scores that did not differ from children who were not stunted (P = 0.6 and P = 0.7, respectively). Those stunted in childhood as well as those stunted in infancy and childhood scored significantly lower on both assessments than children who were not stunted. Based on findings from this study, policy makers and program planners should consider redoubling efforts to prevent stunting and promote catch-up growth over the first few years of life as a way of improving children's physical and intellectual development.

Fetal growth and the lifetime risk of generalized anxiety disorder

BACKGROUND

Anxiety disorders are thought to have their origins in early childhood, though they have not yet been studied as a potential outcome of impaired fetal growth, which has been implicated in the developmental etiologies of many psychopathologies. This study investigated the association between indicators of fetal growth and the development of generalized anxiety disorder (GAD).

METHODS

Indicators of fetal growth, including birth weight (BW) and ponderal index (PI), were assessed among 682 offspring of participants in Providence, Rhode Island, site of the Collaborative Perinatal Project. Participants were interviewed as adults, and their lifetime histories of GAD were assessed using the Diagnostic Interview Schedule. We used Cox regression to estimate the association between fetal growth indicators and development of GAD.

RESULTS

The lifetime risk of GAD differed between infants in the highest category of BW, PI, and all others. Newborns with birth weights below 3.5 kg (hazard ratio, HR: 2.38; CI=1.25, 4.55), in the lowest four BW Z-score quintiles (HR=2.49; CI=1.14, 5.45) or a PI in the lowest four quintiles (HR=2.33; CI=1.04, 5.00) had higher lifetime risks of GAD.

CONCLUSION

In contrast to earlier studies on psychiatric outcomes in relation to fetal growth, there was no linear relationship between birth weight and GAD. Although these results generally support the hypothesis that a healthy nutritional fetal uptake, as indicated by BW and PI, is associated with better lifetime mental health, further work is needed to characterize the nature of the association between fetal growth and subsequent psychopathology.

Life course perspectives on the epidemiology of depression

Life course epidemiology seeks to understand how determinants of health and disease interact across the span of a human life, and has made significant contributions to understanding etiological mechanisms in many chronic diseases, including schizophrenia. The life course approach is ideal for understanding depression: causation in depression appears to be multifactorial, including interactions between genes and stressful events, or between early life trauma and later stress in life; timing of onset and remission of depression varies widely, indicating differing trajectories of symptoms over long periods of time, with possible differing causes and differing outcomes; and early life events and development appear to be important risk factors for depression, including exposure to acute and chronic stress in the first years of life. To better understand etiology and outcome of depression, future research must move beyond basic epidemiologic techniques that link specific exposures to specific outcomes and embrace life course principles and methods. Time-sensitive modelling techniques that are able to incorporate multiple interacting factors across long periods of time, such as structural equation models, will be critical in understanding the complexity of causal and influencing factors from early development to the end stages of life. Using these models to identify key pathways that influence trajectories of depression across the life course will help guide prevention and intervention.

Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries

Schooling predicts better reproductive outcomes, better long-term health, and increased lifetime earnings. We used data from 5 cohorts (Brazil, Guatemala, India, the Philippines, and South Africa) to explore the relative importance of birthweight and postnatal weight gain for schooling in pooled analyses (n = 7945) that used appropriate statistical methods [conditional weight (CW) gain measures that are uncorrelated with prior weights] and controlled for confounding. One SD increase in birthweight, approximately 0.5 kg, was associated with 0.21 y more schooling and 8% decreased risk of grade failure. One SD increase in CW gain between 0 and 2 y, approximately 0.7 kg, was associated with higher estimates, 0.43 y more schooling, and 12% decreased risk of failure. One SD increase of CW gain between 2 and 4 y, approximately 0.9 kg, was associated with only 0.07 y more schooling but not with failure. Also, in children born in the lowest tertile of birthweight, 1 SD increase of CW between 0 and 2 y was associated with 0.52 y more schooling compared with 0.30 y in those in the upper tertile. Relationships with age at school entry were inconsistent. In conclusion, weight gain during the first 2 y of life had the strongest associations with schooling followed by birthweight; weight gain between 2 and 4 y had little relationship to schooling. Catch-up growth in smaller babies benefited schooling. Nutrition interventions aimed at women and children under 2 y are among the key strategies for achieving the millennium development goal of universal primary education by 2015.

Fetal origins of mental health: evidence and mechanisms

The concept of fetal programming states that changes in the fetal environment during sensitive periods of organ development may cause long-lasting changes in the structure and functioning of these organs later in life and influence the risk for chronic diseases such as coronary heart disease and type 2 diabetes. Fetal growth is a summary marker of the fetal environment and is reflected by relatively easy-to-obtain measures of size at birth such as birth weight. In the last two decades, a body of evidence emerged linking fetal growth with behavioural and mental health outcomes later in life. Cognitive functioning and behavioural problems in childhood, in particular inattention/hyperactivity, have been shown to be inversely related to fetal growth. Although results are mixed, risk for personality disorders and schizophrenia seems to be linked with fetal growth and adversity, while the evidence for mood disorders is weak. Vulnerability for psychopathology may also be influenced by prenatal adversity. There is evidence for associations of fetal growth with temperament in childhood as well as stress reactivity and distress. The associations of fetal growth with mental health later in life are potentially caused by specific prenatal factors such as maternal smoking, alcohol, toxins/drugs, nutrition, psychosocial stress and infection during pregnancy. The mechanisms likely involve changes in neurodevelopment and in the set point of neuroendocrine systems, and there is evidence that prenatal adversity interacts with genetic and postnatal environmental factors. Future studies should examine the effects of specific prenatal factors and attempt to disentangle genetic and prenatal environmental effects.

Linear growth in early life is associated with suicidal ideation in 18-year-old Filipinos

Studies in Western societies have shown some evidence that growth in early life may be associated with suicide and suicidal ideation in later life. The pattern of growth retardation in developing countries is different from that in Western societies. This study examines the association between size at birth, postnatal growth from birth to age 24 months and suicidal ideation in 18-year-old Filipinos. The 1941 participants born in 1983 and 1984 in the Philippines were assessed for growth status bimonthly from birth to 24 months of age and were administered an interview in 2002, which included items on suicidal ideation. The pattern of growth stunting in this cohort was similar to that in many other developing countries: a minor level of shortness in crown-heel length at birth followed by sharp decline in length-for-age in the first 24 months of life. The prevalence of suicidal ideation at age 18 was 2.9%; 95% confidence interval [CI] 2.2, 3.8%. Length Z-score at 24 months (odds ratios [OR] = 0.67; 95% CI [0.52, 0.86]; P = 0.002) and gain in length Z-score from birth to age 24 months (OR = 0.74; 95% CI [0.56, 0.98]; P = 0.037) were inversely associated with the odds of suicidal ideation. Adjustment for covariates made little difference. Length at birth Z-score was associated with suicidal ideation only after adjustment for postnatal length gain (OR = 0.61; 95% CI [0.46, 0.80]; P < 0.001). The associations between linear growth in early life and suicidal ideation appeared to be partly mediated by educational attainment. In conclusion, postnatal growth stunting is an important predictor of suicidal ideation in later life. It also affects the association between birth length and suicidal ideation.

Low birthweight and subsequent emotional and behavioural outcomes in 12-year-old children in Soweto, South Africa: findings from Birth to Twenty

BACKGROUND

The fetal origins hypothesis suggests that an adverse prenatal environment, indexed by low birthweight (LBW), may increase the risk of developing later disease. Recently the hypothesis has been extended to psychological outcomes, especially depression. The aim of this analysis was to test, for the first time in a developing country setting, the association between LBW and psychological symptoms, in Soweto, South Africa.

METHODS

A sample of 1029 children was drawn from Birth to Twenty, a longitudinal cohort followed from pregnancy to young adulthood. This sample completed the Youth Self Report at age 12 years, a validated psychological measure of behavioural and emotional adjustment. Scores were compared between LBW (<2500 g) and normal birthweight children using multivariate analysis with adjustment for potential birth and life events confounding factors.

RESULTS

No associations were found between LBW and total [adjusted odds ratio (OR) 1.09, 95% confidence interval (CI) 0.69-1.74], internalizing (adjusted OR 0.81, 95% CI 0.52-1.28) or externalizing profiles (adjusted OR 0.81, 95% CI 0.49-1.36). The only difference detected was for the internalizing sub-profile of Somatic Complaints (adjusted OR 2.02, 95% CI 1.21-3.38), which on subgroup analysis was greatest among females.

CONCLUSIONS

We found no convincing evidence of an association between LBW and emotional and behavioural outcomes in 12-year olds in this sample in urban South Africa. To our knowledge, this is the first published assessment of this association in a developing world context.

Psychiatric disorder in young adults born very preterm: Role of family history

Objective

To investigate whether young adults born very preterm (VPT) (<33 weeks) are at increased risk for psychiatric illness in adulthood and whether a family history of psychiatric disorder further increases this risk.

Methods

We assessed 169 VPT and 101 term born individuals using the Clinical Interview Schedule – Revised.

Results

Young adults born VPT had an increased risk for psychiatric disorder compared to controls (OR = 3.1, 95% CI = 1.1–8.6, p = 0.03). Those born VPT who had a history of psychiatric disorder in a first-degree relative, had an increase in risk for psychiatric disorder compared to those born VPT without a family history (OR = 5.2, 95% CI = 1.8–14.9, p = 0.002).

Conclusion

Individuals born VPT are at increased risk of psychiatric illness in young adulthood compared to controls. In addition, a family history of psychiatric disorder in a first-degree relative may leave young adults born VPT particularly vulnerable to psychiatric illness.

Loss to follow up did not bias associations between early life factors and adult depression

OBJECTIVE

This study examines the consequences of nonresponse in a follow-up survey for the associations of early life factors with adult depression.

STUDY DESIGN AND SETTING

A cohort of 11,532 Danish men born in 1953 had nearly complete follow up for outcomes retrieved from the Danish Psychiatric Register and the National Prescription Register, but only 66% of 9,507 eligible cohort members participated in a follow-up survey in 2004. We examined whether characteristics measured at birth and at ages 12 and 18 years, were associated with survey response. Associations between early life characteristics and four measures of depression were described by odd ratios (OR), estimated by logistic regression. For the register-based measures the effect of nonresponse was described by a relative OR(OR(responders)/OR(entire cohort)=ROR).

RESULTS

Nonresponse at 50 years of age was related to having a single mother at birth, low educational attainment at age 18, and low cognitive function at ages 12 and 18. Hospitalizations for depression and having claimed a prescription for an antidepressive drug were also most frequent among men who did not respond in the follow up. However, the effect of this nonresponse on the estimated ORs was small, and all ROR were nonsignificant.

CONCLUSION

Although early life characteristics were related to response in a follow-up survey, the ORs for the exposure-risk associations were not biased by nonresponse.

Fetal growth restriction and the development of major depression

OBJECTIVE

To test the association between fetal growth restriction and the lifetime risk of major depression and the number of recurrent episodes.

METHOD

Study subjects (n = 1101) were offspring of participants in the Providence, RI, site of the National Collaborative Perinatal Project. Cox regression was used to investigate the relation between measures of birth size and the lifetime risk of depression and the mean number of depressive episodes was compared across categories of birth size.

RESULTS

There was no association between low birth weight, gestational age, ponderal index and small for gestational age and the lifetime risk of major depression, or the number of recurrent episodes.

CONCLUSION

Fetal growth restriction, as reflected by multiple measures of birth size, is not associated with the risk of a major depression or the subsequent recurrence of depressive episodes. Results of this study do not support a 'fetal programming' effect in depression.

Is birth weight associated with risk of depressive symptoms in young women? Evidence from the Southampton Women's Survey

Although some studies have shown negative associations between birth weight and risk of depression, others have not. Studies also differ regarding the age and gender specificity of reported associations. In this paper, the authors report on a study of 5,830 women aged 20-34 years from the general population in Southampton, United Kingdom, interviewed in 2000-2002 that found no relation between birth weight and current depressive symptoms or past treatment for depression. Prevalence ratios for current symptoms and for past treatment, in relation to reported or recorded birth weights, were all remarkably close to 1.0, with narrow 95% confidence intervals. For example, the prevalence ratio from the fully adjusted model for current depressive symptoms in relation to a standard deviation increase in reported birth weight was 1.01 (95% confidence interval: 0.98, 1.05). Generally, the associations reported elsewhere are not strong. The authors found a weak, inverse association in exploratory analyses of duration of gestation at birth in relation to depressive symptoms, but this finding requires replication. Because birth weight and duration of gestation are relatively poor markers of fetal development, other markers of fetal and early development should be explored. However, data from this study do not support a major developmental contribution to the etiology of depression in women.

A longitudinal typology of symptoms of depression and anxiety over the life course

BACKGROUND

Little is known about long-term profiles of depressive and anxious symptomatology over the life course and about the developmental determinants of different trajectories. The objective of this study was to identify a novel typology of symptoms of depression and anxiety over the life course and examine its neurodevelopmental antecedents in an epidemiological sample.

METHODS

A longitudinal latent variable analysis was conducted on measures of anxious and depressive symptoms at ages 13, 15, 36, 43, and 53 years among 4627 members of the Medical Research Council National Survey of Health & Development (the British 1946 birth cohort). Early life predictors of class membership were studied with ordinal logistic regression.

RESULTS

We identified six distinct profiles up to age 53: absence of symptoms (44.8% of sample); repeated moderate symptoms (33.6%); adult-onset moderate symptoms (11.3%); adolescent symptoms with good adult outcome (5.8%); adult-onset severe symptoms (2.9%); and repeated severe symptoms over the life course (1.7%). Heavier babies had lower likelihood of depressive and anxious symptoms (odds ratio [OR] = .92; 95% confidence interval [CI] .85-.99), whereas delay in first standing (OR = 1.19; 95% CI 1.11-1.28) and walking (OR = 1.22; 95% CI 1.14-1.31) was associated with subsequent higher likelihood of symptoms, controlling for social circumstances and stressful life events during childhood.

CONCLUSIONS

There was evidence of distinct profiles of depressive and anxious symptomatology over the life course and associations with markers of neurodevelopment. This suggests very early factors are associated with long-term experience of symptoms of depression and anxiety.

Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation

Stunting is associated with deficits in cognition and school achievement from early childhood to late adolescence; however, there has been little investigation of emotional and behavioral outcomes. The objective of this study was to determine whether linear growth retardation (stunting) in early childhood is associated with poorer psychological functioning in late adolescence. The study was a prospective cohort study of stunted and nonstunted children. Participants were identified at age 9-24 mo by a survey of poor neighborhoods in Kingston, Jamaica, and a 2-y intervention trial of supplementation and stimulation was conducted in the stunted children. Psychological functioning was assessed at age 17 y in 103 of 129 stunted children enrolled and 64 of 84 nonstunted participants. Anxiety, depressive symptoms, self-esteem, and antisocial behavior were reported by participants using interviewer-administered questionnaires and attention deficit, hyperactivity, and oppositional behavior were reported by parent interviews. The stunted participants reported significantly more anxiety (regression coefficient = 3.03; 95% CI = 0.99, 5.08) and depressive symptoms (0.37; 95% CI = 0.01, 0.72) and lower self-esteem (-1.67; 95% CI = -0.38, -2.97) than nonstunted participants and were reported by their parents to be more hyperactive (1.29; 95% CI = 0.12, 2.46). Effect sizes were 0.4-0.5 SD. Participants who received stimulation in early childhood differed from the nonstunted group in hyperactivity only. Children stunted before age 2 y thus have poorer emotional and behavioral outcomes in late adolescence. The findings expand the range of disadvantages associated with early stunting, which affects 151 million children <5 y old in developing countries.

Why do children from socioeconomically disadvantaged families suffer from poor health when they reach adulthood? A life-course study

The authors investigated what risk factors contribute to an excess risk of poor adult health among children who experience socioeconomic disadvantage. Data came from 1,037 children born in Dunedin, New Zealand, in 1972-1973, who were followed from birth to age 32 years (2004-2005). Childhood socioeconomic status (SES) was measured at multiple points between birth and age 15 years. Risk factors evaluated included a familial liability to poor health, childhood/adolescent health characteristics, low childhood intelligence quotient (IQ), exposure to childhood maltreatment, and adult SES. Adult health outcomes evaluated at age 32 years were major depressive disorder, anxiety disorders, tobacco dependence, alcohol or drug dependence, and clustering of cardiovascular disease risk factors. Results showed that low childhood SES was associated with an increased risk of substance dependence and poor physical health in adulthood (for tobacco dependence, sex-adjusted relative risk (RR) = 2.27, 95% confidence interval (CI): 1.41, 3.65; for alcohol or drug dependence, RR = 2.11, 95% CI: 1.16, 3.84; for cardiovascular risk factor status, RR = 2.55, 95% CI: 1.46, 4.46). Together, the risk factors studied here accounted for 55-67% of poor health outcomes among adults exposed to low SES as children. No single risk factor emerged as the prime explanation, suggesting that the processes mediating the link between childhood low SES and adult poor health are multifactorial.

'It's not just about food': mother-infant interaction and the wider context of nutrition

In recent years, attention has increasingly focused on the wider context of nutrition, rather than simply on calorie and nutrient intake. Recent estimates put the figure of people in the world living in extreme poverty (an income of less than $1 a day) at 1.1 billion. This has significant implications for nutritional deficiencies in infants and young children. In this paper, we will show how the physical growth and psychological development of infants and children are intimately linked, and how many of the same aetiological factors (such as caregiver sensitivity, psychosocial support, communicative exchange between infant/child and their caregiver) are implicated in both domains. Preliminary evidence indicates that community-based interventions impact on the mother-infant relationship as well as infant physical growth, and contribute to the increasing sense of how aspects of the early relationship between infants and their caretakers are crucial to any complete understanding of infant growth and development. The paediatric food-based dietary guidelines (PFBDGs) include guidelines relating to the mother-infant relationship and may thus prove to be a significant tool in community interventions.

Length of gestation and depressive symptoms at age 60 years

BACKGROUND

A non-optimal foetal environment, reflected in smaller birth size and shorter duration of gestation, is a risk factor for compromised health later in life.

AIMS

To examine whether smaller birth size and shorter gestation predict depressive symptoms.

METHOD

A total of 1371 members of a cohort born between 1934 and 1944 at term (259-294 days'gestation) in Helsinki, Finland, completed the Beck Depression Inventory (BDI) and the Center for Epidemiological Studies Depression scale (CES-D) at an average age of 61.5 years (BDI) and 63.4 years (BDI and CES-D).

RESULTS

Gestational length predicted depressive symptoms linearly and independently of gender and birth weight: per day decrease in gestational length, depressive symptoms scores increased by 0.8-0.9% (95% CI 0.2-1.4, P<0.009). Weight, length and head circumference at birth showed no linear association with depression, adjusted for gender and gestational length. The results did not change when further controlled for socio-economic characteristics at birth and in adulthood, age and body mass index in adulthood.

CONCLUSIONS

Susceptibility to depressive symptoms may relate to shorter length of gestation.

The impact of gestational stress and prenatal growth on emotional problems in offspring: a review

OBJECTIVE

Events occurring very early in life, even prenatally, may have long-term effects on future health and behaviour. The influence of poor foetal growth and gestational stress in the mother on the risk of emotional problems in offspring was reviewed.

METHOD

A selective review of the literature was undertaken.

RESULTS

Studies of preterm infants and infants born small for gestational age have shown increased levels of emotional problems across the lifespan. In general, studies examining maternal depression/anxiety during pregnancy and other indices of gestational stress have shown significant associations with emotional problems in children. The results of several studies also point to the importance of psychosocial and genetic factors in moderating associations.

CONCLUSION

Future research that focuses on identifying the mechanisms underlying these associations is needed. The moderating role of psychosocial and genetic risk factors is an important area in which future research should be directed. These findings have clinical implications for the provision of antenatal care.

Fetal programming of temperamental negative affectivity among children born healthy at term

The fetal programming hypothesis suggests that an adverse in utero environment, reflected in small body size at birth, has life-long effects on different physiological systems that may affect both health and behavior. We explored whether fetal growth was associated with biologically based temperamental outcomes (negative affectivity scales, the CBQ) among 5(1/2)-year-old children (n = 416) born healthy at term (gestational weeks 37-42). In line with the hypotheses, small body size at birth (thinness measured by ponderal index, kg/m(3)) was related to increased negative affectivity and its subscales: anger-, discomfort-, and sadness-proneness in childhood. Longer length at birth was predictive of higher levels of child anger- and sadness-proneness. Length of gestation moderated the associations of weight and length at birth with negative affectivity. The results suggest that the biological basis of temperament may be subjected to antenatal environmental influences, and that the mechanisms, proposed to be related to fetal glucocorticoid environment, may operate even within the normal range of term birth.

Growth and cognitive function of Indonesian children: Zero-inflated proportion models

This is a study of the cognitive function of Indonesian children. The cognitive function assessment consisted of 17 items and the number of correct answers a child could score therefore ranged between 0 and 17. In this upper bounded situation, a zero-inflated binomial model and a zero-inflated beta-binomial model were considered. The purpose of the analysis was to examine whether the growth status in infancy and at the age of 7 years was related to the cognitive function of the children. The four regression models proposed by Lucas, Fewtrell and Cole were fitted, i.e. an 'early model' relating early body size to the outcome, a 'later model' relating later body size to the outcome, a 'combined model' including both early and later anthropometry measures, and an 'interaction model' further including an interaction term calculated as the product of early and later body size. It was found that social variables predicted the probability of zero-inflation, while weight-for-age at 7 years predicted the proportion of correct answers. The results do not support the existence of a critical window of cognitive development in infancy. Rather they suggest that it is the lack of catch-up growth after poor growth in infancy that is hazardous, and that childhood weight gain is influential regardless of weight in infancy.

Bivariate poisson-poisson model of zero-inflated absenteeism data

Bimodal distributions of counts with one mode at zero are often seen in medical research. In a health survey parents were asked the number of days their children missed their activities (Y(1)) and the number of days their children spent in bed (Y(2)) due to illness in the past four weeks. Both variables exhibited zero inflation. We consider a bivariate Poisson-Poisson regression model, in which the two variables are regarded as indicators of an unobserved health status variable. Based on this, we further develop a bivariate Poisson-Poisson model that constrains Y(1)>or=Y(2). It is often claimed that there is a critical window of growth and nutrition in foetal life and infancy during which subsequent health status is affected. It is not clear whether the claim is true and whether childhood growth matters more. We analyse the bivariate data in relation to weight-for-age in infancy and weight gain from infancy to age 7 years. The findings do not support the existence of a critical window in infancy. There is some indication that childhood weight gain might affect health status.

The effect of birth-weight with genetic susceptibility on depressive symptoms in childhood and adolescence

Low birth-weight has been associated with depression and related outcomes in adults, and with problem behaviours in children. This study aimed to examine the association between low birth-weight for gestation and depressive symptoms in children and adolescents and to examine whether the relationship is moderated by genetic risk for depression. An epidemiological, genetically sensitive design was used including 2,046 twins aged 8-17 years (1,023 families). Data were obtained by parental report and analysed using regression analysis. A small but significant association between birth-weight for gestation and early depressive symptoms was observed. The unit increase in depressive symptoms per unit decrease in birth-weight for gestation was greater for individuals at genetic or familial risk for depression. For low birth-weight children, genetic risk for depression moderated the influence of birth-weight for gestation in predicting early depressive symptoms. Birth-weight for gestation is moderated by genetic and familial risk for depression in influencing early depression symptoms. These observations have clinical implications in that the impact of being small for gestational age on depressive symptoms is greater in children at familial/genetic risk although the association between birth weight and depression does not imply causality.

Interactions between fetal HLA-DQ alleles and maternal smoking influence birthweight

Maternal smoking during pregnancy inhibits fetal growth, and is a major cause of childhood and adult morbidity, including increased risks of cardiovascular disease and diabetes. However, the use of birthweight as a proxy for future smoking-related morbidity is hindered by its wide variability, suggesting a role for other birthweight-modifying factors. We report here, for the first time, that interactions between specific fetal HLA-DQA1 and DQB1 alleles and maternal smoking can influence birthweight. We compared mean birthweights of a series of term, HLA-DQ typed white UK newborns (n = 552) whose mothers had either smoked (n = 211) or not smoked (n = 341) during pregnancy. Maternal smoking during pregnancy resulted in an average birthweight reduction of 244 g, but the combined effects of maternal smoking and fetal DQA1*0101 or DQB1*0501 alleles resulted in a 230 and 240 g further reduction in mean birthweight, respectively, resulting from interactions between smoking and these DQ types. Other fetal DQ allele-specific interactions with maternal smoking are suggested by a "protective" effect on smoking-associated birthweight reduction in newborns typing for DQA1*0201 and DQB1*0201. Our results suggest biological interactions between maternal cigarette smoking during pregnancy and specific fetal DQ alleles that affect fetal growth. The precise nature of these interactions merits further investigation, as knowledge of fetal HLA-DQ type may be useful in refining risk estimates of severe fetal growth restriction because of maternal smoking during pregnancy.

Physical and emotional development, appetite and body image in adolescents who failed to thrive as infants

BACKGROUND

Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development.

METHODS

Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist.

RESULTS

The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem.

CONCLUSIONS

Failure to thrive in infancy is not associated with adverse emotional development in childhood.