Linking extremely low birth weight and internalizing behaviors in adult survivors: Influences of neuroendocrine dysregulation

Abstract

Young adult survivors of extremely low birth weight (ELBW; <1000 g) are known to be at elevated risk for internalizing problems, though little is known about the mechanisms that may lead to higher levels of psychopathology in this vulnerable group. We examined the moderating influence of neuroendocrine functioning on the link between being born at ELBW and internalizing behaviors at age 30-35. Salivary cortisol was collected 20 min after completion of a social stress task in 83 ELBW adult survivors and 89 normal birth weight (NBW; >2500 g) controls. Using a median split, participants were separated into two groups (high or low afternoon cortisol levels). ELBW survivors with "high" afternoon cortisol levels self-reported significantly higher levels of internalizing behaviors compared to those with "low" afternoon cortisol levels. This association between afternoon cortisol and internalizing symptoms did not exist among NBW controls. These results are suggestive of a differential susceptibility for internalizing behaviors among ELBW survivors, depending on their ability to regulate neuroendocrine responses.

Self‐reported mental health and cortisol activity at 27‐28 years of age in individuals born with very low birthweight

“…Bagner et al found a correlation between cortisol reactivity and internalised behaviour and attention problems in premature children 18‐60 months old. Waxman et al studied neuroendocrine regulation by salivary cortisol measurements and internalising problems in surviving ELBW individuals born 1977‐1982 in Canada at 30‐35 years of age and found that higher afternoon values were correlated with internalising‐related behaviours. The authors suggested that different patterns of regulation of the neuroendocrine system in ELBW individuals might affect the development of psychopathology and contributed to the higher levels of anxiety and depressive symptoms seen in adulthood.…”

Long-term Psychiatric Impact of Peer Victimization in Adults Born at Extremely Low Birth Weight

“…The stressful events during fetal and early postnatal development that result in preterm birth may influence brain development 40 and later stress responsiveness, possibly through changes in the hypothalamicpituitary-adrenal (HPA) axis. 41 Indeed, prenatal adversity may predispose individuals to becoming victims. 42 As peer victimization can lead to HPA dysregulation, 43,44 this may place children and adolescents born at ELBW at a greater disadvantage when they need to manage psychosocial stressors during development.…”

The children of preterm survivors: shyness, parenting, and parental stress

“…Due to advances occurring in fetal and neonatal medicine over the past several decades, the first generation of ELBW survivors have survived to adulthood and become parents. Even though preterm survivors appear to be more sensitive to stress and its effects 1,2 no studies have investigated the transmission of this stress vulnerability to their offspring. It is therefore important that we understand the impact of exposure to significant perinatal adversities both for survivors and for their offspring.…”

“…Adverse early experiences can influence parenting and the transmission of personality phenotypes known to portend psychiatric risk of offspring. Indeed, previous research has shown that survivors of prematurity, particularly those born at extremely low birth weight (ELBW) have higher rates of shyness 1,2 , a stress vulnerability factor for mental illness and other adverse health, interpersonal, and vocational outcomes across the life span 3,4 . Until now, however, no one has had the opportunity to examine parenting among ELBW survivors and the transmission of their shy personality phenotype to their children.…”