Extremely Preterm Births Linked to Higher Risk of Depression and Anxiety in Adulthood: Study
Germany: Adults born extremely preterm may face a significantly increased risk of major depressive disorder and anxiety later in life, suggests a new study published in eClinicalMedicine. Led by Dr. Achim Fieß from the Department of Ophthalmology at the University Medical Center of the Johannes Gutenberg University Mainz, Germany, the research explored long-term mental health outcomes associated with early birth and abnormal fetal growth.
While earlier studies have linked prematurity and low birth weight to childhood and adolescent mental health challenges, this study takes a broader, lifespan approach, investigating how these early developmental factors affect adult mental health. The researchers conducted a retrospective cohort analysis involving 606 adults aged 18 to 52 years, born between 1969 and 2002. The participants were categorized based on gestational age: extremely preterm (≤28 weeks), very preterm (29–32 weeks), moderately preterm (33–36 weeks), and full-term (≥37 weeks).
Using multivariable logistic regression, the team assessed adult mental health outcomes—specifically major depressive disorder and anxiety disorder—using the Patient Health Questionnaire, while adjusting for variables such as age, gender, and socioeconomic status. Behavioral problems in early childhood (ages 2–4) were also taken into account, as reported by participants’ mothers.
The study led to the following findings:
- Adults born at or before 28 weeks of gestation had a significantly higher risk of developing mental health disorders compared to those born at full term.
- These individuals were over four times more likely to experience major depressive disorder (OR = 4.14).
- They were also more than five times as likely to be diagnosed with anxiety disorder (OR = 5.17).
- Birth weight percentile, used as an indicator of fetal growth restriction, showed no significant association with mental health outcomes in adulthood.
- Emotional and peer-related problems in early childhood were strongly linked to a higher risk of adult depression among those born preterm.
- After adjusting for maternal alcohol and tobacco use during pregnancy, the association between extreme prematurity and depression was no longer statistically significant.
- The association between extreme prematurity and anxiety disorder remained significant even after accounting for maternal factors.
The research challenges the notion that low birth weight alone contributes to poor mental health outcomes. Instead, it suggests that previous findings may have been influenced by the close relationship between low birth weight and prematurity.
“Our findings highlight the long-term psychological vulnerability of individuals born extremely preterm,” noted the authors. “They reinforce the need for early monitoring, emotional support, and targeted interventions throughout development to help mitigate the risks of depression and anxiety in adulthood.”
This study adds weight to the Developmental Origins of Health and Disease (DOHaD) theory, which posits that early life conditions can have lasting effects on health. It highlights the need for greater awareness and support for individuals born prematurely, not just in childhood but well into adult life.
Reference: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00248-2/fulltext
