Prediction from low birth weight to female adolescent depression: a test of competing hypotheses.
BACKGROUND
Low birth weight (LBW) predicts later-onset hypertension and diabetes mellitus. Its role as a predictor of depression is unclear.


OBJECTIVE
To examine whether LBW predicts depression in male and female children and adolescents and to compare the following 2 hypotheses: Low birth weight is one among several perinatal, childhood, and adolescent risk factors for depression (biopsychosocial hypothesis). Low birth weight is a marker for poor intrauterine conditions that provoke adjustments in fetal development, with long-term consequences for stress response (fetal programming hypothesis).


METHODS
A representative population-based sample from an 11-county area in western North Carolina was assessed annually for psychiatric disorders between the ages of 9 and 16 years. We tested the prediction from LBW and depression in models that included LBW only, LBW plus other prenatal and perinatal adversities, LBW plus significant perinatal and childhood adversities, and LBW plus significant perinatal and childhood adversities and adolescent correlates.


METHODS
Academic research.


METHODS
There were 1420 participants, of whom 49% were female. Main Outcome Measure Cumulative prevalence of DSM-IV depressive disorder at 1 assessment or more during childhood (age range, 9-12 years) and during adolescence (age range, 13-16 years).


RESULTS
The cumulative prevalence of depression among adolescent girls with LBW was 38.1% (95% confidence interval [CI], 16.3%-66.0%) compared with 8.4% (95% CI, 5.2%-13.3%) among adolescent girls with normal birth weight. Rates among children and adolescent boys did not exceed 4.9%. In adolescence, there was a significant interaction between LBW and sex (odds ratio, 0.2 [95% CI, 0.1-0.5]; P<.001). Low birth weight predicted female adolescent depression after controlling for other perinatal, childhood, and adolescent adversities. Girls with LBW and normal birth weight with no adversities had no adolescent depression, but each additional adversity increased the risk of in girls with LBW more than in girls with normal birth weight. Low birth weight did not predict other psychiatric disorders in either sex.


CONCLUSIONS
Low birth weight predicts depression in adolescent girls but not boys. Data support fetal programming over the biopsychosocial hypothesis, suggesting vulnerability to adversities in girls with LBW after puberty.
Costello
Elizabeth Jane
EJ
Center for Developmental Epidemiology, Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC 27710, USA. jcostell@psych.duhs.duke.edu
Worthman
Carol
C
Erkanli
Alaattin
A
Angold
Adrian
A
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D015415:Biomarkers; D002648:Child; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D047109:Fetal Development / Q000502:physiology; D005316:Fetal Distress / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008954:Models, Biological; D008960:Models, Psychological; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011336:Probability; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors
D015415:Biomarkers