Preterm birth and psychiatric disorders in young adult life.
BACKGROUND
Preterm birth, intrauterine growth restriction, and delivery-related hypoxia have been associated with schizophrenia. It is unclear whether these associations pertain to other adult-onset psychiatric disorders and whether these perinatal events are independent.


OBJECTIVE
To investigate the relationships among gestational age, nonoptimal fetal growth, Apgar score, and various psychiatric disorders in young adult life.


METHODS
Historical population-based cohort study.


METHODS
Identification of adult-onset psychiatric admissions using data from the National Board of Health and Welfare, Stockholm, Sweden.


METHODS
All live-born individuals registered in the nationwide Swedish Medical Birth Register between 1973 and 1985 and living in Sweden at age 16 years by December 2002 (n=1 301 522).


METHODS
Psychiatric hospitalization with nonaffective psychosis, bipolar affective disorder, depressive disorder, eating disorder, drug dependency, or alcohol dependency, diagnosed according to the International Classification of Diseases codes for 8 through 10. Cox proportional hazards regression models were used to estimate hazard ratios and 95% CIs.


RESULTS
Preterm birth was significantly associated with increased risk of psychiatric hospitalization in adulthood (defined as ≥16 years of age) in a monotonic manner across a range of psychiatric disorders. Compared with term births (37-41 weeks), those born at 32 to 36 weeks' gestation were 1.6 (95% CI, 1.1-2.3) times more likely to have nonaffective psychosis, 1.3 (95% CI, 1.1-1.7) times more likely to have depressive disorder, and 2.7 (95% CI, 1.6-4.5) times more likely to have bipolar affective disorder. Those born at less than 32 weeks' gestation were 2.5 (95% CI, 1.0-6.0) times more likely to have nonaffective psychosis, 2.9 (95% CI, 1.8-4.6) times more likely to have depressive disorder, and 7.4 (95% CI, 2.7-20.6) times more likely to have bipolar affective disorder.


CONCLUSIONS
The vulnerability for hospitalization with a range of psychiatric diagnoses may increase with younger gestational age. Similar associations were not observed for nonoptimal fetal growth and low Apgar score.
Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK. chiara.nosarti@kcl.ac.uk
Chiara
C
Nosarti
Abraham
A
Reichenberg
Robin M
RM
Murray
Sven
S
Cnattingius
Mats P
MP
Lambe
Li
L
Yin
James
J
MacCabe
Larry
L
Rifkin
Christina M
CM
Hultman
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000437:Alcoholism / Q000453:epidemiology / Q000209:etiology; D001034:Apgar Score; D001714:Bipolar Disorder / Q000453:epidemiology / Q000209:etiology; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology*; D005865:Gestational Age; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology; D012042:Registries; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology / Q000209:etiology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000209:etiology; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult