Author: Sara Sammallahti

One in nine children world-wide are born preterm. Approximately 1 to 2 percent are born very preterm (before 32 weeks of gestation) or with very low birth weight (less than 1500 g). The treatment of very preterm or very low birth weight infants has been one of the success stories of modern medicine: today nine in ten of these infants survive.

Improved survival does not come without a cost. Money-wise, the first year healthcare expenses are 34-fold higher than in term infants, constituting 17% of all infant healthcare costs. Health-wise, children and adults born the earliest and the smallest are also at higher risks of psychological and social problems than those born at term. They may also face higher risks of cardiovascular, lung and other physical diseases when they enter middle age. The RECAP preterm EU Horizon2020 Project aims to understand the causes of these difficulties faced by very preterm children and adults in order improve the health, development and quality of life of these individuals.

Of the 20 RECAP Preterm partners, three come from Finland. DePsy led by Academy Professor Räikkönen has long been committed to studying mental health of adults born preterm. A long-time collaborator is the Kajantie group at THL. Kajantie group is one of the leading groups in the preterm follow-up field world-wide, documented in multiple high-impact publications. Kajantie works in the RCAP project with Extensive Life Inc, a Tampere-based company focusing on mobile eHealth solutions to promote healthy lifestyle.

According to Räikkönen, “with its 9.75 million Euro budget, RECAP Preterm is a major boost for research which will allow leading groups in the preterm follow-up field to join forces and answer questions that could not be answered in any one study alone.”

“RECAP Preterm aligns with the eHealth Strategy 2020 of the Finnish Ministry of Social Affairs and Health, so we expect to that this project will have a major societal impact” says Kajantie. Kajantie adds “RECAP Preterm utilizes up-to-date eHealth developments from several perspectives. We will develop infrastructures to combine data from national healthcare registries in Nordic countries which will enable us to study millions of individuals. The mobile eHealth tools that will be utilized will be highly efficient in collecting real-time lifestyle and mood data.”

Read more on RECAP Preterm at http://recap-preterm.eu/

Helsinki and Uusimaa Hospital District (HUS) coordinates and co-funds – with the other hospital districts in Finland and with the Ministry of Social Affairs and Health – a 12 million euro project that provides digital health services to all Finnish citizens. This project is called the Virtual Hospital project 2.0. The project is already online, though it is continuously developing. It aims at translating research findings into practice and hence have impact! The outcome of the Virtual Hospital project 2.0 is the Health Village (Terveyskylä in Finnish) and it can be found at www.terveyskylä.fi.

DePsy leader, academy professor Katri Räikkönen, and a long-term collaborator, docent Eero Kajantie, are actively involved in two of the Virtual Hospital projects at the Health Village Women’s hub. There are multiple different hubs at the Virtual Hospital Health Village, e.g. Brain hub, Weight management hub, the Helsinki Biobank. Again, these can be found at www.terveyskylä.fi:

The first one of the eHealth solutions that Räikkönen and Kajantie co-create and co-design with the other HUS actors of the Virtual Hospital project relates to promoting growth, development and health of preemies after discharge from the Neonatal Intensive Care Unit (NICU). It also aims at providing support and identify parent(s) who would benefit from enhanced support while the preterm baby is still at the NICU and shortly after discharge. The second one of these eHealth solutions relates to mental health promotion of women during the perinatal period.

Kajantie says: “Participation in these Virtual Hospital projects is very important and very exiting – this will provide us an avenue to translate our almost twenty-years of research into practice to benefit preemies and their families. This avenue can also be exploited to provide evidence-based information to all professionals, not only in the healthcare sector, who work with preemies in their future lives, including teachers in the daycare centers or at schools.” A significant number of the Finnish population is born preterm, nearly 3000 babies each year, reminds Kajantie. Räikkönen continues:

“Promoting maternal mental well-being is important and not only provides benefits for the mother during the perinatal period, but has great benefits for the unborn child as well. I am very happy that this opportunity has opened for us and we can contribute to promoting to the health and well-being of our present as well as next generations.”

DePsy will continue to post blogs about the progress of these two Virtual Hospital eHealth projects.

We could say the Predo and ITU projects are like a pair of sister studies: both include a longitudinal follow-up of pregnant mothers and their children, both tackle themes like developmental origins of health and disease and the fetal effects of maternal stress, mental health and pregnancy disorders – and both are currently undergoing a follow-up data collection phase. The Predo children are now in elementary school, and the eldest of ITU children are turning five this year.

To make data collection possible, we currently have nine very bright future psychologists working in the Depsy group: some are Bachelor’s and some Master’s students. One of the responsibilities of these research assistants is carrying out the neuropsychological tests on the Predo and Itu children. We use a combination of widely used and recognized, age-appropriate measures of cognitive development, assessing areas like general intelligence, memory, executive functioning, and motor skills. We also have several clinical and academic experts training and helping the research assistants.

Most children feel meeting the assistant is fun: depending on the age of child, tests can include tasks like playing with building blocks, reading a story, playing a memory game or drawing together.

One of the most important objectives for the assistant is to keep up a nice atmosphere: things like juice breaks and conversations about the kids’ favorite toys or hobbies, for example, can help the children relax, focus and show their very best in terms of performance. The parents get feedback on how their children did – and as for the children, we hope taking part in a fun study can even give these curious minds a positive first-hand experience of what research is.

To read more about what goes on during research visits, please check out the latest Predo blog post and Itu blog post by our assistants (in Finnish).

/ Sara Sammallahti

When comparing individuals who were all born late-preterm, those who grow faster as infants report better grades in school and do better in tests of cognitive ability as adults, as shown recently by Sara Sammallahti and colleagues in a study published in Pediatric Research.

Late preterm birth occurs close to the lower limit of full-term pregnancy, between 34 weeks and 0 days and 36 weeks and 6 days of gestation, and accounts for the majority of preterm births. Although late preterm infants suffer from fewer complications and receive less intensive monitoring and treatment than more immature babies, they are at an increased risk of early health problems, poorer neurocognitive functioning and problems in school, compared with term-born peers.

In this study of 108 late preterm adults who participated in the Arvo Ylppö Longitudinal Study, we found that those participants who gained more weight and grew more rapidly in head circumference as infants had higher IQ at 25 years of age and higher grades in comprehensive school, and they were less likely to have received special education, compared with slower-growing late preterm peers. In contrast, we did not find differences in mental health outcomes at 25 years of age. The associations were not explained by gestational age, parental education, prenatal growth patterns, manifest developmental disability or congenital malformations, or common pregnancy or neonatal disorders.

To alter the trajectory of neurodevelopment, early intervention is important. Our study suggests that environmental factors such as care and nutrition during the neonatal period may affect both early growth and long-term neurodevelopment, and early growth problems could help identify those at risk. The study also encourages further research into how  interventions in infancy could compensate for the long-lasting risks associated with late preterm birth.

/ Sara Sammallahti, M.Psych., MD+PhD student
University of Helsinki
sara.sammallahti at helsinki.fi

Participants might be assigned to a bright light group, or receive sleep coaching, or maybe even play a sleep game on their mobile phone. All participants are also thoroughly measured (their sleep, skin temperature, saliva cortisol), and given instructions on how to improve their sleeping schedules. 

/Liisa Kuula-Paavola

Traits related to autism-spectrum disorder (ASD) are linked with problems in visual processing in adults who were born preterm, as shown by Elina Wolford and colleagues in a recent study published in The Journal of Developmental Origins of Health and Disease.

Autism spectrum disorder (ASD) is a neuropsychiatric disorder characterized by impairments in social communication and interaction, and has often been associated with an enhanced ability to find and focus on details and problems in global visual processing, i.e. integrating parts to form a whole. This is often described as not being able to “see the forest for the trees”. ASD is considered as a continuum ranging from mild traits in the general public to the more severe form of the disorder, and the atypical visual processing style has also been reported in individuals with a higher level of ASD-traits. Those adults who were born preterm, i.e. before 37 weeks of gestation, have previously been reported to have more ASD-type problems in social interaction and more problems in visual processing, compared with term-born peers, but the association of these two types of problems has never before been studied in adults born preterm.

The Helsinki Study of Very Low Birth Weight Adults (HeSVA) is a follow-up study of originally 335 individuals who were born preterm at very low birth weight (VLBW; birth weight <1500g) in Helsinki between 1978-1985. The DEPSY group with our collaborators has published multiple studies on the long term effects on adult health, neurocognitive abilities, and personality of individuals born preterm based on the longitudinal data from the HeSVA study.

In this study by Wolford and colleagues, we examined the association of ASD-traits and visual processing skills at the average age of 25 years in 113 adults born preterm at VLBW and 105 controls born at term. We used self-rated questionnaires of ASD-traits and a complex design copying task to assess global visual processing skills. We found that a higher level of self-rated ASD-traits was associated with slower performance in the global visual processing task among those born preterm at VLBW, but not among the term-born group.

Our findings suggest that the associations between ASD-traits and visual processing may be restricted to individuals born preterm, and related specifically to problems in global visual processing, not an enhanced ability to focus on details. In addition, our findings point to cumulative social and neurocognitive problems in those born preterm at VLBW which persist into adulthood. This study emphasizes the need to follow-up individuals born preterm and focus on finding ways to attenuate these cumulative problems.

/ Elina Wolford

Last Friday, we blogged about our latest article on licorice consumption during pregnancy and its potential risks for fetal development, published in the American Journal of Epidemiology.

During the weekend, the study has drawn quite a bit of media attention. The Academy of Finland, the Finnish National Institute for Health and Welfare, and the University of Helsinki released news of the findings. Finnish newspapers and other media, including  Iltalehti, Aamulehti, Yle Svenska, Turun Sanomat and Lännen Media, Länsi-Suomi, Aamuset, Keskisuomalainen, Ilkka, Kaleva, Lääkärilehti, Mediuutiset, Apteekkari, Talouselämä, Auran aallot, Uusi Suomi, Vantaan Sanomat, Helsingin Uutiset, Sipoon Sanomat, and Seinäjoen Sanomat featured the story. Internationally, Science Daily, Huffington Post, Medical Daily, WCNC, MSN and Hindustan Times reported on the findings. What a pleasure to see the word gets out!

/ EDIT: Check out the New York Times and NHS Health news, too!

/ Sara Sammallahti

The consumption of licorice during pregnancy may be associated with long-lasting risks for the developing child. The study, “Maternal licorice consumption during pregnancy and pubertal, cognitive and psychiatric outcomes in children” by Katri Räikkönen et al. was published today in the American Journal of Epidemiology, along with an invited commentary, “An Ingenious Approach to Examining the Relationship Between Maternal Stress and Offspring Health?” by Drs Keyes and Susser.

In our study, those 12-year-olds whose mothers ate large amounts of licorice during pregnancy scored lower on tests of general cognitive ability and memory and had more ADHD symptoms, compared with children whose mothers had consumed little or no licorice during pregnancy. Girls whose mothers had consumed a lot of licorice during pregnancy also entered puberty earlier.

Based on animal studies, the natural sweetener of licorice called glycyrrhizin strongly interferes with placental metabolism of cortisol, sometimes called the “stress hormone”. During pregnancy, the placenta acts as an active barrier between the mother and the fetus, but maternal consumption of glycyrrhizin disrupts this barrier, causing the fetus to be over-exposed to maternal cortisol. This is likely to explain why licorice consumption during pregnancy may harm the developing fetus.

The study was carried out as part of the Glaku longitudinal study project, which was funded by the Academy of Finland and private foundations. We compared 51 Finnish children whose mothers reported consuming at least 500 mg of glycyrrhizin peer week (roughly equivalent to 250 grams of licorice) with 327 children whose mothers reported they had consumed less than 250 mg of glycyrrhizin per week.

In light of the findings from Glaku and other recent studies, the Finnish nutritional guidelines for pregnant women were recently revised.

As the amount of glycyrrhizin one can safely consume during pregnancy is unknown, women are advised to avoid sweet and salty licorice throughout pregnancy.

/ Sara Sammallahti

When a mother suffers from depressive symptoms during pregnancy, her child is more likely to have psychiatric problems in early childhood, as we show in our most recent article “Maternal Depressive Symptoms During and After Pregnancy and Psychiatric Problems in Children” published in the Journal of American Academy of Child and Adolescent Psychiatry in January 2017.

In our large cohort study, maternal depressive symptoms during pregnancy predicted increased psychiatric problems in children.

This association was independent of maternal depressive symptoms at the time when the mother assessed the child, of perinatal and sociodemographic factors, of maternal history of depression before pregnancy, and of maternal cardiometabolic pregnancy disorders. Maternal depressive symptoms during pregnancy increased the risk of many different types of psychiatric problems in children, both internalizing problems (such as emotional problems, anxiousness and depressiveness, withdrawal, and somatic complaints) and externalizing problems (such as aggressive behavior and attention problems). Associations were similar in younger and older children. Maternal depressive symptoms were highly stable during and after pregnancy. If the mother was depressed throughout pregnancy and/or both during and after pregnancy, child psychiatric problems were especially increased.

Our study cohort, Prediction and Prevention of Pre-Eclampsia and Intrauterine Growth Retardation (PREDO), included 2,296 women and their children born in 2006-2010. The women were recruited to the study at their first antenatal visit at one of the ten participating antenatal clinics in Southern and Eastern Finland. Every two weeks during pregnancy, the mothers completed a questionnaire on their depressive symptoms. Child psychiatric problems were mother-rated at child age 1.9-5.9 years.

The current findings suggest that maternal depression during pregnancy is an independent risk factor for child psychiatric problems. The findings highlight the adverse effects of maternal depressive symptoms during and after pregnancy on child psychological development. Maternal depressive symptoms are very common during pregnancy, with over 20 % of pregnant women reporting clinically significant levels of depression.

Our findings suggest that assessment of maternal depressive symptoms should become a routine part of antenatal care, and interventions targeting the mental health of the expectant mother may benefit the well-being of both the mother and the child.

/ Marius Lahti
Docent, Ph.D.
Department of Psychology and Logopedics,
Faculty of Medicine, University of Helsinki, Helsinki, Finland
E-mail: marius.lahti@helsinki.fi

We would like to warmly welcome our newest team member, Soili Marianne Lehto! Her background is in medicine, and she holds a clinical specialist degree in psychiatry. After completing her PhD in 2009, and being appointed as docent in experimental psychiatry at the University of Eastern Finland in 2010, she has worked as clinical lecturer and acting professor of psychiatry, and spent a year as a visiting researcher at the University of Oxford. Her research interests focus on characterizing how mental phenomena and the physiology of the human body interact, and discovering new ways to modulate the observed interactions (www.uef.fi/mindandbrain).

As part of the Developmental Psychology Research Group, Soili is excited to resume back to a full-time research post. At the group, her interests focus on the interaction of biological and psychosocial factors during pregnancy, and the impact of these factors on child development. Aside from her passion towards science, she loves all kinds of physical exercise, travelling and good books.