Preterm birth may predict psychological wellbeing in adulthood

Preterm birth may have long-term consequences on emotional wellbeing and behaviour lasting into adulthood. This was found by Pyhälä, Wolford and others and published earlier this year in Pediatrics. In more detail, adults born preterm at very low birth weight reported more internalizing and socially avoidant personality problems, as well as less externalizing problems than those born full term. The results indicate that former severely preterm infants are on average more withdrawn and experience more emotional problems which often manifest as depressive or anxiety symptoms. Also, they express less socially unacceptable behavior such as rule-breaking or intrusive behavior.

The study was carried out as an individual participant data meta-analysis within our international research network called Adults Born Preterm International Collaboration (APIC). APIC is a group of researchers around the world who aim to combine their forces to answer questions related to preterm birth that cannot be answered in any one single cohort study alone.

Now, for the first time, it enabled us to combine adulthood follow-up data on self-reported mental health problems from six preterm cohort studies from five different countries including USA, Canada, Germany, Norway and Finland. The final study sample included altogether 747 adults born preterm and 1512 born at term.

Collaboration and data pooling across several studies offers us an opportunity to overcome some of the limitations that previous studies have had. For example, we have already learned from earlier studies based on nationwide registries that the risk for diagnosed psychiatric disorders is higher among adults born preterm in comparison to those born at full term. Further, a few original cohort studies have indicated that adults born preterm may also themselves report more mental health problems. But registries only include severe disorders diagnosed by medical doctors, and individual cohort studies, in turn, are relatively small which makes it difficult to detect all group differences, for example, whether the effects of preterm birth are different in men and women.

Photo by Tom Markham

Therefore, this new study specifically adds to our knowledge of those subjective symptoms that may not exceed the clinical threshold or may not have been diagnosed, but may still impair psychological wellbeing, social life and normal everyday functioning. It was also possible to show that these effects of preterm birth were fairly similar among women and men, and among those who were born small in relation to the duration of pregnancy.

Given the emotional and social problems that adults born preterm may experience, supporting their coping skills and peer relationship skills already in childhood may be warranted in addition to the early support for parents. But simultaneously, it is important to note that not all adults born preterm experience mental health problems and most of them do well. Besides being a vulnerability factor, preterm birth may in fact serve as a protective factor in some respect as was demonstrated in their lesser amount of externalizing problems in our study. Therefore, finding the key features to plan timely and targeted preventive interventions to promote long-term resilience in all areas of psychological wellbeing among preterm individuals is an important goal for future research.

/ Elina Wolford & Riikka Pyhälä

RECAP Preterm combines eHealth solutions and Finnish and Nordic Register studies for the benefit of children and adults born preterm

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.

Photo by Bridget Coila

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/

Räikkönen and Kajantie co-create and co-design two novel eHealth solutions

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:

Click the image to visit Terveyskylä!

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.

Psychological follow-up – what currently goes on in Predo and Itu

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.

Research assistant Silja with testing equipment for 3-year-olds

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

Meet – Eat – Repeat or How Developmental Psychology Group Keeps Up High-Quality Research

Developmental Psychology Research Group at the University of Helsinki is a big group of talented individuals with a wide range of interests. In our work some researchers focus on prenatal factors affecting health and development of children, while others look into cognitive aging in older population; some focus on physical health, whereas others are interested in mental disorders. But every other week we join together for a nice breakfast and fruitful discussion.

Every season we have different themes. For example, in spring 2016 each member of the group chose an article of personal interest (not necessarily related to the research topics) and presented an overview of the paper. It was a great practice of oral presentation skills, training of analytical thinking, and a fun experiment as some papers were related to daily life experiences like coffee consumption or toys to play with kids.

In autumn 2016 we shared the newest results of our research work, newly published papers, and poster/oral presentations from the conferences we attended. This practice demonstrated yet again the wide range of topics DePsy researchers focus on. For more information check out short descriptions and links for Tuhat profiles here: https://blogs.helsinki.fi/depsy-group/personnel/

Spring 2017 is a combination of guest talks and practical skills workshops. We have already learned about new regulations and research life in the Faculty of Medicine, which we have just joined this year. We have learned new tools to improve the quality of our figures and graphs from Dr. Christian Hakulinen. We looked into benefits and cautions of using Tobit regression analyzes with Dr. Jari Lipsanen. We explored collaboration opportunities and perks of studying health impact of weather and climate with Reija Ruuhela. And we are looking forward to many more interesting topics. Below is this spring schedule.

Date Scheduled topic
18.01 First meeting of the year. Discussion of the program for spring 2017 and some new regulations from the Faculty of Medicine
1.02 Marius, Elina and Anna talk about experience from ISPNE conference in Miami and give presentations of the posters. Additionally, Marius will share his experience from Edinburgh.
15.02 Christian Hakulinen will give workshop on how to make nice figures
1.03 Jari Lipsanen workshop on Tobit regression, truncated models, etc.
15.03 Guest talk by Reija Ruuhela from Finnish Meteorological Institute:  http://en.ilmatieteenlaitos.fi/cv-reija-ruuhela
29.03 Discussion about the group’s shared network P drive and more efficient use of it
12.04 Jari Lipsanen workshop on Mixed models
26.04 Group discussion and development of template tables and figures when writing a manuscript
10.05 Guest talk by Professor Hannes Lohi: http://research.med.helsinki.fi/neuro/lohi/research/default.html

Last but not least, at these meetings we are free to ask any questions and raise any topics, find solutions for organizational and other issues at hand, etc. Never underestimate the power of informal conversations over good food and coffee!

Ilona Merikanto and Satu Kumpulainen arranging the breakfast table

We welcome new collaborations and topics for discussion. So if you are interested in being a speaker in our meetings, give a workshop on new methods, or raise awareness on some contemporary topics, please, do not hesitate to leave a comment on our Facebook page (https://www.facebook.com/depsyhelsinki/ ) or send email to anna.suarez@helsinki.fi

/Anna Suarez

 

Late-preterm babies: growth predicts neurodevelopment

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.

Photo by PAHO.

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

Sleep, Helsinki, sleep

Everyone knows sleep is important, especially if they’ve experienced any difficulties with their sleep. During a person’s life, there are several developmental phases when sleep problems are likely to emerge. The sleep research team within the Developmental Psychology Research Group currently focuses on the teenage years, and especially on problems relating to sleep timing. From a typical adult’s point of view sleep timing doesn’t seem to be a “real” problem – teenagers just need to go to bed earlier, right?

Unfortunately, it isn’t that simple. If sleep timing during the teen years was so easy, it wouldn’t be a problem to the 57 % of adolescents who report sleeping too little. Or the 16 % of teens who develop a clinically significant disorder called Delayed Sleep Phase Disorder (DSPD). To provide solutions to these issues, SleepHelsinki was launched in autumn 2016. SleepHelsinki is a research project which tries to find solutions to those sleep problems which typically emerge in adolescence, namely relating to circadian regulation.
photo by anoldent
There are several reasons for the high prevalence of problems, and, of course, some of them could be solved just by going to bed earlier. However, most of the troubles have a biological basis: adolescents’ sleep regulation goes through major changes as the brain matures, and as these changes take place, a natural shift in sleep timing also occurs. In addition to this, teenagers have high resilience to resist the homeostatic sleep pressure which builds up when staying awake. When you add mobile devices, complicated social lives, a thirst for independence, and important educational choices into the equation, sleep timing is suddenly a very real problem.

Since last year, SleepHelsinki! -study has been collecting data to reveal all possible causes for problems in sleep timing among 16-17-year-olds adolescents living in Helsinki. Participants who filled in online questionnaires have provided valuable information, and based on those answers, the sleep research team has now begun looking for the best solutions. Because everyone is different, the solutions need to be different: therefore SleepHelsinki is testing seven different approaches to problems relating to sleep timing.
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. 
The SleepHelsinki team recently published a review article in the Finnish Medical Association’s journal, discussing delayed sleep phase and how to tackle it (Viivästyneen unijakson lääkkettömät hoidot“, or Non-pharmacological treatment of Delayed Sleep Phase]. However, the work has only begun. SleepHelsinki has a great team working on the project, but the most important part of the study is the participants. Every adolescent who participates in the study provides unique data, which will help in finding optimal solutions. Time will tell which of the solutions really works and has long-lasting effects. In the meantime, sleep well and prosper!
/Liisa Kuula-Paavola

Adults born preterm are at a higher risk of cumulative social and neurocognitive problems

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.

Image by Justin Lincoln

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

Licorice consumption article draws media attention

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

Licorice consumption during pregnancy may harm the child

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.

Photo by Kristin Banks

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