People born preterm have higher rates of psychotropic drug prescriptions in adolescence

People who were born preterm had higher rates of psychotropic drug prescriptions during adolescence and young adulthood than those born at term, according to results of a cohort study published in JAMA Network Open.

These higher rates may signal further evidence of increased risk for mental health impairment among those born preterm, researchers noted.

“The increased risk [for] mental health impairment among children born preterm is found throughout their lifespan, from childhood through adolescence and into adulthood,” Christine Strand Bachmann, MD, of the department of public health and nursing at the Norwegian University of Science and Technology, and colleagues wrote. “However, to our knowledge, a minority of the studies in this field have targeted adolescence, a period during which many mental health difficulties emerge. The aim of this study was to assess the association between individuals’ degree of preterm birth and prescriptions of psychotropic drugs during adolescence and into young adulthood.”

The investigators analyzed registry data of all Norwegians (n = 505,030) born after 23 weeks of completed gestation between 1989 and 1998. They included individuals who were born without registered birth defects, alive at age 10 years and who had maternal data available. The follow-up period was between 2004 and 2016. Bachmann and colleagues compared psychotropic drug prescriptions received between ages 10 to 23 years among preterm groups and peers born at term. Further, to control for shared family confounding, they compared participants with their siblings. Participants comprised four groups according to gestational age at birth: 762 extremely preterm (23 weeks and 0 days to 27 weeks and 6 days), 2,907 very preterm (28 weeks and 0 days to 31 weeks and 6 days), 25,988 moderately or late preterm (32 weeks and 0 days to 36 weeks and 6 days) and 475,373 full term (37 weeks and 0 days to 44 weeks and 6 days).

Results showed increased risk for psychotropic drug prescription among those born preterm. The researchers noted a dose-response association between gestational age and prescription. Prescriptions for all drug types were higher among the extremely preterm group vs. peers born at term, with ORs from 1.7 (95% CI, 1.4-2.1) for antidepressants to 2.7 (95% CI, 2.1-3.4) for psychostimulants. The moderately to late preterm group had a less significant increased risk for prescription of all types, with ORs of 1.1 (95% CI, 1-1.1) for antidepressants to 1.2 (95% CI, 1.1-1.2) for psychostimulants. The sibling comparison demonstrated smaller increased risk, with increases insignificant for several groups. In the sibling analysis, the OR for any prescription was 1.8 (95% CI, 1.2-2.8) among the very preterm group and 1 (95% CI, 0.9-1.1) among the moderately or late preterm group.

“Children born preterm have increased mental and social risks in adolescent and young adult years,” Bachmann and colleagues wrote. “This increased risk may be largely associated with factors involving genetics and childhood environment for the later preterm groups. Trajectories established during adolescence are associated with later mental health status and lifetime opportunities, and this period could thus be an important target for health-promoting measures and preventive measures for this group.”