A study of German adults born between 1969 and 2002 revealed that those born before the 29th week of pregnancy (extremely premature) have a significantly increased risk of developing panic disorder later in life. Panic disorder was present in 2% to 4% of individuals born after the 29th week of pregnancy but in 14% of those born before. The research was published in the Journal of Psychiatric Research.
A typical human pregnancy lasts about 40 weeks, measured from the first day of the last menstrual period. However, some babies are born early. If a baby is born before the 37th week of pregnancy, this is referred to as prematurity. Premature births can occur for various reasons, such as infections, issues with the placenta, or carrying multiples (twins, triplets). Maternal health conditions like high blood pressure, diabetes, or a history of preterm birth also increase the risk of prematurity.
Babies born prematurely may face immediate health challenges, such as difficulty breathing and feeding, due to underdeveloped organs. Prematurity is the leading cause of newborn deaths. It is estimated that 15 million babies are born prematurely each year worldwide, accounting for about 11% of all births. Although most premature babies survive due to modern medical technology, premature birth carries long-term health risks, including developmental delays, learning difficulties, and vision or hearing problems, among others.
Study author Jonas Tesarz and his colleagues sought to determine whether individuals born prematurely are more likely to develop anxiety and panic disorders later in life compared to those carried to term. Previous studies have linked childhood stress and parental deprivation to anxiety disorders later in life, but questions remained as to whether prematurity also increases an individual’s risk of developing such disorders. The researchers hypothesized that individuals born prematurely would have higher rates of panic disorder later in life, driven by the stress experienced at birth and the prolonged intensive medical care required.
The researchers analyzed data from the Gutenberg Prematurity Study, conducted by the University Medical Center of the Johannes Gutenberg-University Mainz in Germany. This study included 40,189 newborns born between 1969 and 2002, all of whom were adults at the time of analysis (aged 18-52). From this group, the researchers selected 427 participants, prioritizing as many prematurely born individuals as possible.
For each participant, the researchers collected medical history data from the university’s medical records. The presence of panic disorder was assessed using the panic module of the Patient Health Questionnaire (PHQ). Participants were categorized by gestational age at birth: full-term (born after at least 37 weeks of pregnancy), moderately preterm (born between 33 and 36 weeks), very preterm (born between 29 and 32 weeks), and extremely preterm (born before the 29th week of pregnancy). Women made up 57% of the participants.
The results showed that 18 participants (4.2%) met the criteria for panic disorder. The prevalence of panic disorder was similar across all categories of individuals born after the 29th week of pregnancy, ranging from 2% to 4%. However, among those born before the 29th week, 14% had panic disorder.
Additionally, compared to participants without panic disorder, those with the disorder were more likely to be female, unemployed, and have lower levels of education. They also spent longer in intensive care, more time in an incubator, and had higher levels of carbon dioxide in their blood after birth, indicating breathing difficulties or inadequate lung function. When the researchers accounted for the length of time spent in intensive care, the link between being born before the 29th week and panic disorder disappeared.
“This study provides first evidence that prematurity is associated with increased risk of panic disorder later in life. Individuals born at a GA below 29 weeks [before the 29th gestational week] showed an over 4-fold higher prevalence than individuals born full-term,” the study authors concluded. “Adjusting for the length of postnatal ICU [intensive care unit] stay eliminated the association between preterm birth and later onset of panic disorder. This finding suggests that the postnatal intensive care stay of preterm infants might be of critical importance for mental health later in life, indicating a specific risk factor for psychological morbidity.”
The study makes an important contribution to understanding how experiences soon after birth might affect mental health later in life. However, it should be noted that the number of participants with panic disorder was low, as was the number of individuals born before the 29th week of pregnancy.
The study, “Impact of preterm birth on the onset of panic disorder in later life – Results from the Gutenberg Prematurity Study (GPS),” was authored by Jonas Tesarz, Alexander K. Schuster, Eva Mildenberger, Michael S. Urschitz, Mareike Ernst, Manfred Beutel, Michelle Hermes, Bernhard Stoffelns, Fred Zepp, Norbert Pfeiffer, and Achim Fieß.