Better neonatal care means more preemies and other infants who are born at an extremely low birth weight will survive into adulthood. Now a new study offers some surprising insight into their adult lives. Those who arrive in this world either premature and at an extremely low birth weight are less likely than normal birth weight babies to have alcohol or substance use disorders as adults. However, they appear to be at a higher risk for other psychiatric problems.

“Those exposed to [antenatal corticosteroids] were at especially high risk and manifested no reduction in alcohol or substance use disorders,” wrote the authors in their published research appearing in Pediatrics. For this reason, preemie survivors exposed to a full course of life-saving steroids while still in the womb “may be a special group at risk for psychopathology in adulthood,” the researchers noted.

In childhood and adolescence, preemies and other low birth weight survivors develop psychiatric problems at greater than average numbers; in particular, they are prone to attentive deficit hyperactivity disorder (ADHD), anxiety disorders, and social difficulties. A few studies also suggest when these survivors reach their 20s, their risk for ADHD, mood disorders, anxiety, and social problems also are higher than normal. Researchers theorize, in the absence of substantial proof, these individuals also may be more likely to develop depression, anxiety, and avoidant personality problems in their early to mid-20s.

For the current study, then, the team of researchers investigated how former preemies fared once they reached their 30s. The team interviewed 84 extremely low birth weight survivors and, for comparison purposes, 90 normal birth weight participants born in Ontario, Canada between the years 1977 and 1982. The interviewers, who did not know whether participants had been born at a normal or low weight, assessed each person using the Mini-International Neuropsychiatric Interview. This short, structured interview was developed in 1990 by psychiatrists and clinicians in the United States and Europe to diagnose psychiatric disorders.

After collecting the information and crunching the numbers, the research team found that former preemies were nearly three times less likely than their normal peers to develop an alcohol or substance use disorder in their early 30s. However, these same survivors were two and a half times more likely to develop a psychiatric problem such as depression, an anxiety disorder, or ADHD.

Worse, the extremely low birth weight babies who received steroids prior to birth had even higher odds (nearly four and a half times) of these same psychiatric issues, while all protection again alcohol or substance use disorders disappeared — they were as likely as former normal weight babies to develop an alcohol or drug problem.

“This understanding will help us better predict, detect, and treat mental disorders in this population,” Dr. Ryan Van Lieshout, lead author and a professor of psychiatry and behavioral neurosciences at McMaster University, said in a release. All bets are on these survivors, once again, conquer any odds against them.

Source: Van Lieshout R, Boyle MH, Saigal S, Morrison K, Schmidt LA. Mental Health of Extremely Low Birth Weight Survivors in Their 30s. Pediatrics. 2015.