Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply

doi:10.1016/j.jpeds.2013.07.001

The Journal of Pediatrics

Volume 163, Issue 5, November 2013, Pages 1289-1295

https://doi.org/10.1016/j.jpeds.2013.07.001 Get rights and content

Objective

To assess separate and joint effects of low socioeconomic status (SES) and moderate prematurity on preschool developmental delay.

Study design

Prospective cohort study with a community-based sample of preterm- and term-born children (Longitudinal Preterm Outcome Project). We assessed SES on the basis of education, occupation, and family income. The Ages and Stages Questionnaire was used to assess developmental delay at age 4 years. We determined scores for overall development, and domains fine motor, gross motor, communication, problem-solving, and personal-social of 926 moderately preterm-born (MP) (32-36 weeks gestation) and 544 term-born children. In multivariable logistic regression analyses, we used standardized values for SES and gestational age (GA).

Results

Prevalence rates for overall developmental delay were 12.5%, 7.8%, and 5.6% in MP children with low, intermediate, and high SES, respectively, and 7.2%, 4.0%, and 2.8% in term-born children, respectively. The risk for overall developmental delay increased more with decreasing SES than with decreasing GA, but the difference was not statistically significant: OR (95% CI) for a 1 standard deviation decrease were: 1.62 (1.30-2.03) and 1.34 (1.05-1.69), respectively, after adjustment for sex, number of siblings, and maternal age. No interaction was found except for communication, showing that effects of SES and GA are mostly multiplicative.

Conclusions

Low SES and moderate prematurity are separate risk factors with multiplicative effects on developmental delay. The double jeopardy of MP children with low SES needs special attention in pediatric care.

Section snippets

Methods

Data for this study are from the Longitudinal Preterm Outcome Project (Lollipop), a large prospective cohort study designed to investigate growth, development, and general health of preterm-born children, with a special focus on MP children (32⁰ to 35⁶ weeks of gestation) in The Netherlands.⁶ Lollipop consists of a community-based sample of preterm children and a random sample of term-born controls (38⁰ to 41⁶ weeks of gestation). At the time in which the study was designed, MP children

Results

In Table I, we show the characteristics of all preterm and term children with low, intermediate, and high SES. Characteristics were statistically different between SES groups for family composition, maternal age, and maternal ethnicity. In analyses for the preterm and term-born children separately, we found no other characteristics that differed with statistical significance. The GA distribution of the 926 MP children was 32 weeks, 113 (12.2%); 33 weeks, 177 (19.1%); 34 weeks, 257 (27.8%); and

Discussion

Our study showed that moderate prematurity and low SES are separate risk factors with multiplicative effects on developmental delay in early childhood. Only effects on communication skills were less than multiplicative. Decreasing SES and decreasing GA were both associated with increased risks of delay in overall development and delay in domains fine motor, communication, and personal-social skills. The risk of delay in problem-solving skills was significantly associated with decreasing SES but

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Citation Excerpt :
Finally, the direct infant assessment outcomes varied significantly across the latent classes, but differences were slight. On average, biological-risk infants scored the lowest on cognitive, motor, and responsivity, which makes sense given the developmental delays that can stem from prematurity and LBW (Aarnoudse-Moens et al., 2009; Dieterich et al., 2004; Kerstjens et al., 2012; Potijk et al., 2013; Spittle et al., 2009). Low-risk infants performed better than high-risk infants on the cognitive and responsivity measures, and high-risk mothers displayed the lowest sensitivity levels, all of which is consistent with previous research on risk, infant development, and parenting (Blair et al., 2011; Friedson, 2016).
This study examined profiles of maternal-infant risk with data from the Early Childhood Longitudinal Study- Birth Cohort (a nationally representative sample of U.S. families with a new infant in 2001) based on various infant (birth weight, prematurity), maternal (education, unemployment, unwanted pregnancy, teen birth), relationship (infant difficulty, authoritarian parenting, low developmental knowledge), and socio-environmental (poverty, public assistance) characteristics. Results of latent class analysis suggested three distinct profiles, with 56.1 % of families characterized as having little risk in these areas (low risk), 4.3 % characterized by a low birth weight and/or premature infant (high-biological risk), and 39.6 % characterized by a greater probability of risk in all areas, particularly poverty (high-risk). Mothers in the high-risk profile were disproportionately single, as well as reported greater food insecurity and depressive symptoms. Non-English households and families of color were also overrepresented in the high-risk profile, indicating important race and ethnic disparities. Additionally, profile membership was associated with observed mother-infant interactions and infant developmental outcomes when infants were 9 months old, with families from the low risk profile tending to demonstrate the best outcomes. However, small effect sizes indicated only slight differences across these three broad groups. More research is needed to examine variation in parenting and child outcomes within each risk profile, particularly family strengths that support mothers and infants most prone to risk.

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: Supported by the research foundation of Beatrix Children's Hospital, the Cornelia Foundation for the Handicapped Child, the A. Bulk Preventive Child Health Care Research Fund, the Dutch Brain Foundation, FrieslandCampina, Friso Infant Nutrition, Abbott, and Pfizer Europe. M.P. was supported by the Junior Scientific Master Class of the University of Groningen. The authors declare no conflicts of interest.

: Longitudinal Preterm Outcome Project (Lollipop) was registered with Controlled-Trials.com: ISRCTN 80622320.

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Original ArticleDevelopmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

Clin Perinatol

Clin Perinatol

J Pediatr

Social Sci Res

Early Hum Dev

Semin Fetal Neonatal Med

Lancet Neurol

Semin Perinatol

The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity

Bull World Health Organ

Births: final data for 2009

Natl Vital Stat Rep

Late preterm infants have worse 24-month neurodevelopmental outcomes than term infants

Pediatrics

Educational and behavioural problems in babies of 32-35 weeks gestation

Arch Dis Child Fetal Neonatal Ed

Early childhood development of late-preterm infants: a systematic review

Pediatrics

Gestational age and birth weight in relation to school performance of 10-year-old children: a follow-up study of children born after 32 completed weeks

Pediatrics

Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study

Arch Dis Child Fetal Neonatal Ed

Original Article
Developmental Delay in Moderately Preterm-Born Children with Low Socioeconomic Status: Risks Multiply