Children born moderately preterm (32-33 weeks) or late preterm (34-36 weeks) have higher long-term risks of neurodevelopmental difficulties that can affect their behavior and ability to learn, according to a study of more than 1 million children.
The results of research were published in The BMJ.
What can cause a preterm birth?
Because these babies make up about 80% of all preterm births, these risks should not be underestimated, researchers say. The findings could also help professionals and families achieve better risk assessment and follow-up of these children.
Previous research shows that children born preterm have higher risks of neurodevelopmental and behavioral disabilities in early life and throughout childhood and adolescence than children born full-term. However, few population-based studies have investigated the long-term neurodevelopmental outcomes of these children compared to children born at term.
To fill this knowledge gap, the researchers used data from the Swedish national registry to evaluate the long-term neurodevelopmental outcomes of children born at different gestational ages, specifically 32-33 weeks (moderately preterm) and 34-36 weeks (late preterm), compared to 39-39 weeks (late preterm). 40 weeks (full term).
Their findings are based on 1,281,690 singleton babies without birth defects born in Sweden between 32 and 41 weeks between 1998 and 2012 and a subset of 349,108 full siblings to control for unmeasured shared genetic and environmental factors.
The main outcomes of interest were motor (motor), brain (cognitive), seizure, auditory, and visual disorders, and a combination of any neurodevelopmental disorder, diagnosed up to 16 years of age.
Potentially influential factors were taken into account including the mother's age, parity, country of birth, cohabitation status, body mass index at the beginning of pregnancy, smoking during pregnancy, diabetic diseases and hypertensive, the calendar period of childbirth, the level of education of the parents and the history of neurological pathologies and psychiatric disorders, sex and birth weight of the child for gestational age.
During an average follow-up period of 13 years, 75,311 children (48 per 10,000 person-years) had at least one diagnosis of any neurodevelopmental impairment.
Approximately 5,899 (4 out of 10,000 person-years) had motor problems, 27,371 (17 out of 10,000) cognitive problems, 11,870 (7 out of 10,000) seizure problems, 19,700 (12 out of 10,000) visual problems, and 20,393 (13 out of 10,000) hearing problems.
Overall, compared to children born at term, those born moderately or late preterm showed higher risks of any impairment (e.g., 475 additional cases per 10,000 population at age 16 for children born moderately preterm compared to those born complete).
The highest relative risk for children born moderately preterm compared to those born full-term was that of motor impairment (an almost five-fold increased risk), followed by seizure disorder (an almost two-fold increased risk).
Risks for neurodevelopmental disorders appeared highest from 32 weeks, then gradually decreased through 41 weeks, with risks also higher at the beginning of the term (37-38 weeks) compared to full term.
In the sibling comparison analysis, most associations remained stable, with the exception of gestational age and seizure and hearing disorders, for which no association was found.
This is an observational study, so it is not possible to establish the cause, and the researchers acknowledge that they were unable to provide precise information for some results and that any under-reporting or misclassification of diagnoses could lead to an underestimation of the associations found.
They also cannot rule out the possibility that other unmeasured factors, such as alcohol and substance abuse during pregnancy, may have influenced the results.
However, this was a large population-based study using high-quality comprehensive national registries, allowing clinically relevant risks to be investigated across the gestational age spectrum.
Therefore, they say, “children born moderately or late pretwrmine have higher risks of adverse neurodevelopmental outcomes. The risks should not be underestimated as these children make up the largest proportion of babies born preterm.”
“The findings could help professionals and families better assess risk, follow-up and health systems planning for children born moderately or late preterm,” they add.
During adolescence and young adulthood, higher rates of psychotropic drug prescription are observed for those born preterm compared to those born at term.
Preterm birth can pose a risk of later mental health problems
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April 9, 2021
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Pediatrics
Preterm birth can pose a risk of later mental health problems
Preterm birth can pose a risk of later mental health problems
(HealthDay) — Higher rates of psychotropic drug prescriptions are seen for preterm infants compared to full-term infants during adolescence and young adulthood, according to a study published online March 12 in JAMA Network Open .
Christine Strand Bachmann, MD, of the Norwegian University of Science and Technology in Trondheim, and colleagues compared psychotropic drug prescribing in adolescence and young adulthood (ages 10 to 23) among 505,030 individuals born preterm or full-term (between 1989 and 1989). 1998).
The researchers found that individuals born prematurely had a higher risk of being prescribed psychotropic medications, with a dose-response association between gestational age and prescription. Higher prescription rates were found for all types of drugs in the extremely preterm group compared to their peers born at term (odds ratio [OR]from 1.7 for antidepressants to 2.7 for psychostimulants [intervalli di confidenza al 95% (IC), da 1,4 a 2,1 e da 2,1 a 3,4 , rispettivamente]).
In the moderate-to-late preterm group, the elevated odds of prescribing all types were less pronounced (OR, 1.1 [IC al 95%, da 1,0 a 1,1] for antidepressants and 1,2 [IC al 95%, da 1,1 a 1,2] for psychos
timulants). In a sibling analysis, the OR for any prescription was 1.8 (95% CI, 1.2 to 2.8) in the very preterm group and 1.0 (95% CI, 0 .9 to 1.1) in the moderate or late preterm group.
“These findings provide further evidence of an increased risk of mental health problems among individuals born preterm and suggest that this is not limited to more preterm groups,” the authors write.
Further research conducted by the Universities of Kent and Warwick found that, contrary to previous beliefs, teenagers born preterm have the same levels of self-esteem and general wellbeing as those born at term.
Preterm birth, defined as birth before 37 weeks of gestation, has previously been found to be associated with an increased risk of lower educational achievement, higher mental health problems and greater difficulties in social relationships compared to those born at term. This new study, conducted by Dr. Ayten Bilgin (Kent) together with colleagues from Warwick, demonstrates that, on the contrary, preterm birth does not affect the development of subjective well-being and self-esteem, which are personal assessments and therefore different from school grades. or psychiatric diagnoses.
The research paper, published by the Journal of Developmental & Behavioral Pediatrics, reveals how adolescents born very preterm (28 to 32 weeks) or moderate to late preterm (32 to 37 weeks) are no different from those born full-term for regarding the general conditions. subjective well-being, well-being related to family, school, physical appearance and global self-esteem.
The study, however, found that adolescents born very prematurely perceived their relationships with peers as poorer than those born full-term. This would indicate that interventions to improve well-being in very preterm adolescents could focus on improving peer relationships in childhood and adolescence.
Dr Bilgin said: “It is very encouraging to find that adolescents born preterm show the same levels of self-esteem and wellbeing as adolescents born at term, despite the association between preterm birth and increased mental health problems. We hope that our findings will influence the focus of future studies.”
Dieter Wolke, Professor of Developmental Psychology and Individual Differences in the Department of Psychology at the University of Warwick, added: “It is worrying that those born preterm perceive themselves to have poorer peer relationships. Along with our previous evidence that preterm children may be more likely to be the targets of bullying, supporting friendships and peer relationships in school and leisure activities should be a priority.”
A study using large, nationwide registry data showed that girls born extremely preterm, before 28 weeks of gestational age, were three times more likely to be diagnosed with depression than their peers born close to their due date. The increased risk of depression also applies to girls and boys with poor fetal growth born at term and post-term. The effects of poor fetal growth were more evident with increasing gestational age.
All results were adjusted for paternal psychopathology, paternal immigrant status, maternal psychopathology, maternal depression, maternal substance abuse, number of previous births, maternal marital status, maternal socioeconomic status, maternal smoking during pregnancy, and place of birth of the child .
Depression is a common psychiatric disorder that has been reported to affect 1-2% of preschool and prepubertal children and 3-8% of adolescents. However, childhood depression is a serious disorder and its prevention can be advanced by identifying risk groups.
“The study highlights the need for preventative interventions for high-risk newborns and support programs for parental mental health during pregnancy and newborn care, particularly for extremely preterm newborns and growth-restricted term newborns . Follow-up care practices should include psychosocial screening and developmental testing for children born preterm and their families, with adequate support for good mental health,” says researcher Subina Upadhyaya of the Research Center for Psychiatry of the University of Turku.
“Future studies should examine the risk associated with preterm birth and long-term newborn outcomes in the current era of family-centered newborn care practices,” he continues.
The study involved 37,682 children born in Finland between January 1987 and December 2007 who were diagnosed with depression. They were compared with 148,795 matched controls without depression.
The study is part of a larger body of research investigating associations between prenatal risk factors and major psychiatric disorders.
“The findings are significant both for understanding risk factors for psychiatric disorders and for prevention, notes lead researcher,” Professor Andre Sourander.
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