Profiles and predictors of risk for developmental delay: Insights gained from a community-based universal screening program

Associations of prenatal maternal psychosocial stress and depression with neurodevelopmental outcomes in 7.5-month-old infants in the ECHO.CA.IL prospective birth cohorts

BACKGROUND

Exposure to maternal stress and depression during pregnancy can have a marked impact on birth outcomes and child development, escalating the likelihood of preterm birth, lower birth weight, and various domains of physical and neurodevelopment.

METHODS

The joint ECHO.CA.IL cohort is comprised of the Chemicals in Our Bodies (CIOB) and Illinois Kids Development Study (IKIDS) prospective cohorts, recruiting pregnant women in San Francisco, CA, and Urbana-Champaign, IL, respectively. Using a combined sample of 428 mother-infant dyads, we examined associations between two prenatal measures of maternal stress (perceived stress (PSS) and stressful events (SLE)), as well as maternal depression, and five domains of neurodevelopment via the Ages & Stages Questionnaire (ASQ) administered at 7.5 months. Linear regression models were adjusted for relevant demographic characteristics and used to identify patterns of association.

RESULTS

CIOB mothers were comparatively racially/ethnically diverse (52 % white, 28 % Asian American/Pacific Islander, 12 % Hispanic), while IKIDS mothers were disproportionately white (80 %). Both cohorts demonstrated high levels of maternal education and were similar in terms of other demographic characteristics. CIOB mothers reported higher levels of stress (e.g.

, SLE

49.63 % report ≥1 event) compared to IKIDS mothers (e.g.

, SLE

16.34 % report ≥1 event). In adjusted linear models, patterns of association were nearly uniformly negative between stress and ASQ measures, with associations between PSS and fine motor skills (β-0.26, CI = -0.52; 0.00) and SLEs and communication skills (β = -2.9245, CI = -6.1643; 0.3152) showing the strongest associations (p < 0.1). Depression showed no significant or clear pattern of association with ASQ scores.

CONCLUSION

This study found negative associations between prenatal maternal stress and infant neurodevelopment in the combined ECHO.CA.IL cohort, suggesting that prenatal stress is associated with delayed development of motor and communication skills during infancy. The inconclusive links between maternal depression and ASQ outcomes leave open the question regarding the influence of prenatal depression on early child neurodevelopment.

Early childhood trajectories of domain-specific developmental delay and gestational age at birth: An analysis of the All Our Families cohort

OBJECTIVE

To describe developmental domain-specific trajectories from ages 1 through 5 years and to estimate the association of trajectory group membership with gestational age for children born between ≥34 and <41 weeks gestation.

METHODS

Using data from the All Our Families cohort, trajectories of the domain-specific Ages & Stages Questionnaire scores were identified and described using group-based trajectory modeling for children born ≥34 and <41 weeks of gestation (n = 2664). The trajectory groups association with gestational age was estimated using multinomial logistic regression.

RESULTS

Across the five domains, 4-5 trajectory groups were identified, and most children experienced changing levels of risk for delay over time. Decreasing gestational age increases the Relative risk of delays in fine motor (emerging high risk: 1.46, 95% CI: 1.19-1.80; resolving moderate risk: 1.11, 95% CI: 1.03-1.21) and gross motor (resolving high risk: 1.21, 95% CI: 1.04-1.42; and consistent high risk: 1.64, 95% CI: 1.20-2.24) and problem solving (consistent high risk: 1.58 (1.09-2.28) trajectory groups compared to the consistent low risk trajectory groups.

CONCLUSION

This study highlights the importance of longitudinal analysis in understanding developmental processes; most children experienced changing levels of risk of domain-specific delay over time instead of having a consistent low risk pattern. Gestational age had differential effects on the individual developmental domains after adjustment for social, demographic and health factors, indicating a potential role of these factors on trajectory group membership.

The association of gestational age at birth with trajectories of early childhood developmental delay among late preterm and early term born children: A longitudinal analysis of All Our Families pregnancy cohort

BACKGROUND

Like infants born very preterm (<32 weeks), late preterm (≥34 and <37 weeks) and early term (≥37 and <39 weeks) births have been associated with increased risk of developmental delay (DD); yet, the evidence remains heterogeneous across the continuum of gestational ages, hindering early identification and intervention.

OBJECTIVE

To estimate the association of gestational age at birth with early childhood trajectories of DD in early childhood for infants born ≥34 and <41 weeks, and determine how various maternal, pregnancy and infant characteristics relate to these trajectory groups.

METHODS

Analysis of mother-child dyad data with infants born ≥34 and <41 weeks gestational age within an observational pregnancy cohort in Alberta, Canada, from 2008 to 2011 (n = 2644). The association between gestational age and trajectories of the total number of Ages and Stages Questionnaire domains indicating risk of DD from 1 through 5 years of age were estimated using group-based trajectory modelling along with other perinatal risk factors.

RESULTS

Three distinct trajectory groups were identified: low-risk, moderate-risk (transiently at risk of DD in one domain over time) and high-risk (consistently at risk of delay in ≥2 domains over time). Per week of decreasing gestational age, the risk ratio of membership in the high-risk group increases by 1.77 (95% confidence interval [CI] 1.43, 2.20) or 1.84 (95% CI 1.49, 2.27) relative to the moderate-risk and low-risk respectively. Increasing maternal age, identifying as Black, indigenous or a person of colour, elevated maternal depressive symptoms in pregnancy, and male infant sex were associated with high- and moderate-risk trajectories compared to the low-risk trajectory.

CONCLUSIONS

In combination with decreasing gestational age, poor maternal mental health and social determinants of health increase the probability of membership in trajectories with increased risk of DD, suggesting that additional monitoring of children born late preterm and early term is warranted.

Revealing the importance of prenatal gut microbiome in offspring neurodevelopment in humans

BACKGROUND

It has been widely recognized that a critical time window for neurodevelopment occurs in early life and the host's gut microbiome plays an important role in neurodevelopment. Following recent demonstrations that the maternal prenatal gut microbiome influences offspring brain development in murine models, we aim to explore whether the critical time window for the association between the gut microbiome and neurodevelopment is prenatal or postnatal for human.

METHODS

Here we leverage a large-scale human study and compare the associations between the gut microbiota and metabolites from mothers during pregnancy and their children with the children's neurodevelopment. Specifically, using multinomial regression integrated in Songbird, we assessed the discriminating power of the maternal prenatal and child gut microbiome for children's neurodevelopment at early life as measured by the Ages & Stages Questionnaires (ASQ).

FINDINGS

We show that the maternal prenatal gut microbiome is more relevant than the children's gut microbiome to the children's neurodevelopment in the first year of life (maximum Q2 = 0.212 and 0.096 separately using the taxa at the class level). Moreover, we found that Fusobacteriia is more associated with high fine motor skills in ASQ in the maternal prenatal gut microbiota but become more associated with low fine motor skills in the infant gut microbiota (rank = 0.084 and -0.047 separately), suggesting the roles of the same taxa with respect to neurodevelopment can be opposite at the two stages of fetal neurodevelopment.

INTERPRETATION

These findings shed light, especially in terms of timing, on potential therapeutic interventions to prevent neurodevelopmental disorders.

FUNDING

This work was supported by the National Institutes of Health (grant numbers: R01AI141529, R01HD093761, RF1AG067744, UH3OD023268, U19AI095219, U01HL089856, R01HL141826, K08HL148178, K01HL146980), and the Charles A. King Trust Postdoctoral Fellowship.

Maternal Inflammatory Biomarkers during Pregnancy and Early Life Neurodevelopment in Offspring: Results from the VDAART Study

Maternal infection and stress during the prenatal period have been associated with adverse neurodevelopmental outcomes in offspring, suggesting that biomarkers of increased inflammation in the mothers may associate with poorer developmental outcomes. In 491 mother-child pairs from the Vitamin D Antenatal Asthma Reduction Trial (VDAART), we investigated the association between maternal levels of two inflammatory biomarkers; interleukin-8 (IL-8) and C-Reactive Protein (CRP) during early (10-18 wks) and late (32-38 wks) pregnancy with offspring scores in the five domains of the Ages and Stages Questionnaire, a validated screening tool for assessing early life development. We identified a robust association between early pregnancy IL-8 levels and decreased fine-motor (β: -0.919, 95%CI: -1.425, -0.414, p = 3.9 × 10-4) and problem-solving skills at age two (β: -1.221, 95%CI: -1.904, -0.414, p = 4.9 × 10-4). Associations between IL-8 with other domains of development and those for CRP did not survive correction for multiple testing. Similarly, while there was some evidence that the detrimental effects of early pregnancy IL-8 were strongest in boys and in those who were not breastfed, these interactions were not robust to correction for multiple testing. However, further research is required to determine if other maternal inflammatory biomarkers associate with offspring neurodevelopment and work should continue to focus on the management of factors leading to increases in IL-8 levels in pregnant women.