Long‐term cognition and behavior in children born at early term gestation: A systematic review

Executive Function Outcomes at School Age in Children Born Moderate-to-Late Preterm

OBJECTIVE

To compare executive function (EF) outcomes at school age between children born moderate-to-late preterm (MLP; 32-36 weeks' gestation) and term (≥37 weeks' gestation) across subdomains of attentional control, cognitive flexibility, goal setting, and everyday executive behaviors.

STUDY DESIGN

201 children born MLP and 201 born at term were recruited from the Royal Women's Hospital, Melbourne, Australia. Children completed EF measures at 9 years of corrected age. Group differences in mean or median outcome z-scores were estimated using linear or quantile regression. EF impairment risk ratios [RRs] between groups were estimated using generalized linear models. Analyses were adjusted for multiple birth and social risk.

RESULTS

159 children born MLP (79%) and 134 born at term (67%) were assessed. Compared with the term group, the MLP group performed poorer in goal setting (mean difference = -0.26, 95% CI = -0.50, -0.03, P = .03) and cognitive flexibility (mean difference = -0.32, 95% CI = -0.59, -0.05, p = .02). Children born MLP were at increased risk of behavioral executive dysfunction (RR = 1.86, 95% CI = 1.05, 3.27, P = .03), impairments in cognitive flexibility (RR = 1.80, 95% CI = 1.05, 3.09, p = .03), and goal setting (RR = 1.69, 95% CI = 1.08, 2.65, P = .02).

CONCLUSIONS

Children born MLP demonstrate a pattern of increased EF difficulties at school-age compared with term children, mostly within the goal setting subdomain. These difficulties are likely to affect other outcomes such as academic performance and social skills.

Gestational Age and Cognitive Development in Childhood

Importance

Preterm and early-term births are known risk factors for cognitive impairment, but studies that comprehensively include genetics, prenatal risk, and child-specific factors in high-risk populations are lacking.

Objective

To investigate the long-term cognitive outcomes of children born at various gestational ages, including very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), and early term (37-38 weeks), compared with full-term (≥39 weeks), accounting for genetics and other risk factors.

Design, Setting, and Participants

In this prospective, multicenter, longitudinal cross-sectional study, children aged 9 to 10 years were recruited from the Adolescent Brain and Cognitive Development Study between January 1, 2016, and December 31, 2018. Children underwent cognitive assessments using the National Institutes of Health Toolbox, Little Man Task, and Rey Auditory Verbal Learning Test. Polygenic scores for cognitive performance (cogPGS) were generated using results of a genome-wide association study from the genetic variants related to cognitive performance, educational attainment, and mathematical ability. Data analysis was performed from March to June 2024.

Exposure

Preterm (very preterm, moderately preterm, late preterm) and early-term birth status, with full-term birth status as the reference group.

Main Outcomes and Measures

The primary outcome of interest was the composite cognitive score, while secondary outcomes included individual cognitive domain scores. Hierarchical regression models were used to examine associations between gestational age and cognitive outcomes, adjusting for socioeconomic status (SES), cogPGS, prenatal risks, and child-specific factors.

Results

Among 5946 children included in the study (mean [SD] age, 9.9 [0.6] years; 3083 [51.8%] male), 55 (0.9%) were born very preterm, 110 (1.8%) were born moderately preterm, 454 (7.6%) were born late preterm, 261 (4.4%) were born early term, and 5066 (85.2%) were born full term. The cogPGS was positively associated with the composite cognitive score (β = 0.14; 95% CI, 0.12-0.17; P < .001) in the overall cohort. Compared with full-term children, those born moderately preterm had lower composite cognitive scores (β = -0.39; 95% CI, -0.55 to -0.22; P < .001) and lower scores in vocabulary (β = -0.36; 95% CI, -0.53 to -0.19; P < .001), working memory (β = -0.27; 95% CI, -0.45 to -0.09; P = .003), episodic memory (β = -0.32; 95% CI, -0.50 to -0.14; P < .001), and both short-delay recall (β = -0.36; 95% CI, -0.54 to -0.18; P < .001) and long-delay recall (β = -0.29; 95% CI, -0.48 to -0.11; P = .002). These associations were independent of SES, cogPGS, and other risk factors. Importantly, the lowest cognitive scores appeared among children born at 32 weeks or less. In contrast, late-preterm and early-term children performed similarly to full-term peers.

Conclusions and Relevance

In this cross-sectional study of children aged 9 to 10 years, moderately preterm birth was associated with long-term cognitive problems independent of SES, genetics, and other risk factors. These findings underscore the need for continued follow-up of all preterm children, with particular focus on those born before 34 weeks' gestational age, because they may face greater developmental challenges over time.

Time Trend Analysis of Early Term Births in Greece (1980-2023): Persistent High Rates Raise Public Health Concerns

INTRODUCTION

Neonates born at 37-38 weeks of gestation have been shown to face a relatively higher risk of mortality and various morbidities compared to those born at full term (39-41 weeks). The aim of this study was to conduct a comprehensive analysis of early term birth rate (ETBR) trends in Greece from 1980 to 2023.

MATERIALS AND METHODS

Data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority (ELSTAT), based on birth certificate records. A total of 4,595,020 live births were categorized by gestational age. The annual ETBR was calculated as the number of live births occurring at 37-38 completed gestational weeks (from 37+0 to 38+6 weeks) per 100 total live births. Additionally, ETBR was calculated separately for 37 and 38 gestational weeks, as well as the overall birth rate < 39 weeks of gestation. Time trends were evaluated using joinpoint regression analysis.

RESULTS

The ETBR decreased with an annual percent change (APC) of -1.4 (95% confidence interval (CI): -1.8 to -0.9, p = 0.004) between 1980 and 1994, followed by a sharper decline with an APC of -12.8 (95% CI: -14.4 to -8.5, p = 0.005) during 1994-1997. Subsequently, the ETBR increased with an APC of 3.2 (95% CI: 2.0 to 5.6, p = 0.016) from 1997 to 2004. This trend reversed again from 2004 to 2010, with an APC of -2.6 (95% CI: -5.9 to -1.1, p = 0.016), while in the most recent period (2010-2023), the ETBR stabilized (p = 0.630), fluctuating between 41.9% in 2010 and 44.3% in 2012 and 2013. During the study period (1980-2023), the ETBR at 37 weeks increased by an average of 7.1% per year, whereas the ETBR at 38 weeks decreased by an average of -2.1% annually. The overall birth rate < 39 weeks of gestation has remained consistently above 50% over the past two decades (2004-2023). In 2023, the ETBR was 43.7%, while a total of 56.0% of neonates were born < 39 gestational weeks.

CONCLUSIONS

 This study provides a comprehensive analysis of ETBR in Greece, revealing persistently high levels that exceed those of all developed countries. The elevated rate is likely driven by factors such as maternal demographics and obstetrical practices. The alarmingly high levels of ETBR, combined with the country's extremely high preterm birth rates, result in a substantial burden of neonatal morbidity and an increased risk of potential chronic diseases. These findings underscore an enormous public health challenge.

Timing of antenatal corticosteroid exposure and its association with childhood mental disorders in early- and full-term births: A population-based cohort study

Although the administration of antenatal corticosteroids (ACS) is generally recognized as cost-effective and beneficial, recent studies have indicated potential long-term adverse effects on neurodevelopment, particularly for term-born infants. However, limited research has explored the association between the timing of ACS exposure, gestational age (GA) at birth, and their potential implications for mental and behavioral outcomes in offspring compared to non-exposed infants. This study aimed to examine the association between the timing of antenatal corticosteroid (ACS) exposure for threatened preterm labor and childhood mental disorders among early-term and full-term births. All eligible term infants born between 2010 to 2014 were included in this nationwide study and followed until the end of 2021. The primary outcome was any childhood mentaldisorders, with secondary outcomes being attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and developmental delay (DD). Compared to unexposed infants, ACS exposure before 34 weeks of GA increased the risk of developing mental behavior disorders. Exposure to ACS before 34 weeks was significantly associated with an increased risk of ADHD and DD; however, this association was observed only in early-term births but not in those born at full-term.

CONCLUSION

Our finding suggests a need for further investigation into the influence of GA at birth on these disorders and supports that the risk of childhood mental disorders in term infants varied among different ACS exposure timing.

WHAT IS KNOWN

• While administration of antenatal corticosteroids (ACS) for preterm birth threats is widely acknowledged as both cost-effective and beneficial, recent studies have raised concerns about potential long-term adverse effects on neurodevelopment, particularly in term-born infants. • Previous studies have found that early-term birth is associated with lower intelligence, ADHD, and poorer school performance compared to full-term birth.

WHAT IS NEW

• There is an interaction between the timing of ACS treatment and gestational age at birth with respect to the likelihood of neurodevelopmental outcomes in term-born infants. • Exposure to ACS before 34 weeks is associated with an increased risk of any childhood mental disorders, specifically ADHD and DD, among early-term births, whereas this association was not observed in infants who reached full-term gestation.

Cognitive and academic outcomes of large-for-gestational-age babies born at early term: A systematic review and meta-analysis

INTRODUCTION

Early induction of labor (37+0-38+6 gestational weeks) in large-for-gestational-age infants may reduce perinatal risks such as shoulder dystocia, but it may also increase the long-term risks of reduced cognitive abilities. This systematic review aimed to evaluate the cognitive and academic outcomes of large-for-gestational-age children born early term vs full term (combined or independent exposures).

MATERIAL AND METHODS

The protocol was registered in the PROSPERO database under the registration no. CRD42024528626. Five databases were searched from their inception until March 27, 2024, without language restrictions. Studies reporting childhood cognitive or academic outcomes after early term or large-for-gestational-age births were included. Two reviewers independently screened the selected studies. One reviewer extracted the data, and the other double-checked the data. The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale. In addition to narrative synthesis, meta-analyses were conducted where possible.

RESULTS

Of the 2505 identified articles, no study investigated early-term delivery in large-for-gestational-age babies. Seventy-six studies involving 11 460 016 children investigated the effects of either early-term delivery or large-for-gestational-age. Children born at 37 weeks of gestation (standard mean difference, -0.13; 95% confidence interval, -0.21 to -0.05), but not at 38 weeks (standard mean difference, -0.04; 95% confidence interval, -0.08 to 0.002), had lower cognitive scores than those born at 40 weeks. Large-for-gestational-age children had slightly higher cognitive scores than appropriate-for-gestational-age children (standard mean difference, 0.06; 95% confidence interval, 0.01-0.11). Similar results were obtained using the outcomes of either cognitive impairment or academic performance.

CONCLUSIONS

No study has investigated the combined effect of early-term delivery on cognitive scores in large-for-gestational-age babies. Early-term delivery may have a very small detrimental effect on cognitive scores, whereas being large for gestational age may have a very small benefit. However, evidence from randomized controlled trials or observational studies is required.

Childcare use and the social-emotional and behavioural outcomes of late-preterm and early-term born children at age 5: An analysis of the All Our Families longitudinal cohort

OBJECTIVES

Gestational age at birth (GA) shows an inverse gradient of risk with social-emotional and behavioural outcomes among children born late preterm (≥ 34 and < 37 weeks) and early term (≥ 37 and < 39 weeks). Childcare has the potential to influence this association. This study aimed to estimate the association between GA and social-emotional/behavioural problems among children born between ≥ 34 and < 41 weeks gestation, determine whether this association was modified by childcare use, and describe the relationship between childcare and behavioural and social-emotional functioning at age 5.

METHODS

Using data from the All Our Families cohort (n = 1324), logistic regression models were used to model the association between GA and social-emotional/behavioural problems (BASC-2 composite scales at age 5). Models were fit with interaction terms between GA and childcare variables (amount, multiplicity, and type of childcare at age 3) to assess effect modification.

RESULTS

GA showed no significant associations with social-emotional/behavioural problems at age 5, though the type of childcare significantly modified the association between GA and externalizing and internalizing problems. Neither the number of hours spent in childcare (amount) nor the number of childcare arrangements used (multiplicity) modified the association between GA and social-emotional/behavioural problems. However, multiplicity was associated with externalizing behavioural problems (aOR = 2.09, 95% CI 1.14‒3.83).

CONCLUSION

This study found no significant association between GA and social-emotional/behavioural problems at age 5, though childcare type modified this association. Factors such as using multiple childcare arrangements to meet families' childcare needs have the potential to influence a child's social-emotional and behavioural functioning at age 5.

Sensitivity to vocal emotions emerges in newborns at 37 weeks gestational age

Emotional responsiveness in neonates, particularly their ability to discern vocal emotions, plays an evolutionarily adaptive role in human communication and adaptive behaviors. The developmental trajectory of emotional sensitivity in neonates is crucial for understanding the foundations of early social-emotional functioning. However, the precise onset of this sensitivity and its relationship with gestational age (GA) remain subjects of investigation. In a study involving 120 healthy neonates categorized into six groups based on their GA (ranging from 35 and 40 weeks), we explored their emotional responses to vocal stimuli. These stimuli encompassed disyllables with happy and neutral prosodies, alongside acoustically matched nonvocal control sounds. The assessments occurred during natural sleep states using the odd-ball paradigm and event-related potentials. The results reveal a distinct developmental change at 37 weeks GA, marking the point at which neonates exhibit heightened perceptual acuity for emotional vocal expressions. This newfound ability is substantiated by the presence of the mismatch response, akin to an initial form of adult mismatch negativity, elicited in response to positive emotional vocal prosody. Notably, this perceptual shift's specificity becomes evident when no such discrimination is observed in acoustically matched control sounds. Neonates born before 37 weeks GA do not display this level of discrimination ability. This developmental change has important implications for our understanding of early social-emotional development, highlighting the role of gestational age in shaping early perceptual abilities. Moreover, while these findings introduce the potential for a valuable screening tool for conditions like autism, characterized by atypical social-emotional functions, it is important to note that the current data are not yet robust enough to fully support this application. This study makes a substantial contribution to the broader field of developmental neuroscience and holds promise for future research on early intervention in neurodevelopmental disorders.

Neonatal Markers of Prematurity as Predictors of Permanent Childhood Hearing Loss and Neurodevelopmental Impairment in Children Admitted to the Neonatal Intensive Care Unit

Need for admission to the neonatal intensive care unit (NICU) confers an increased risk of hearing loss in the newborn and of later neurodevelopmental impairment. In this retrospective longitudinal case-controlled study, we assess how the degree of prematurity, measured via gestational age, birth weight, and z-scores, in 138 infants admitted to the NICU are associated with permanent childhood hearing loss (PCHI) and 2-year developmental outcomes. Logistic regression analyses, Kruskal-Wallis analysis of variance, and Chi-squared tests were used. Independent of prematurity, PCHI and NICU admission were predictive of poor developmental outcomes. Twenty-one (47%) children with PCHI had a moderate-to-severe developmental delay, compared to three (7%) matched controls. Days in the NICU but not z-scores predicted PCHI. Z-score was not prognostic of moderate or severe developmental impairment in children with PCHI. The odds ratio of moderate-to-severe neurodevelopmental impairment with PCHI was high, at 12.48 [95% CI = 3.37-46.40]. Children with PCHI were significantly more likely to have cerebral palsy than their matched counterparts (30% vs. 2%). These findings challenge the conventional focus on gestational age and birth weight on neurodevelopmental outcomes for children with PCHI and NICU admission. A more nuanced approach to monitoring and intervention is needed.

Neonatal and maternal outcomes at early vs. full term following induction of labor; A secondary analysis of the OBLIGE randomized trial

INTRODUCTION

Birth at early term (37+0-38+6 completed gestational weeks [GW] and additional days) is associated with adverse neonatal outcomes compared with waiting to ≥39 GW. Most studies report outcomes after elective cesarean section or a mix of all modes of births; it is unclear whether these adverse outcomes apply to early-term babies born after induction of labor (IOL). We aimed to determine, in women with a non-urgent induction indication (elective/planned >48 h in advance), if IOL at early and late term was associated with adverse neonatal and maternal outcomes compared with IOL at full term.

MATERIAL AND METHODS

An observational cohort study as a secondary analysis of a multicenter randomized controlled trial of 1087 New Zealand women with a planned IOL ≥37+0 GW. Multivariable logistic regression was used to analyze neonatal and maternal outcomes in relation to gestational age; 37+0-38+6 (early term), 39+0-40+6 (full term) and ≥41+0 (late term) GW. Neonatal outcome analyses were adjusted for sex, birthweight, mode of birth and induction indication, and maternal outcome analyses for parity, age, body mass index and induction method. The primary neonatal outcome was admission to neonatal intensive care unit (NICU) for >4 hours; the primary maternal outcome was cesarean section.

RESULTS

Among the 1087 participants, 266 had IOL at early term, 480 at full term, and 341 at late term. Babies born following IOL at early term had increased odds for NICU admission for >4 hours (adjusted odds ratio [aOR] 2.16, 95% confidence intervals (CI) 1.16-4.05), compared with full term. Women having IOL at early term had no difference in emergency cesarean rates but had an increased need for a second induction method (aOR 1.70, 95% CI 1.15-2.51) and spent 4 h longer from start of IOL to birth (Hodges-Lehmann estimator 4.10, 95% CI 1.33-6.95) compared with those with IOL at full term.

CONCLUSIONS

IOL for a non-urgent indication at early term was associated with adverse neonatal and maternal outcomes and no benefits compared with IOL at full term. These findings support international guidelines to avoid IOL before 39 GW unless there is an evidence-based indication for earlier planned birth and will help inform women and clinicians in their decision-making about timing of IOL.

Long-term Risk for Type 1 Diabetes and Obesity in Early Term Born Offspring: A Systematic Review and Meta-Analysis

CONTEXT

Prematurity increases the long-term risks for endocrine and metabolic morbidity of offspring, but there is uncertainty regarding the risks for early-term deliveries (370/7-386/7 weeks of gestation).

OBJECTIVE

We aim to evaluate whether early-term deliveries increase the long-term risk for type 1 diabetes and obesity of offspring up to the age of 18 years compared with full-term children. PubMed, Medline, and EMBASE were searched. Observational cohort studies addressing the association between early-term delivery and long-term risk for type 1 diabetes and obesity, were included. Two independent reviewers extracted data and assessed risk of bias. Pooled relative risks (RRs) and heterogeneity were determined. Publication bias was assessed by funnel plots with Egger's regression line and contours, and sensitivity analyses were performed.

RESULTS

Eleven studies were included following a screen of 7500 abstracts. All studies were scored as high quality according to the Newcastle-Ottawa Quality Assessment Scale. Early-term delivery was significantly associated with an increased risk for type 1 diabetes (RR 1.19, 1.13-1.25), while the association was weaker for overweight and obesity (RR 1.05, 0.97-1.12). It is challenging to determine whether the association between early-term births and long-term morbidity represents a cause and effect relationship or is attributable to confounders. Most of the included studies adjusted for at least some possible confounders.

CONCLUSION

Compared with full-term offspring, early-term delivery poses a modest risk for long-term pediatric type 1 diabetes. Our analysis supports that, whenever medically possible, elective delivery should be avoided before 39 completed weeks of gestation.

The Relationship Between Early Term Birth and the Risk of Later Childhood Mental Disorders Within a Pregnancy Cohort

This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis

CONTEXT

Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk.

OBJECTIVES

To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks).

DATA SOURCES

Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature.

STUDY SELECTION

Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks.

DATA EXTRACTION

A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses.

RESULTS

Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58).

LIMITATIONS

Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies.

CONCLUSIONS

Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.

Risks of stillbirth, neonatal mortality, and severe neonatal morbidity by birthweight centiles associated with expectant management at term

BACKGROUND

Determining the optimal time of birth at term is challenging given the ongoing risks of stillbirth with increasing gestation vs the risks of significant neonatal morbidity at early-term gestations. These risks are more pronounced in small infants.

OBJECTIVE

This study aimed to evaluate the risks of stillbirth, neonatal mortality, and severe neonatal morbidity by comparing expectant management with delivery from 37+0 weeks of gestation.

STUDY DESIGN

This was a retrospective cohort study evaluating women with singleton, nonanomalous pregnancies at 37+0 to 40+6 weeks' gestation in Queensland, Australia, delivered from 2000 to 2018. Rates of stillbirth, neonatal death, and severe neonatal morbidity were calculated for <3rd, 3rd to <10th, 10th to <25th, 25th to <90th, and ≥90th birthweight centiles. The composite risk of mortality with expectant management for an additional week in utero was compared with rates of neonatal mortality and severe neonatal morbidity.

RESULTS

Of 948,895 singleton, term nonanomalous births, 813,077 occurred at 37+0 to 40+6 weeks' gestation. Rates of stillbirth increased with gestational age, with the highest rate observed in infants with birthweight below the third centile: 10.0 per 10,000 (95% confidence interval, 6.2-15.3) at 37+0 to 37+6 weeks, rising to 106.4 per 10,000 (95% confidence interval, 74.6-146.9) at 40+0 to 40+6 weeks' gestation. The rate of neonatal mortality was highest at 37+0 to 37+6 weeks for all birthweight centiles. The composite risk of expectant management rose sharply after 39+0 to 39+6 weeks, and was highest in infants with birthweight below the third centile (125.2/10,000; 95% confidence interval, 118.4-132.3) at 40+0 to 40+6 weeks' gestation. Balancing the risk of expectant management and delivery (neonatal mortality), the optimal timing of delivery for each birthweight centile was evaluated on the basis of relative risk differences. The rate of severe neonatal morbidity sharply decreased in the period between 37+0 to 37+6 and 38+0 to 38+6 weeks, particularly for infants with birthweight below the third centile.

CONCLUSION

Our data suggest that the optimal time of birth is 37+0 to 37+6 weeks for infants with birthweight <3rd centile and 38+0 to 38+6 weeks' gestation for those with birthweight between the 3rd and 10th centile and >90th centile. For all other birthweight centiles, birth from 39+0 weeks is associated with the best outcomes. However, large numbers of planned births are required to prevent a single excess death. The healthcare costs and acceptability to women of potential universal policies of planned birth need to be carefully considered.

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.

Sex differences in the effects of prematurity and/or low birthweight on neurodevelopmental outcomes: systematic review and meta-analyses

BACKGROUND

Premature birth and/or low birthweight have long-lasting effects on cognition. The purpose of the present systematic review is to examine whether the effects of prematurity and/or low birth weight on neurodevelopmental outcomes differ between males and females.

METHODS

Web of Science, Scopus, and Ovid MEDLINE were searched for studies of humans born premature and/or of low birthweight, where neurodevelopmental phenotypes were measured at 1 year of age or older. Studies must have reported outcomes in such a way that it was possible to assess whether effects were greater in one sex than the other. Risk of bias was assessed using both the Newcastle-Ottawa scale and the National Institutes of Health Quality assessment tool for observational cohort and cross-sectional studies.

RESULTS

Seventy-five studies were included for descriptive synthesis, although only 24 presented data in a way that could be extracted for meta-analyses. Meta-analyses found that severe and moderate prematurity/low birthweight impaired cognitive function, and severe prematurity/low birthweight also increased internalizing problem scores. Moderate, but not severe, prematurity/low birthweight significantly increased externalizing problem scores. In no case did effects of prematurity/low birthweight differ between males and females. Heterogeneity among studies was generally high and significant, although age at assessment was not a significant moderator of effect. Descriptive synthesis did not identify an obvious excess or deficiency of male-biased or female-biased effects for any trait category. Individual study quality was generally good, and we found no evidence of publication bias.

CONCLUSIONS

We found no evidence that the sexes differ in their susceptibility to the effects of severe or moderate prematurity/low birthweight on cognitive function, internalizing traits or externalizing traits. Result heterogeneity tended to be high, but this reflects that one sex is not consistently more affected than the other. Frequently stated generalizations that one sex is more susceptible to prenatal adversity should be re-evaluated.

Higher risk for poor handwriting in Taiwanese children born late preterm

BACKGROUND

Late-preterm and early-term births constitute a significant proportion of live births. However, handwriting skills of these two populations remain unclear. We aimed to investigate their risk for poor Chinese handwriting in grade two.

METHODS

In this observational study, 185 second graders born late preterm (34⁺⁰-36⁺⁶ weeks' gestation, n = 54), early term (37⁺⁰-38⁺⁶ weeks' gestation, n = 56), and full term (39⁺⁰-41⁺⁶ weeks' gestation, n = 75) without any intervention or diagnosis related to developmental delays were included. Their handwriting performance was rated by class teachers using the Chinese Handwriting Evaluation Form (CHEF), which is a standardized handwriting scale including five handwriting dimensions (construction, accuracy, directionality, speed, and pencil grasp).

RESULTS

After controlling for demographic risk factors, the late-preterm born group had a greater risk of having worse performance in the full form (adjusted odds ratio [aOR] = 3.93; p = .038) and construction dimension (aOR = 4.77; p = .009) of the CHEF than peers born at full term, whereas the risks were comparable for the early- and full-term born groups (aOR = 0.14-1.90; p = .073-0.453 in the handwriting dimensions).

CONCLUSIONS

Late-preterm but not early-term born children were found to be at higher risk for poor Chinese handwriting in grade two. They particularly have difficulty with spatial construction including size, spacing, and alignment of Chinese characters and components that may influence handwriting legibility.

Sports participation and preterm birth: a nationwide birth cohort in Japan

BACKGROUND

Children born preterm may be less physically active than children born term because of neurocognitive problems, reduced lung function, and poor physical fitness. We evaluated sports participation of children and adolescents who had been born preterm (<37 weeks) and early term (37-38 weeks) in 2001.

METHODS

Data from a nationwide longitudinal survey (n = 47,015, including 2375 children born preterm) were analyzed. As indicators of sports participation, we used responses to questions about participation in sports clubs at 7 and 10 years old and in extracurricular school sports at 15 years old.

RESULTS

Children born very preterm (25-31 weeks) and moderately to late preterm (32-36 weeks) were less likely to participate in sports clubs at 7, 10, and 15 years old than children born full term (39-41 weeks). Compared with children born full term, the adjusted risk ratios for participation in extracurricular school sports at 15 years old were 0.86 (95% confidence interval: 0.75-0.98) for children born very preterm, 0.92 (0.88-0.97) for children born moderately to late preterm, and 1.00 (0.98-1.02) for children born early term.

CONCLUSIONS

Our findings suggest that preterm birth is associated with less participation in organized sports during childhood and adolescence than full-term birth.

IMPACT

Research investigating associations between preterm birth and physical activity among children born in the 2000s is limited. This study shows that preterm birth was associated with less participation in organized sports during childhood and adolescence than full-term birth, especially in boys, and the participation in organized sports of children born preterm decreased as gestation shortened. During childhood, boys born early term were also less likely to participate in organized sports than boys born full term, suggesting a continuum with preterm births. These findings offer important additional insights into the limited evidence available for predicting future health outcomes for preterm infants.

Time of delivery among low-risk women at 37-42 weeks of gestation and risks of stillbirth and infant mortality, and long-term neurological morbidity

BACKGROUND

The most important knowledge gap in connection with obstetric management for time of delivery in term low-risk pregnancies relates to the absence of information on long-term neurodevelopmental outcomes.

OBJECTIVES

We examined risks of stillbirth, infant mortality, cerebral palsy (CP) and epilepsy among low-risk pregnancies.

METHODS

In this population-based Swedish study, we identified, from 1998 to 2019, 1,773,269 singleton infants born between 37 and 42 completed weeks in women with low-risk pregnancies. Poisson log-linear regression models were used to examine the association between gestational age at delivery and stillbirth, infant mortality, CP and epilepsy. Adjusted rate ratios (RR) and 95% confidence intervals expressing the effect of birth at a particular gestational week compared with birth at a later gestational week were estimated.

RESULTS

Compared with those born at a later gestation, RRs for stillbirth and infant mortality were higher among births at 37 weeks' and 38 weeks' gestation. The RRs for infant mortality were approximately 20% and 25% lower among births at 40 or 41 weeks compared with those born at later gestation, respectively. Infants born at 37 and 38 weeks also had higher RRs for CP (vs infants born at ≥38 and ≥39 weeks, respectively), while those born at 39 gestation had similar RRs (vs infants born at ≥40 weeks); infants born at 40 and 41 weeks had lower RRs of CP (vs those born at ≥41 and 42 weeks, respectively). The RRs for epilepsy were higher in those born at 37 and 38 weeks compared with those born at later gestation.

CONCLUSIONS

Among low-risk pregnancies, birth at 37 or 38 completed weeks' gestation is associated with increased risks of stillbirth, infant mortality and neurological morbidity, while birth at 39-40 completed weeks is associated with reduced risks compared with births at later gestation.

nnLong-Term Respiratory Outcomes in Early Term Born Offspring: A Systematic Review and Meta-Analysis

OBJECTIVE

Newborns exhibit the lowest immediate respiratory morbidity rates when born at full term (39-40) completed weeks of gestation. We evaluated whether early-term deliveries (37^0/7-38^6/7 weeks of gestation) bare a significant impact on overall and specific long-term respiratory outcomes of offspring up to the age of 18 years, as compared to offspring born at full term or later.

DATA SOURCES

PubMed/Medline, EMBASE, and relevant reference lists from January 2012 to May 2020.

STUDY ELIGIBILITY CRITERIA

This systematic review and meta-analysis was conducted according to the PRISMA guidelines and was registered in PROSPERO. Any observational or randomized human trials addressing the association between early term delivery and long-term respiratory outcomes in the offspring, restricted to studies published in English, were included. Search included terms relating to gestational age, pediatric morbidity, and respiratory outcomes. We included studies assessing long term respiratory disease (1-18 years) of offspring born during early term as compared to full term and later.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two independent reviewers extracted data and assessed risk of bias. Using a random-effect meta-analysis, pooled relative risk with their 95% confidence intervals and heterogeneity were determined. Publication bias was assessed by Funnel plots with Eggers regression line and contours, and sensitivity analyses were performed using Baujat plots.

RESULTS

Fourteen studies were included following a screen of nearly 2500 abstracts. These studies included nearly eight million patients, and were subjected to qualitative and quantitative analyses. Early term delivery significantly increased the risk of total respiratory morbidity in the offspring (RR= 1.20, 95% CI= 1.16, 1.26) as compared to full term delivery. The increased respiratory morbidity was attributed to obstructive airway diseases (RR=1.19, 95% CI= 1.12, 1.27) and infectious respiratory diseases (RR= 1.22, 95% CI= 1.17, 1.29). Most studies were of acceptable quality.

CONCLUSION

This comprehensive meta-analysis suggests that early term delivery poses a risk for long term pediatric respiratory morbidity, as compared to full term delivery. Notably, other factors over the years cannot be accounted for. This adds an important perspective to be considered when balancing the fetal, maternal, and neonatal risks associated with delivery timing.

Gestational age at term delivery and children's neurocognitive development

BACKGROUND

Preterm birth is associated with lower neurocognitive performance. However, whether children's neurodevelopment improves with longer gestations within the full-term range (37-41 weeks) is unclear. Given the high rate of obstetric intervention in the USA, it is critical to determine whether long-term outcomes differ for children delivered at each week of term.

METHODS

This secondary analysis included 39 199 live-born singleton children of women who were admitted to the hospital in spontaneous labour from the US Collaborative Perinatal Project (1959-76). At each week of term gestation, we evaluated development at 8 months using the Bayley Scales of Infant Development, 4 years using the Stanford-Binet IQ (SBIQ) domains and 7 years using the Wechsler Intelligence Scales for Children (WISC) and Wide-Range Achievement Tests (WRAT).

RESULTS

Children's neurocognitive performance improved with each week of gestation from 37 weeks, peaking at 40 or 41 weeks. Relative to those delivered at 40 weeks, children had lower neurocognitive scores at 37 and 38 weeks for all assessments except SBIQ and WISC Performance IQ. Children delivered at 39 weeks had lower Bayley Mental (β = -1.18; confidence interval -1.77, -0.58) and Psychomotor (β = -1.18; confidence interval -1.90, -0.46) scores. Results were similar for within-family analyses comparing siblings, with the addition of lower WRAT scores at 39 weeks.

CONCLUSIONS

The improvement in development scores across assessment periods indicates that each week up to 40 or 41 weeks of gestation is important for short- and long-term cognitive development, suggesting 40-41 weeks may be the ideal delivery window for optimal neurodevelopmental outcomes.

Association of Gestational Age at Birth With Subsequent Neurodevelopment in Early Childhood: A National Retrospective Cohort Study in China

BACKGROUND

The association between preterm birth and neurodevelopmental delays have been well examined, however, reliable estimates for the full range of gestational age (GA) are limited, and few studies explored the impact of post-term birth on child development.

OBJECTIVE

This study aimed to examine the long-term neuropsychological outcomes of children born in a full range of GA with a national representative sample in China.

METHODS

In this retrospective population-based cohort study, a total of 137,530 preschoolers aged 3-5 years old (65,295/47.5% females and 72,235/52.5% males) were included in the final analysis. The Ages and Stages Questionnaires-Third Edition (ASQ-3) was completed by parents to evaluate children's neurodevelopment. The associations between GA and neurodevelopment were analyzed by a generalized additive mixed model with thin plate regression splines. Logistic regression was also conducted to examine the differences in children's development with different GAs.

RESULTS

There was a non-linear relationship between GA and children's neurodevelopmental outcomes with the highest scores at 40 weeks gestational age. The adjusted risks of GAs (very and moderately preterm, late-preterm, early-term, and post-term groups) on suspected developmental delays were observed in communication (OR were 1.83, 1.28, 1.13, and 1.21 respectively, each p < 0.05), gross motor skill (OR were 1.67, 1.38, 1.10, and 1.05 respectively, each p < 0.05), and personal social behavior (OR were 1.01, 1.36, 1.12, and 1.18 respectively, each p < 0.05). The adjusted OR of very and moderately preterm, late-preterm, and early-term were observed in fine motor skills (OR were 1.53, 1.22, and 1.09 respectively, each p < 0.05) and problem-solving (OR were 1.33, 1.12, and 1.06 respectively, each p < 0.05).

CONCLUSION

GAs is a risk factor for neurodevelopmental delays in preschoolers after controlling for a wide range of covariates, and 40-41 weeks may be the ideal delivery GA for optimal neurodevelopmental outcomes. Close observation and monitoring should be considered for early- and post-term born children as well as pre-term children.

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

OBJECTIVE

To describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy.

DESIGN

Cross-sectional study.

PARTICIPANTS

The cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB.

RESULTS

The weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05).

CONCLUSION

The incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.

Association of Gestational Age at Birth With Subsequent Suspected Developmental Coordination Disorder in Early Childhood in China

IMPORTANCE

It remains unknown whether children born at different degrees of prematurity, early term, and post term might have a higher risk of developmental coordination disorder (DCD) compared with completely full-term children (39-40 gestational weeks).

OBJECTIVE

To differentiate between suspected DCD in children with different gestational ages based on a national representative sample in China.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective cohort study was conducted in China from April 1, 2018, to December 31, 2019. A total of 152 433 children aged 3 to 5 years from 2403 public kindergartens in 551 cities of China were included in the final analysis. A multilevel regression model was developed to determine the strength of association for different gestational ages associated with suspected DCD when considering kindergartens as clusters.

MAIN OUTCOMES AND MEASURES

Children's motor performance was assessed using the Little Developmental Coordination Disorder Questionnaire, completed by their parents. Gestational age was determined according to the mother's medical records and divided into 7 categories: completely full term (39 to 40 weeks' gestation), very preterm (<32 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), late term (41 weeks), and post term (>41 weeks).

RESULTS

A total of 152 433 children aged 3 to 5 years (mean [SD] age, 4.5 [0.8] years), including 80 370 boys (52.7%) and 72 063 girls (47.3%), were included in the study. There were 45 052 children (29.6%) aged 3 years, 59 796 (39.2%) aged 4 years, and 47 585 (31.2%) aged 5 years. Children who were born very preterm (odds ratio [OR], 1.35; 95% CI, 1.23-1.48), moderately preterm (OR, 1.18; 95% CI, 1.02-1.36), late preterm (OR, 1.24; 95% CI, 1.16-1.32), early term (OR, 1.11; 95% CI, 1.06-1.16), and post term (OR, 1.17; 95% CI, 1.07-1.27) were more likely to be classified in the suspected DCD category on the Little Developmental Coordination Disorder Questionnaire than completely full-term children after adjusting for the same characteristics. Additionally, there was no association with suspected DCD in younger (aged 3 years) early-term and postterm children by stratified analyses.

CONCLUSIONS AND RELEVANCE

In this cohort study, every degree of prematurity at birth, early-term birth, and postterm birth were associated with suspected DCD when compared with full-term birth. These findings have important implications for understanding motor development in children born at different gestational ages. Long-term follow-up and rehabilitation interventions should be considered for children born early and post term.

The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder common from childhood to adulthood, affecting 5% to 12% among the general population in developed countries. Potential etiological factors have been identified, including genetic causes, environmental elements and epigenetic components. Nutrition is currently considered an influencing factor, and several studies have explored the contribution of restriction and dietary supplements in ADHD treatments. Iron is an essential cofactor required for a number of functions, such as transport of oxygen, immune function, cellular respiration, neurotransmitter metabolism (dopamine production), and DNA synthesis. Zinc is also an essential trace element, required for cellular functions related to the metabolism of neurotransmitters, melatonin, and prostaglandins. Epidemiological studies have found that iron and zinc deficiencies are common nutritional deficits worldwide, with important roles on neurologic functions (poor memory, inattentiveness, and impulsiveness), finicky appetite, and mood changes (sadness and irritability). Altered levels of iron and zinc have been related with the aggravation and progression of ADHD. Objective: This is a systematic review focused on the contribution of iron and zinc in the progression of ADHD among children and adolescents, and how therapies including these elements are tolerated along with its effectiveness (according to PRISMA guidelines). Method: The scientific literature was screened for randomized controlled trials published between January 2000 to July 2021. The databases consulted were Medline, PsycINFO, Web of Science, and Google Scholar. Two independent reviewers screened studies, extracted data, and assessed quality and risk of bias (CONSORT, NICE, and Cochrane checklists used). Conclusion: Nine studies met the eligibility criteria and were selected. Evidence was obtained regarding the contribution of iron-zinc supplementation in the treatment of ADHD among young individuals. The discussion was focused on how the deficits of these elements contribute to affectation on multiple ADHD correlates, and potential mechanisms explaining the mediational pathways. Evidence also suggested that treating ADHD with diet interventions might be particularly useful for specific subgroups of children and adolescents, but further investigations of the effects of these diet interventions are needed.

Transcutaneous Bilirubin Levels and Risk of Significant Hyperbilirubinemia in Early-Term and Term Newborns

OBJECTIVE

To compare the course of the transcutaneous bilirubin (TcB) values of early-term newborns with those of term newborns in the first month of life and to investigate whether early-term newborns have an increased risk of significant hyperbilirubinemia requiring treatment.

DESIGN

A prospective, controlled cohort analysis.

SETTING

A tertiary level mother-child birth and health care center.

PARTICIPANTS

Four hundred early-term (37 0/7 to 38 6/7 weeks) and 320 term (39 0/7 to 41 6/7 weeks) newborns born during a 27-month period.

METHODS

A total of six TcB measurements in a longitudinal manner were made in early-term and term newborns: the first two at 6 and 48 hours after birth and the next four on routine examination days (Days 4, 7, 15, and 30). Demographic characteristics, values of daily TcB measurements, number of newborns with significant hyperbilirubinemia, and risk of jaundice requiring treatment were compared between the two groups.

RESULTS

All six TcB values were significantly greater in the early-term group than in the term group (p < .001 for each). Early-term newborns had a statistically significant increased risk of jaundice requiring treatment compared to term newborns (risk ratio = 1.91; 95% confidence interval [1.23-2.96]; p = .0046). Results of the repeated-measures analysis of variance and post hoc adjusted multiple comparison analysis showed that TcB levels increased to and peaked at 96 hours after birth and then gradually decreased to baseline (first measurement) levels at 30 days after birth in each group.

CONCLUSIONS

Early-term newborns should not be treated as full-term newborns because they have significantly higher TcB levels. These newborns should be closely monitored for pathologic jaundice because they have increased risk for significant hyperbilirubinemia requiring phototherapy.

Antenatal awareness and obstetric outcomes in large fetuses: A retrospective evaluation

INTRODUCTION

There is currently no consensus on the management of large fetuses in order to minimize fetal complications. The aim of this study was to assess whether antenatal recognition of large-for-gestational age (LGA) reduced poor obstetric newborn outcomes in a hospital where expectant management was used.

MATERIAL AND METHODS

A retrospective cohort study was made of two delivery units at Karolinska University Hospital, Stockholm, Sweden, using expectant management of LGA. All deliveries > 37⁺⁰ weeks of gestation during an 8-year period (2002-2009) were included. The main outcome was severe adverse outcome, a composite variable including neonatal trauma (brachial plexus birth palsy [BPBP] and fractures) and asphyxic sequelae (severe asphyxia, cerebral damage, and fetal/infant death).

RESULTS

The study population consisted of 63,542 appropriate-for-gestational age (AGA) and 3,343 LGA pregnancies (of which 21 % were identified before delivery). Compared to AGA, LGA pregnancies showed a five-fold increased risk of neonatal trauma (OR 5.1, 95 % CI 4.0 - 6.4), but no differences were seen regarding asphyxic sequelae. LGA fetuses identified antenatally had adverse outcomes in 3.7 % of all cases, compared to 3.5 % where LGA was not identified (OR 1.07 95 % CI 0.7 - 1.7). When adjusted for newborn weight deviation, the OR was 0.96, 95 % CI 0.6 - 1.5. There was a three-fold higher risk (OR 3.0, 95 % CI 1.2 - 7.4) of neonatal trauma among non-identified LGA cases > 41⁺⁰ gestational weeks. A total of 81 % of those with LGA were identified after a week 41 routine ultrasound. Out of 68 cases with planned vaginal delivery and expected birth weight > 5000 g, 7.4 % suffered BPBP, representing a 31-fold increase in risk, compared to 0% BPBP among those delivered by elective caesarean section.

CONCLUSION

Antenatal awareness of LGA did not lower the risk of severe adverse outcomes in a unit using expectant management, but those identified postdate were at a lower risk of neonatal trauma. For every 14 fetuses with an expected birth weight > 5000 g delivered by cesarean section, one case of BPBP could be avoided.

[Neurobehavioral development of 25 254 children with different gestational ages at birth in three cities of China]

OBJECTIVE

To study the effect of gestational age at birth on the neurobehavioral development of preschool children.

METHODS

A total of 25 254 preschool children from Ma'anshan of Anhui Province, Taizhou of Zhejiang Province, and Yangzhou of Jiangsu Province were enrolled. The preschool children were divided into three groups based on their gestational ages at birth: preterm group (2 760 cases; 28-36⁺⁶ weeks), early term group (6 005 cases; 37-38⁺⁶ weeks), and full term group (16 489 cases; ≥39 weeks). The Ages and Stages Questionnaires-Third Edition (ASQ-3) was employed to evaluate the children's neurobehavioral development.

RESULTS

The preterm group had significantly lower scores of the five domains of ASQ-3, communication, gross motor, fine motor, problem solving, and personal-social, than the full term group (P<0.05), and significantly lower scores of communication, gross motor, fine motor, and problem solving than the early term group (P<0.05). There were no significant differences in the scores of the five domains of ASQ-3 between the early term and full term groups (P>0.05). The multiple linear regression analysis indicated a significant positive correlation between gestational age and the five domains of ASQ-3 after adjustment for confounding factors including sex, age, body mass index, and parental education level (P<0.01).

CONCLUSIONS

Children born preterm have poorer neurobehavioral development than those born full term and early term, whereas children born full term and early term have similar neurobehavioral development. Gestational age at birth is an independent influencing factor for neurobehavioral development in preschool children.

Mental health outcomes of adults born very preterm or with very low birth weight: A systematic review

Preterm birth research is poised to explore the mental health of adults born very preterm(VP; <32⁺⁰ weeks gestational age) and/or very low birth weight(VLBW; <1500g) through individual participant data meta-analyses, but first the previous evidence needs to be understood. We systematically reviewed and assessed the quality of the evidence from VP/VLBW studies with mental health symptoms or disorders appearing in adulthood, excluding childhood onset disorders. Participants (≥18 years, born >1970) included VP/VLBW individuals with controls born at term(≥37⁺⁰ weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed.