Early life antecedents of positive child health among 10-year-old children born extremely preterm

Abstract

Objective.To identify modifiable antecedents during pre-pregnancy and pregnancy windows associated with a positive child health at 10 years of age.Study design.Data on 889 children enrolled in the Extremely Low Gestational Age Newborn (ELGAN) study in 2002–2004 were analyzed for associations between potentially modifiable maternal antecedents during pre-pregnancy and pregnancy time windows and a previously described positive child health index (PCHI) score at 10 years of age. Stratification by race was also investigated for associations with investigated antecedents.Results.Factors associated with higher PCHI (more positive health) included greater gestational age, birth weight, multiple gestation, and medical interventions, including assisted reproduction, and cervical cerclage. Factors associated with lower PCHI included correlates of lower socioeconomic status, pre-pregnancy chronic medical disorders in the mother like pre-pregnancy BMI, maternal asthma. When stratified by race, variation in significant results was observed.Conclusions.Among children born extremely preterm, medical interventions and higher SES were associated with improved PCHI while chronic illness and high BMI in the mother is associated with lower PCHI at 10 years of age. Knowledge of such antecedent factors could inform efforts to develop interventions that promote positive child health outcomes in future pregnancies.

Placental programming, perinatal inflammation, and neurodevelopment impairment among those born extremely preterm

“…Early life factors that influence health and development of individuals born extremely preterm include prenatal factors such as maternal BMI, placental microorganisms, fetal growth restrictions, and lower maternal socioeconomic status. 101,120,121,[189][190][191][192] The body of evidence reviewed here suggests at least two broad causal pathways between early life predictors and childhood outcomes. These factors, which are not mutually exclusive, include: (1) increased neonatal systemic inflammation, which consistently has been associated with later life impairments; and (2) disrupted placental programming that may be controlled, at least in part, through epigenetic mechanisms.…”

A mixed-effects two-part model for twin-data and an application on identifying important factors associated with extremely preterm children’s health disorders

“…Investigating the outcomes of preterm-born children remains critical for evaluating and improving clinical care, planning long-term support and for advancing our understanding of the life-course consequences of immaturity at birth [ 7 ]. Identifying important factors that are associated with the risk and burden of such health disorders is important to both clinicians and researchers [ 12 ]. Indeed, determining important biomarkers associated with adverse health outcomes has long been recognized as a critical component in investigating disease etiologies, developing new therapeutic interventions, and accurately predicting disease progression [ 13 , 14 ].…”

“…The current research is motivated by recent epidemiological studies investigating the positive child health outcomes among 10-year-old children who were born extremely preterm [ 9 , 12 ]. One of our primary scientific interests in these studies was to identify important factors associated with the positive child health index (PCHI) outcome, which summates information about the presence or absence of 11 adverse health disorders at age 10 and transforms the cumulative number to a scale from 0 (the child experienced all the disorders) to 100% (no disorders), accounting for the number of non-missing responses [ 12 ]. That is, the fewer disorders the child experienced, the higher the child’s PCHI score.…”

Psychosocial and medical adversity associated with neonatal neurobehavior in infants born before 30 weeks gestation

“…Adverse psychosocial and environmental conditions in pregnancy compromise the intrauterine environment, are associated with very premature birth, and escalate medical risks, leading to poor outcomes for infants born before 30 weeks post-menstrual age (PMA) (1,2). These same risk factors can disrupt brain development (3,4), and are associated with atypical newborn neurobehavior, as well as adverse neurodevelopmental and psychological outcomes throughout childhood (5)(6)(7). Similarly, very premature birth also presents challenges to maternal affective warmth and responsive interactions that support the infant's postnatal development and the developing mother-infant relationship (8).…”