Prenatal maternal infections and early childhood developmental outcomes: Analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland

Abstract

BackgroundPrevious research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection.MethodsThis study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, in 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 weeks or 27-30 months health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention, and speech-language-communication), and (b) the trimester(s) in which infections occurred.ResultsAfter confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was consistent across almost all developmental outcome types, and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), i.e. the trimesters in which fetal brain myelination occurs. Infection-related prescriptions were not associated with a significant increase in odds of having at least one developmental concern after confounders/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development.ConclusionsPrenatal infections, particularly those which are hospital-diagnosed (and likely more severe) are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.Key PointsPrevious studies suggest that prenatal infections, and the maternal immune activation that comes with them, are associated with child developmental outcomes. However, research to date has been based on infections data that is either self-reported or included infections diagnosed in hospital only.This study examined associations between prenatal infections, measured by both hospital-diagnosed infections and receipt of infection-related prescriptions, and child developmental concerns identified by health visitors at ages 6-8 weeks and 27-30 months.Hospital-diagnosed prenatal infections were consistently associated with developmental concerns. Maternal receipt of infection-related prescriptions during pregnancy were also associated with developmental concerns, but only those related to personal-social and emotional-behavioural-attention development.This suggests that prenatal infections, particularly severe infections, are associated with early childhood developmental outcomes.

Investigating low birthweight and preterm birth as potential mediators in the relationship between prenatal infections and early child development: A linked administrative health data analysis

“…Maternal health during pregnancy plays an important role in shaping later childhood development, and there is now a growing body of evidence suggesting that prenatal maternal infections are associated with early childhood developmental outcomes. Previous research has found associations between maternal infections during pregnancy and reduced cognitive abilities [1, 2], emotional difficulties [3], health visitor developmental concerns [4] and a range of other developmental vulnerabilities [5] in children. There is also a large body of evidence linking prenatal maternal infections to childhood diagnoses of neurodevelopmental conditions such as autism [6-8] and attention-deficit/hyperactivity-disorder (ADHD) [9], as well as to adulthood mental health conditions including schizophrenia [10] and bipolar disorder [11].…”