title: Late-preterm birth by delivery circumstance and its association with parent-reported attention problems in childhood.
abstract: OBJECTIVE
  Late-preterm birth (LPB, 34-36 wk) has been associated with an increased risk of attention problems in childhood relative to full-term birth (FTB, ≥37 wk), but little is known about factors contributing to this risk. The authors investigated the contributions of clinical circumstances surrounding delivery using follow-up data from the Pregnancy Outcomes and Community Health (POUCH) Study.
  
  
  METHODS
  Women who delivered late preterm or full term and completed the sex- and age-referenced Conners' Parent Rating Scales-Short Form: Revised were included in the present analysis (N = 762; children's age, 3-9 y). The Conners' Parent Rating Scales-Short Form: Revised measures dimensions of behavior linked to attention problems, including oppositionality, inattention, hyperactivity, and a global attention problem index. Using general linear models, the authors evaluated whether LPB subtype (medically indicated [MI] or spontaneous) was associated with these dimensions relative to FTB.
  
  
  RESULTS
  After adjustment for parity, sociodemographics, child age, and maternal symptoms of depression and serious mental illness during pregnancy and at the child survey, only MI LPB was associated with higher hyperactivity and global index scores (mean difference from FTB = 3.8 [95% confidence interval {CI}: 0.5, 7.0] and 3.1 [95% CI 0.0, 6.2]). These findings were largely driven by children between 6 and 9 years. Removal of women with hypertensive disorders during pregnancy (N = 85) or placental findings related to hypertensive conditions (obstruction, decreased maternal spiral artery conversion; N = 134) reduced the differences below significance thresholds.
  
  
  CONCLUSIONS
  Among LPBs, only MI LPB was associated with higher levels of parent-reported childhood attention problems, suggesting that complications motivating medical intervention during the late-preterm period mark increased risk for such problems. Hypertensive disorders seem to play a role in these associations.
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824, USA. ntalge@epi.msu.edu
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Talge
authors.forename: Claudia
authors.initials: C
authors.lastname: Holzman
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Van Egeren
authors.forename: Laura L
authors.initials: LL
authors.lastname: Symonds
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Scheid
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Senagore
authors.forename: Alla
authors.initials: A
authors.lastname: Sikorskii
mesh_terms: D000328:Adult; D000367:Age Factors; D001288:Attention; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000209:etiology* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D009035:Mothers / Q000523:psychology; D010922:Placenta Diseases / Q000523:psychology; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000523:psychology; D011256:Pregnancy Outcome / Q000523:psychology; D047928:Premature Birth / Q000523:psychology*; D012917:Social Adjustment