title: Maternal and pregnancy-related factors associated with developmental delay in moderately preterm-born children.
abstract: OBJECTIVE
  To estimate the association between pre-existing maternal and pregnancy-related factors and developmental delay in early childhood in moderately preterm-born children.
  
  
  METHODS
  We measured development with the Ages and Stages Questionnaire at age 43-49 months in 834 moderately preterm-born (between 32 0/7 and 35 6/7 weeks of gestation) children born in 2002-2003. We obtained data on preexisting maternal, maternal pregnancy-related, fetal, and delivery-related factors. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) and attributable risks for developmental delay adjusted for sociodemographic and lifestyle variables.
  
  
  RESULTS
  Attributable risk for developmental delay for small-for-gestational-age (SGA, as a proxy for intrauterine growth restriction [IUGR]) was 14.2% (SGA 21.9%, no SGA 7.7%, P<.05, adjusted OR 2.75, CI 1.25-6.08), for preexisting maternal obesity 10.5% (obesity 18.0%, no obesity 7.5%, P<.01, adjusted OR 2.73, CI 1.35-5.52), for multiple pregnancy 4.2% (multiple 12.0%, singleton 7.8%, P<.05, adjusted OR 1.86, CI 1.02-3.42), and for male sex 9.3% (male 13.0%, female 3.8%, P<.001, adjusted OR 4.20, CI 2.09-8.46). No other preexisting or pregnancy-related maternal factors or any delivery-related factors were associated with increased risk of developmental delay.
  
  
  CONCLUSIONS
  Of all preexisting maternal and pregnancy-related factors studied, SGA, maternal prepregnancy obesity, being one of a multiple, and male sex were associated with the risk of developmental delay in early childhood after moderately preterm birth. Reinforced focus on prevention of IUGR, preconception lifestyle interventions aiming at weight reduction in fertile women, and reinforced efforts to reduce rates of multiple pregnancies in assisted reproduction may all contribute toward more favorable developmental outcomes in moderately preterm-born children.
  
  
  METHODS
  II.
authors: Division of Neonatology, Beatrix Children's Hospital, and the Department of Health Sciences and the Division of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors: Jorien M
authors: JM
authors: Kerstjens
authors: Andrea F
authors: AF
authors: de Winter
authors: Krystyna M
authors: KM
authors: Sollie
authors: Inger F
authors: IF
authors: Bocca-Tjeertes
authors: Marieke R
authors: MR
authors: Potijk
authors: Sijmen A
authors: SA
authors: Reijneveld
authors: Arend F
authors: AF
authors: Bos
mesh_terms: D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors
references: Shapiro Mendoza CK, Lackritz EM. Epidemiology of late and moderate preterm birth. Semin Fetal Neonatal Med 2012;17:120–5.
references: McGowan JE, Alderdice FA, Holmes VA, Johnston L. Early childhood development of late-preterm infants: a systematic review. Pediatrics 2011;127:1111–24.
references: Jain L. School outcome in late preterm infants: a cause for concern. J Pediatr 2008;153:5–6.
references: Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL. School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation. J Pediatr 2008;153:25–31.
references: Lipkind HS, Slopen ME, Pfeiffer MR, McVeigh KH. School-age outcomes of late preterm infants in New York City. Am J Obstet Gynecol 2012;206:222.e1–6.
references: Kerstjens JM, de Winter AF, Bocca-Tjeertes IF, ten Vergert EM, Reijneveld SA, Bos AF. Developmental delay in moderately preterm–born children at school-entry. J Pediatr 2011;159:92–8.
references: MacKay DF, Smith GC, Dobbie R, Pell JP. Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren. PLoS Med 2010;8:e1000289.
references: Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008;359:262–73.
references: Petrou S, Khan K. Economic costs associated with moderate and late preterm birth: primary and secondary evidence. Semin Fetal Neonatal Med 2012;17:170–8.
references: Dimitriou G, Fouzas S, Georgakis V, Vervenioti A, Papadopoulos VG, Decacalas G, et al.. Determinants of morbidity in late preterm infants. Early Hum Dev 2010;86:587–91.
references: Bastek JA, Sammel MD, Paré E, Srinivas SK, Posencheg MA, Elovitz MA. Adverse neonatal outcomes: examining the risks between preterm, late preterm, and term infants. Am J Obstet Gynecol 2008;199:367.e1–8.
references: Sibai BM. Preeclampsia as a cause of preterm and late preterm (near-term) births. Semin Perinatol 2006;30:16–9.
references: Bocca-Tjeertes IF, Kerstjens JM, Reijneveld SA, de Winter AF, Bos AF. Growth and predictors of growth restraint in moderately preterm children aged 0 to 4 years. Pediatrics 2011;128:e1187–94.
references: Crone M, Vogels A, Hoekstra F. A comparison of four scoring methods based on the parent-rated Strengths and Difficulties Questionnaire as used in the Dutch preventive child health care system. BMC Public Health 2008;8:106.
references: Kerstjens JM, Bos AF, ten Vergert EMJ, de Meer G, Butcher PR, Reijneveld SA. Support for the global feasibility of the ages and stages questionnaire as developmental screener. Early Hum Dev 2009;85:443–7.
references: Kloosterman GJ. On intrauterine growth: the significance of prenatal care. Int J Gynaecol Obstet 1970;8:895–912.
references: Ganzeboom HBG, Treiman DJ. Internationally comparable measures of occupational status for the 1988 International Standard Classification of Occupations. Soc Sci Res 1996;25:201–39.
references: Helderman JB, O’Shea TM, Kuban KC, Allred EN, Hecht JL, Dammann O, et al.. Antenatal antecedents of cognitive impairment at 24 months in extremely low gestational age newborns. Pediatrics 2012;129:494–502.
references: Strauss RS. Adult functional outcome of those born small for gestational age: twenty-six-year follow-up of the 1970 British Birth Cohort. JAMA 2000;283:625–32.
references: Bamberg C, Kalache KD. Prenatal diagnosis of fetal growth restriction. Semin Fetal Neonatal Med 2004;9:387–94.
references: Tozuka Y, Kumon M, Wada E, et al.. Maternal obesity impairs hippocampal BDNF production and spatial learning performance in young mouse offspring. Neurochem Int 2010;57:235–47.
references: Djelantik AA, Kunst AE, van der Wal MF, Smit HA, Vrijkotte TG. Contribution of overweight and obesity to the occurrence of adverse pregnancy outcomes in a multi-ethnic cohort: population attributive fractions for Amsterdam. BJOG 2012;119:283–90.
references: Cooke RWI. Does neonatal and infant neurodevelopmental morbidity of multiples and singletons differ? Semin Fetal Neonatal Med 2010;15:362–6.
references: Hintz SR, Kendrick DE, Vohr BR, Kenneth Poole W, Higgins RD; NICHD Neonatal Research Network. Gender differences in neurodevelopmental outcomes among extremely preterm, extremely-low-birthweight infants. Acta Paediatr 2006;95:1239–48.
references: Glascoe F. Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev 2005;11:173–9.
references: Goldenberg RL, Gravett MG, Iams J, Papageorghiou AT, Waller SA, Kramer M, et al.. The preterm birth syndrome: issues to consider in creating a classification system. Obstet Gynecol 2012;206:113–8.
references: Kramer MS, Papageorghiou A, Culhane J, Bhutta Z, Goldernberg RL, Gravett M, et al.. Challenges in defining and classifying the preterm birth syndrome. Obstet Gynecol 2012;206:108–12.
references: Rattihalli R, Smith L, Field D. Prevention of preterm births: are we looking in the wrong place? the case for primary prevention. Arch Dis Child Fetal Neonatal Ed 2012;97:F160–1.
references: Krans EE, Davis MM. Preventing Low Birthweight: 25 years, prenatal risk, and the failure to reinvent prenatal care. Am J Obstet Gynecol 2012;206:398–403.