title: Developmental delay in moderately preterm-born children with low socioeconomic status: risks multiply.
abstract: OBJECTIVE
  To assess separate and joint effects of low socioeconomic status (SES) and moderate prematurity on preschool developmental delay.
  
  
  METHODS
  Prospective cohort study with a community-based sample of preterm- and term-born children (Longitudinal Preterm Outcome Project). We assessed SES on the basis of education, occupation, and family income. The Ages and Stages Questionnaire was used to assess developmental delay at age 4 years. We determined scores for overall development, and domains fine motor, gross motor, communication, problem-solving, and personal-social of 926 moderately preterm-born (MP) (32-36 weeks gestation) and 544 term-born children. In multivariable logistic regression analyses, we used standardized values for SES and gestational age (GA).
  
  
  RESULTS
  Prevalence rates for overall developmental delay were 12.5%, 7.8%, and 5.6% in MP children with low, intermediate, and high SES, respectively, and 7.2%, 4.0%, and 2.8% in term-born children, respectively. The risk for overall developmental delay increased more with decreasing SES than with decreasing GA, but the difference was not statistically significant: OR (95% CI) for a 1 standard deviation decrease were: 1.62 (1.30-2.03) and 1.34 (1.05-1.69), respectively, after adjustment for sex, number of siblings, and maternal age. No interaction was found except for communication, showing that effects of SES and GA are mostly multiplicative.
  
  
  CONCLUSIONS
  Low SES and moderate prematurity are separate risk factors with multiplicative effects on developmental delay. The double jeopardy of MP children with low SES needs special attention in pediatric care.
authors: Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: m.r.potijk@umcg.nl.
authors: Marieke R
authors: MR
authors: Potijk
authors: Jorien M
authors: JM
authors: Kerstjens
authors: Arend F
authors: AF
authors: Bos
authors: Sijmen A
authors: SA
authors: Reijneveld
authors: Andrea F
authors: AF
authors: de Winter
mesh_terms: D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty; D011340:Problem Solving; D011446:Prospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D047929:Term Birth
keywords: ASQ; Ages and Stages Questionnaire; GA; Gestational age; Lollipop; Longitudinal Preterm Outcome Project; MP; Moderately preterm-born; PCH; Preventive child healthcare; SES; Socioeconomic status