Page 16 - Sample Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood

Chapter 2
ABSTRACT
Objective Socioeconomic status (SES) may (partially) explain associations of moderate prematurity with developmental delay. Therefore, we assessed separate and joint effects of low SES and moderate prematurity on preschool developmental delay.
Study design Prospective cohort study with a community-based sample of preterm- and term-born children (Lollipop-study). 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 four. We determined scores for overall development, and domains fine motor, gross motor, communication, problem-solving, and personal-social of 926 moderately preterm-born (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 moderately preterm-born 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: odds ratios (95% confidence intervals) for a one standard deviation decrease were: 1.62 (1.30- 2.03) and 1.34 (1.05-1.69), respectively, after adjustment for gender, 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 moderately preterm-born children with low SES needs special attention in pediatric care.
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