Page 45 - Sample Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood

Effects of SES on behavioural and emotional problems
INTRODUCTION
Moderately preterm (MP) children, born at 32 to 36 weeks’ gestation, are at greater risk of behavioural and emotional problems than term-born children.1-3 Risks increase with decreasing gestational age, but 85% of preterm children are born after 32 weeks’ gestation.4,5 As a consequence, children born moderately to late preterm contribute most to the societal burden associated with preterm birth.6
Although 8-10% of 4-year-old MP children struggle significantly with
behavioural and emotional problems,3 the majority of MP children do not
exhibit any difficulties. For some extent, this may be explained by differences in socioeconomic status (SES). Children from low SES families are more likely to
face multiple adversities, putting them at considerable higher risk of behavioural
and emotional problems.7 Moreover, MP children are more frequently confronted
with socioeconomic-related adversities than term-born children because preterm 4 birth is more likely to occur in deprived areas than in prosperous ones.8-10 Several
mediating factors may have a share in this link between low SES and preterm birth. For example, lifestyle-associated factors, such as smoking, increase the risk of spontaneous preterm labour.8,10 In addition, women with low SES are more likely to experience psychosocial stress, a significant and independent risk factor for preterm birth5,8,11 and for behavioural and emotional problems in preterm- born offspring.12
Next to SES, gender also seems to be an important determinant of the occurrence of behavioural and emotional problems in preterm children.3,13,14 Overall, preterm boys tend to have more externalizing and attention problems, while preterm girls tend to be more susceptible to internalizing problems, such as withdrawn behaviour.13 However, interrelationships of gender with MP birth and low SES remain unclear.
It is unknown to what extent low SES contributes to the higher prevalence of behavioural and emotional problems observed in MP children. If MP birth and low SES multiply each other’s risk of behavioural and emotional problems, this combination of risk factors may identify the MP children who are in greatest need of early intervention.15,16 Therefore, the aim of this study was to determine the independent and joint effects of MP birth and low SES on behavioural and emotional problems in a large population-based sample, with a special focus on gender differences.
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