Association of Socioeconomic Status and Brain Injury With Neurodevelopmental Outcomes of Very Preterm Children

Abstract

Key Points Question Does the association of brain injury with adverse neurodevelopmental outcome in preterm neonates vary by the socioeconomic status of the parents? Findings In this cohort study of 226 preterm neonates, cognitive and motor outcomes were associated with different prenatal and postnatal clinical factors, with maternal education and brain injury having similar effect sizes for cognitive outcomes. Importantly, cognitive scores in preterm children in the higher-status group did not differ between those with and without brain injury. Meaning Maternal education is associated with cognitive outcome in preterm neonates, with higher status appearing to attenuate the association of brain injury with neurodevelopmental outcome.

Maternal Prenatal Stress Is Associated With Altered Uncinate Fasciculus Microstructure in Premature Neonates

“…To our knowledge, this represents the largest sample in studies of prenatal stress exposure and infant brain development, as well as the first study to investigate this relationship in a preterm sample. In a recent study by Benavente-Fernández et al (100), the association between brain injury and cognitive outcomes in a sample of children born preterm (24-32 weeks GA) was mediated by maternal SES. Similarly, it is possible that exposure to maternal prenatal stress may exacerbate the risk for negative outcomes in preterm-born children.…”

Mental development is associated with cortical connectivity of the ventral and nonspecific thalamus of preterm newborns

“…This relationship appears to be affected by parents' SES and duration of mechanical ventilation during the NICU stay. SES has previously been confirmed to be an important mediator of cognitive and language development in newborns (Benavente-Fernandez et al, 2019). Duration of mechanical ventilation has been associated with more brain abnormalities (Brouwer et al, 2017), with white matter abnormalities (Anjari et al, 2009;Ball et al, 2010) and, more recently, with alterations in fiber density (Pecheva et al, 2019).…”

Is Social Inequality in Cognitive Outcomes Increased by Preterm Birth–Related Complications?

“…Previous research that compared those born at high risk, ie, very preterm, with those born at term 6 found that high SES was a protective factor for both very preterm and term children and adults. The study by Benavente-Fernández et al 1 indicates that high SES may have been protective, whether children had brain injury or not. However, those who experienced brain injury had the greatest association with low SES, ie, they had the lowest IQ scores.…”

“…The study by Benavente-Fernández et al 1 investigated the association of maternal education as a marker of socioeconomic status (SES) and complications related to very preterm birth, such as chronic lung disease (CLD), intraventricular hemorrhage (IVH), and reduced white matter volume (WMV), with cognitive development in preschool-aged children. The study found that within the very preterm group, maternal education at time of birth was similar in effect size to indicators of brain injury, such as WMV or IVH.…”

“…Another mechanism of transmission is genetics, with IQ being moderately heritable. 1 Last but not least, parental education is associated with parenting. 7 Thus, a multitude of factors, from better health behavior to housing, living in better neighborhoods, parenting, and access to higher-quality education, are more frequent in high-SES households.…”