Behavioural and emotional problems in moderately preterm children with low socioeconomic status: a population-based study

Abstract

Moderately preterm (MP) birth is associated with higher rates of behavioural and emotional problems. To determine the extent to which low socioeconomic status (SES) contributes to these higher rates, we assessed independent and joint effects of MP birth and low SES, overall and by gender. Dutch preventive child health care centres provided a population-based sample of 915 MP children (32-36 weeks gestation) and 543 term-born children, born in 2002/2003. In multivariable logistic regression analyses, we determined the risk of behavioural and emotional problems per standard deviation (SD) decrease in gestational age and SES, using standardized measures for both. We also assessed three SES categories, being low (1SD or more below mean of standardized SES), intermediate (mean ± 1SD), and high (greater than mean + 1SD). The Child Behavior Checklist for 1.5-5 years was used to assess behavioural (externalizing), emotional (internalizing), and total problems at age 4 years. MP children with low SES had significantly higher total problem scores than those with high SES (11.3 vs. 5.1%, respectively). Each SD decrease in SES was associated with a 42% higher odds of elevated total problem scores (OR 1.42, 95% CI 1.14-1.77). No joint effects were found, meaning that lower gestational age independently added to the risk of behaviour problems (OR 1.24, 95% CI 1.00-1.56). Effects of MP birth and low SES were more pronounced in girls. In conclusion, MP birth and low SES multiply the risk of behavioural and emotional problems. The combination of risk factors identifies children who could benefit greatly from early intervention.

Early Emergence of Delayed Social Competence in Infants Born Late and Moderately Preterm

“…We also found that sociodemographic factors were the only significant independent predictors of delayed social competence in LMPT infants. The additive effect of low SES has previously been reported in this population 25,26 and may represent a potential target for identifying LMPT children who may benefit from early intervention.…”

Early childhood health and morbidity, including respiratory function in late preterm and early term births

“…Few studies have so far attempted to investigate in more detail individual factors that may place subgroups at higher risk of later morbidity. Such factors might include genetic factors, maternal morbidity during pregnancy, reason for early delivery, variation in early care or nutrition, and socio-economic or environmental factors [21,30,[76][77][78][79]. Now that ongoing morbidities have been defined, further work is needed to elucidate whether there are modifiable factors with respect to pre-pregnancy, antenatal, neonatal, or childhood care that might improve outcomes.…”

Transforming Life: A Broad View of the Developmental Origins of Health and Disease Concept from an Ecological Justice Perspective

“…In turn, even moderate preterm (32–36 weeks) birth multiplies the independent risk of low SES on behavioral and emotional problems in children [66]. Thus, supporting healthy pregnancy outcomes represents a salient and early way to begin to dismantle inequalities and transform life.…”