Risk factors for emotional and behavioral problems in moderately-late preterms

Haan, Pauline J den; Kroon, Marlou L. A. de; Dokkum, Nienke H. van; Kerstjens, Jorien M.; Reijneveld, Sijmen A.; Bos, Arend F.

doi:10.1371/journal.pone.0216468

Cited by 4 publications

(4 citation statements)

References 43 publications

(78 reference statements)

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“…This may have biased the published results towards the null, if cannabis use/exposure was under-reported more often among those with child experiencing cognitive and behavioral problems. On the other hand, many reports did not adjust for prenatal exposure to tobacco, an important covariate that is strongly associated with both the exposure [ 90 ] and various cognitive [ 91 , 92 ] and behavioral [ 93 , 94 , 95 , 96 , 97 , 98 ] problems in the offspring, which may result in a bias away from the null.…”

Section: Discussionmentioning

confidence: 99%

Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study

Moore

Salmons

Hoyt³

et al. 2023

IJERPH

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Background: Prenatal exposure to cannabis may influence childhood cognition and behavior, but the epidemiologic evidence is mixed. Even less is known about the potential impact of secondhand exposure to cannabis during early childhood. Objective: This study sought to assess whether prenatal and/or postnatal exposure to cannabis was associated with childhood cognition and behavior. Study design: This sub-study included a convenience sample of 81 mother–child pairs from a Colorado-based cohort. Seven common cannabinoids (including delta 9-tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD)) and their metabolites were measured in maternal urine collected mid-gestation and child urine collected at age 5 years. Prenatal and postnatal exposure to cannabis was dichotomized as exposed (detection of any cannabinoid) and not exposed. Generalized linear models examined the associations between prenatal or postnatal exposure to cannabis with the NIH Toolbox and Child Behavior Checklist T-scores at age 5 years. Results: In this study, 7% (n = 6) of the children had prenatal exposure to cannabis and 12% (n = 10) had postnatal exposure to cannabis, with two children experiencing this exposure at both time points. The most common cannabinoid detected in pregnancy was Δ9-THC, whereas the most common cannabinoid detected in childhood was CBD. Postnatal exposure to cannabis was associated with more aggressive behavior (β: 3.2; 95% CI: 0.5, 5.9), attention deficit/hyperactivity problems (β: 8.0; 95% CI: 2.2, 13.7), and oppositional/defiant behaviors (β: 3.2; 95% CI: 0.2, 6.3), as well as less cognitive flexibility (β: −15.6; 95% CI: −30.0, −1.2) and weaker receptive language (β: −9.7; 95% CI: −19.2, −0.3). By contrast, prenatal exposure to cannabis was associated with fewer internalizing behaviors (mean difference: −10.2; 95% CI: −20.3, −0.2) and fewer somatic complaints (mean difference: −5.2, 95% CI: −9.8, −0.6). Conclusions: Our study suggests that postnatal exposure to cannabis is associated with more behavioral and cognitive problems among 5-year-old children, independent of prenatal and postnatal exposure to tobacco. The potential risks of cannabis use (including smoking and vaping) during pregnancy and around young children should be more widely communicated to parents.

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Section: Discussionmentioning

confidence: 99%

Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study

Moore

Salmons

Hoyt³

et al. 2023

IJERPH

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“…We found that SHIP was associated with higher internalizing scores in children, indicating more emotional development problems in children. Several previous studies have found associations between maternal infection during pregnancy and increased risk of emotional and behavioral problems in children through disruption of blood vessel formation between placenta and fetus that have long-term implications on development [ 26 , 32 , 50 ]. Maternal infection in pregnancy activates the mothers’ inflammatory immune response; several studies have identified this increase in inflammation as the mechanism that leads to increased risk of behavioral problems and disorders in offspring [ 51 – 53 ].…”

Section: Discussionmentioning

confidence: 99%

Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin

et al. 2021

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Background An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Principal findings Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Conclusions Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries.

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“…It contrasts with the fact that there is published evidence on the best handling of psychosocial problems (e.g. [14][15][16][17]). This incorrect assumption prevents pediatricians from making use of existing evidence.…”

Section: Interpretation Of Main Findingsmentioning

confidence: 91%

Evidence-based practice in well-child care

et al. 2022

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Evidence-based practice (EBP) significantly improves the quality of healthcare, but its use in community pediatrics has not yet been proven. We aimed to assess how Dutch community pediatricians use scientific findings and apply evidence-based practice in everyday well-child care. We interviewed a purposive sample of 14 community pediatricians in the Netherlands regarding their professional activities in daily practice, focusing on instances in which their professional knowledge was insufficient to address the issue at hand. We transcribed the interviews verbatim, and coded them using ATLAS.ti software. We structured the information using template analysis. Community pediatricians relied largely on guidelines of their own profession. If these were not sufficient, they first consulted other medical specialists or colleagues, or used different sources that they considered reliable. They only rarely performed an EBP search, and if so, only for somatic problems. For psychosocial problems, they used a strategy of extensive interaction with clients and members of multidisciplinary teams. We identified five barriers to performing an EBP search: (1) a conviction that not every community pediatrician needs to be able to perform an EBP search; (2) a conviction that an EBP search is not suitable for psychosocial problems; (3) lack of confidence in one’s own abilities to perform an EBP search; (4) limited access to literature; (5) lack of time.Conclusions: Community pediatricians rely on professional guidelines; this indicates a need to keep these up-to-date and user-friendly. Furthermore, pediatricians should be better trained in performing EBP searches, and in working in multidisciplinary teams, especially for psychosocial problems. What is Known: • Conducting an evidence-based practice search is considered indispensable to determine the best management of the patient’s problem. • Conducting such a search is still considered challenging in many medical disciplines, including pediatrics. What is New: • There is a need to strengthen skills of community pediatricians to find evidence on psychosocial problems and to present this effectively in multidisciplinary teams. • The pediatricians’ broad use of other sources of evidence, like experts and online sources, shows the importance of critical evaluation skills.

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Risk factors for emotional and behavioral problems in moderately-late preterms

Cited by 4 publications

References 43 publications

Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study

Associations between Prenatal and Postnatal Exposure to Cannabis with Cognition and Behavior at Age 5 Years: The Healthy Start Study

Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin

Evidence-based practice in well-child care

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