Abstract
Background
To determine if a key marker of socioeconomic status, maternal education, is associated with later neurocognitive and academic outcomes among children born extremely preterm (EP).
Method
Eight hundred and seventy-three children born at 23 to 27 weeks of gestation were assessed for cognitive and academic ability at age 10 years. With adjustments for gestational age (GA) and potential confounders, outcomes of children whose mothers had fewer years of education at the time of delivery and children whose mother advanced in education between birth and 10 years were examined.
Results
Children of mothers in the lowest education stratum at birth were significantly more likely to score ≥2 SDs below normative expectation on 17 of 18 tests administered. Children of mothers who advanced in education (n=199) were at reduced risk for scoring ≥2 SDs on 15 of 18 measures, but this reduction was statistically significant on only 2 of 18 measures.
Conclusion
Among EP children, socioeconomic disadvantage at birth, indexed by maternal education, is associated with significantly poorer neurocognitive and academic outcomes at 10 years of age, independently of GA. Maternal educational advancement during the child’s first 10 years of life is associated with modestly improved neurocognitive outcomes.
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References
Johnson S . Cognitive and behavioural outcomes following very preterm birth. Semin Fetal Neonatal Med 2007;12:363–373.
Anderson PJ . Neuropsychological outcomes of children born very preterm. Semin Fetal Neonatal Med 2014;19:90–96.
Johnson S, Fawke J, Hennessy E et al. Neurodevelopmental disability through 11 years of age in children born before 26 weeks of gestation. Pediatrics 2009;124:e249–e257.
Kerr-Wilson C, Mackay D, Smith G, Pell J . Meta-analysis of the association between preterm delivery and intelligence. Journal of Public Health 2012;34:209–216.
Joseph RM, O'Shea TM, Allred EN et al. Neurocognitive and academic outcomes at age 10 years of extremely preterm newborns. Pediatrics 2016;137:e20154343.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braveman PA . Socioeconomic disparities in adverse birth outcomes: a systematic review. Am J Prev Med 2010;39:263–272.
Wong HS, Edwards P . Nature or nurture: a systematic review of the effect of socio-economic status on the developmental and cognitive outcomes of children born preterm. Matern Child Health J 2013;17:1689–1700.
Manley BJ, Roberts RS, Doyle LW et al. Caffeine for Apnea of Prematurity Trial I, Caffeine for Apnea of Prematurity CAPTISocial variables predict gains in cognitive scores across the preschool years in children with birth weights 500 to 1250 grams. J Pediatr 2015;166:870–876 e871–872.
Schneider LA, Burns NR, Giles LC et al. Cognitive abilities in preterm and term-born adolescents. J Pediatr 2014;165:170–177.
Ekeus C, Lindstrom K, Lindblad F, Rasmussen F, Hjern A . Preterm birth, social disadvantage, and cognitive competence in Swedish 18- to 19-year-old men. Pediatrics 2010;125:e67–e73.
Eryigit Madzwamuse S, Baumann N, Jaekel J, Bartmann P, Wolke D . Neuro-cognitive performance of very preterm or very low birth weight adults at 26 years. J Child Psychol Psychiatry 2015;56:857–864.
Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N . Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr 2015;169:1162–1172.
Potharst ES, Houtzager BA, van Sonderen L et al. Prediction of cognitive abilities at the age of 5 years using developmental follow-up assessments at the age of 2 and 3 years in very preterm children. Dev Med Child Neurol 2012;54:240–246.
Lorch SA, Enlow E . The role of social determinants in explaining racial/ethnic disparities in perinatal outcomes. Pediatr Res 2016;79:141–147.
Leviton A, Paneth N, Reuss ML et al. Maternal infection, fetal inflammatory response, and brain damage in very low birth weight infants. Pediatric Res 1999;46:566–575.
Noble KG, Houston SM, Brito NH et al. Family income, parental education and brain structure in children and adolescents. Nat Neurosci 2015;18:773–778.
Wolke D . Psychological development of prematurely born children. Arch Dis Child 1998;78:567–570.
Bendersky M, Lewis M . Environmental risk, biological risk, and developmental outcome. Dev Psychol 1994;30:484.
Doyle LW, Cheong JL, Burnett A, Roberts G, Lee KJ, Anderson PJ . Victorian Infant Collaborative Study G Biological and social influences on outcomes of extreme-preterm/low-birth weight adolescents. Pediatrics 2015;136:e1513–e1520.
Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC . Risk factors accounting for racial differences in the rate of premature birth. N Engl J Med 1987;317:743–748.
Trzaskowski M, Harlaar N, Arden R et al. Genetic influence on family socioeconomic status and children's intelligence. Intelligence 2014;42:83–88.
O'Shea TM, Allred EN, Dammann O et al. The ELGAN study of the brain and related disorders in extremely low gestational age newborns. Early Hum Dev 2009;85:719–725.
Kaufman AS, Kaufman NL . Kaufman Brief Intelligence Test-2 (KBIT-2). San Antonio, TX: Pearson Education.
Palisano RJ, Hanna SE, Rosenbaum PL et al. Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 2000;80:974–985.
Elliott CD . Differential Ability Scales. San Antonio, TX: Pearson Education, 2007.
Carrow-Woolfolk E . Oral and Written Language Scales (OWLS). San Antonio, TX: Pearson Education, 1995.
Korkman M, Kirk U, Kemp S . NEPSY-II: Clinical and Interpretive Manual. San Antonio, TX: Pearson Education, 2007.
Wechsler D . The Wechsler Individual Achievement Test-III. San Antonio, TX: Pearson Assessment, 2009.
Farah MJ, Shera DM, Savage JH et al. Childhood poverty: specific associations with neurocognitive development. Brain Res 2006;1110:166–174.
Noble KG, Norman MF, Farah MJ . Neurocognitive correlates of socioeconomic status in kindergarten children. Dev Sci 2005;8:74–87.
Sirin SR . Socioeconomic status and academic achievement: a meta-analytic review of research. Rev Educ Res 2005;75:417–453.
Ardila A, Rosselli M, Matute E, Guajardo S . The influence of the parents' educational level on the development of executive functions. Dev Neuropsychol 2005;28:539–560.
Duncan GJ, Magnuson K, Votruba-Drzal E . Moving beyond correlations in assessing the consequences of poverty. Annu Rev Psychol 2017;68:413–434.
Burris HH, Baccarelli AA, Wright RO, Wright RJ . Epigenetics: linking social and environmental exposures to preterm birth. Pediatr Res 2016;79:136–140.
Rubin LP . Maternal and pediatric health and disease: integrating biopsychosocial models and epigenetics. Pediatr Res 2016;79:127–135.
Garg A, Boynton-Jarrett R, Dworkin PH . Avoiding the unintended consequences of screening for social determinants of health. JAMA 2016;316:813–814.
Acknowledgements
We express our gratitude to the children and their families who participated in this study. We also gratefully acknowledge the contributions of the ELGAN Study Investigators.
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Members of the ELGAN Study Investigators
The members of the ELGAN Study Investigators are as follows: Boston Children’s Hospital, Boston MA—Janice Ware, Taryn Coster, Brandi Henson, Rachel Wilson, Kirsten McGhee, Patricia Lee, Aimee Asgarian, Anjali Sadhwani; Tufts Medical Center, Boston MA—Ellen Perrin, Emily Neger, Kathryn Mattern, Jenifer Walkowiak, Susan Barron—University of Massachusetts Medical School, Worcester MA—Jean Frazier, Lauren Venuti, Beth Powers, Ann Foley, Brian Dessureau, Molly Wood, Jill Damon-Minow; Yale University School of Medicine, New Haven, CT—Richard Ehrenkranz, Jennifer Benjamin, Elaine Romano, Kathy Tsatsanis, Katarzyna Chawarska, Sophy Kim, Susan Dieterich, Karen Bearrs; Wake Forest University Baptist Medical Center, Winston-Salem NC—T. Michael O’Shea, Nancy Peters, Patricia Brown, Emily Ansusinha, Ellen Waldrep, Jackie Friedman, Gail Hounshell, Debbie Allred—University Health Systems of Eastern Carolina, Greenville, NC—Stephen C. Engelke, Nancy Darden-Saad, Gary Stainback; North Carolina Children's Hospital, Chapel Hill, NC—Diane Warner, Janice Wereszczak, Janice Bernhardt, Joni McKeeman, Echo Meyer; Helen DeVos Children's Hospital, Grand Rapids, MI—Steve Pastyrnak, Wendy Burdo-Hartman, Julie Rathbun, Sarah Nota, Teri Crumb; Sparrow Hospital, Lansing, MI—Madeleine Lenski, Deborah Weiland, Megan Lloyd; University of Chicago Medical Center, Chicago, IL—Scott Hunter, Michael Msall, Rugile Ramoskaite, Suzanne Wiggins, Krissy Washington, Ryan Martin, Barbara Prendergast, Megan Scott—William Beaumont Hospital, Royal Oak, MI—Judith Klarr, Beth Kring, Jennifer DeRidder, Kelly Vogt.
STATEMENT OF FINANCIAL SUPPORT
This study was supported by the National Institute of Neurological Disorders and Stroke (5U01NS040069-09; 5U01NS04006-05), the National Institute of Child Health and Human Development (5P30HD018655-28), and the NIH ECHO Program (UG3OD023348-01).
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Joseph, R., O'Shea, T., Allred, E. et al. Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm. Pediatr Res 83, 767–777 (2018). https://doi.org/10.1038/pr.2017.267
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DOI: https://doi.org/10.1038/pr.2017.267
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