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Gestational Age at Term, Delivery Circumstance, and Their Association with Childhood Attention Deficit Hyperactivity
Nicole M Talge1, Dana M Allswede2, Claudia Holzman1
1Department of Epidemiology & Biostatistics, Michigan State University, East Lansing, MI.
Insights
Term-born children whose mothers had induced labor resulting in cesarean delivery showed higher attention deficit hyperactivity disorder (ADHD) symptoms. These findings highlight potential risks associated with specific delivery circumstances for childhood behavioral outcomes.
Area of Science:
- Perinatal research
- Child psychology
- Obstetrics
Background:
- Perinatal factors can indicate risks for academic and behavioral issues in term-born children.
- Identifying at-risk subgroups is crucial for early intervention.
Purpose of the Study:
- To investigate the association between perinatal characteristics (gestational age, delivery circumstance) and attention deficit hyperactivity disorder (ADHD) symptoms in term-born children.
Main Methods:
- Utilized data from the Pregnancy Outcomes and Community Health Study.
- Included 610 term-born children (ages 3-9) whose mothers completed the Conners' Parent Rating Scales-Revised-Short Form (CPRS-R-S).
- Employed general linear models to assess delivery circumstances (labor onset, mode of delivery) and gestational age in relation to ADHD symptoms.
Main Results:
- Children born after induced labor followed by cesarean delivery showed higher scores for inattention and the ADHD Index compared to spontaneous labor with vaginal delivery.
- These associations were statistically significant after adjusting for parity, sociodemographics, and maternal mental health.
- The observed effects were predominantly noted in male children.
Conclusions:
- Induction of labor culminating in cesarean delivery was linked to elevated ADHD symptoms in term-born children.
- Prenatal, antepartum, and/or postnatal factors related to this delivery profile may signify an increased risk for behavioral problems.
Background:
Perinatal characteristics may identify subgroups of term-born children at risk for academic and behavioural difficulties. Using follow-up data from the Pregnancy Outcomes and Community Health Study, we subdivided term births according to two potential markers of perinatal risk (gestational age, delivery circumstance) and evaluated their association with attention deficit hyperactivity disorder (ADHD) symptoms.
Methods:
We included children born at term whose mothers completed the Conners' Parent Rating Scales-Revised-Short Form (CPRS-R-S) (n = 610; ages: 3-9 years). The CPRS-R-S yields age and sex-referenced T-scores for the two primary dimensions of ADHD (inattention, hyperactivity) and an ADHD Index that reflects both dimensions. Using general linear models, we evaluated whether: (1) term delivery defined by gestational week (reference: 39-40 weeks), or (2) term delivery circumstance defined by labour onset type and mode of delivery (reference: spontaneous labour, vaginal delivery) was associated with these problems.
Results:
Following adjustment for parity, sociodemographics, and maternal mental health both during pregnancy and at the child follow-up survey, the induced labour plus caesarean group exhibited higher inattention and ADHD Index scores relative to the spontaneous labour, vaginal delivery group (inattention: mean difference = 5.1, 95% CI 0.6, 9.7; ADHD Index: mean difference = 4.1, 95% CI 0.5, 7.8). Findings were primarily driven by male children.
Conclusions:
Among term-born children, only those whose mothers experienced induction of labour that culminated in caesarean delivery exhibited higher levels of ADHD symptoms. Prenatal, antepartum, and/or postnatal factors associated with this delivery profile may reflect increased risk for such problems.
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