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Maternal Social Risk, Gestational Age at Delivery, and Cognitive Outcomes among Adolescents Born Extremely Preterm

Robert M Joseph1, Stephen R Hooper2, Tim Heeren3

  • 1Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA.

Paediatric and Perinatal Epidemiology
|December 19, 2022
PubMed

Insights

Children born extremely preterm face cognitive deficits. Maternal disadvantage and early birth impact cognitive outcomes, with neonatal issues partially explaining the link between early birth and cognition.

Area of Science:

  • Neuroscience
  • Developmental Pediatrics
  • Cognitive Psychology

Background:

  • Children born extremely preterm (EP) exhibit a higher risk for persistent cognitive deficits into adulthood.
  • Limited large-scale studies explore cognitive function impairments in EP adolescents concerning early life risk factors.
  • Key risk factors include maternal social disadvantage, gestational age at birth, and common neonatal morbidities in EP infants.

Purpose of the Study:

  • To evaluate cognitive abilities in extremely preterm-born adolescents at 15 years of age.
  • To examine the relationship between early life risk factors and cognitive outcomes in this cohort.
  • To investigate potential mediating roles of gestational age and neonatal morbidities.

Main Methods:

  • The Extremely Low Gestational Age Newborn Study followed participants from birth.
  • At 15 years, 681 survivors underwent cognitive assessments using Wechsler Abbreviated Scale of Intelligence-II and NIH Toolbox Cognition Battery (NTCB).
  • Cognitive outcomes (WASI-II IQ, NTCB verbal cognition, NTCB fluid processing) were analyzed for associations with maternal social disadvantage and gestational age, with mediation analyses conducted.

Main Results:

  • Fluid processing abilities were generally lower than verbal abilities and IQ scores.
  • Both social disadvantage and gestational age were significantly associated with all three cognitive outcomes.
  • Neonatal morbidities partially mediated the association between lower gestational age and cognitive outcomes, but gestational age did not mediate the social risk-cognition link.

Conclusions:

  • Increased maternal social disadvantage and lower gestational age correlate with poorer cognitive outcomes in extremely preterm-born adolescents.
  • Neonatal morbidities play a partial role in mediating the impact of lower gestational age on cognitive development.
  • Findings underscore the necessity for enhanced medical and educational interventions to support cognitive development in extremely preterm survivors.
Abstract

Keywords:
adolescentcognitioncohort studiesextremely preterm birthneuropsychological testsrisk factors

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