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Published on: November 20, 2015
Association of Preterm Birth and Socioeconomic Status With Neonatal Brain Structure
Katie Mckinnon1, Paola Galdi1, Manuel Blesa-Cábez1
1Medical Research Council Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
Insights
Gestational age (GA) at birth significantly impacts neonatal brain structure more than socioeconomic status (SES). This study highlights GA
Area of Science:
- Neonatal brain development
- Neuroimaging
- Developmental neuroscience
Background:
- Preterm birth and socioeconomic status (SES) are linked to childhood brain structure.
- The distinct contributions of gestational age (GA) and SES to neonatal brain morphology are not well understood.
Purpose of the Study:
- To examine the associations between birth gestational age (GA) and socioeconomic status (SES) with neonatal brain morphology.
- To test if SES-infant brain morphology associations differ by GA.
- To investigate how different operationalizations of SES affect its association with brain structure.
Main Methods:
- A UK-based cohort study included 170 extremely/very preterm infants and 91 term-born infants.
- Birth GA and SES (neighborhood, family, subjective measures) were assessed.
- Neonatal brain morphology (volume, surface area, gyrification) was measured at term-equivalent age using MRI.
Main Results:
- Birth GA showed broader associations with neonatal brain volumes (31.8% of parcels) compared to neighborhood-level SES (1.2%) or family-level SES (4.7% for education).
- GA was linked to cortical surface area and gyrification index, while SES measures were not associated with cortical morphology.
- Interactions were observed between GA and family/subjective SES measures on regional brain volumes.
Conclusions:
- Gestational age at birth has a more widespread impact on neonatal brain structure than socioeconomic status.
- Both GA and SES are associated with neonatal brain morphology, with GA demonstrating a more significant influence.
- Further research is needed to understand the mechanisms linking GA and SES to early brain development.
Importance:
Preterm birth and socioeconomic status (SES) are associated with brain structure in childhood, but the relative contributions of each during the neonatal period are unknown.
Objective:
To investigate associations of birth gestational age (GA) and SES with neonatal brain morphology by testing 3 hypotheses: GA and SES are associated with brain morphology; associations between SES and brain morphology vary with GA; and associations between SES and brain structure and morphology depend on how SES is operationalized.
Design, Setting, And Participants:
This cohort study recruited participants from November 2016 to September 2021 at a single center in the United Kingdom. Participants were 170 extremely and very preterm infants and 91 full-term or near-term infants. Exclusion criteria were major congenital malformation, chromosomal abnormality, congenital infection, cystic periventricular leukomalacia, hemorrhagic parenchymal infarction, and posthemorrhagic ventricular dilatation.
Exposures:
Birth GA and SES, operationalized at the neighborhood level (using the Scottish Index of Multiple Deprivation), the family level (using parental education and occupation), and subjectively (World Health Organization Quality of Life measure).
Main Outcomes And Measures:
Brain volume (85 parcels) and 5 whole-brain cortical morphology measures (gyrification index, thickness, sulcal depth, curvature, surface area) at term-equivalent age (median [range] age, 40 weeks, 5 days [36 weeks, 2 days to 45 weeks, 6 days] and 42 weeks [38 weeks, 2 days to 46 weeks, 1 day] for preterm and full-term infants, respectively).
Results:
Participants were 170 extremely and very preterm infants (95 [55.9%] male; 4 of 166 [2.4%] Asian, 145 of 166 [87.3%] White) and 91 full-term or near-term infants (50 [54.9%] male; 3 of 86 [3.5%] Asian, 78 of 86 [90.7%] White infants) with median (range) birth GAs of 30 weeks, 0 days (22 weeks, 1 day, to 32 weeks, 6 days) and 39 weeks, 4 days (36 weeks, 3 days, to 42 weeks, 1 day), respectively. In fully adjusted models, birth GA was associated with a higher proportion of brain volumes (27 of 85 parcels [31.8%]; β range, -0.20 to 0.24) than neighborhood-level SES (1 of 85 parcels [1.2%]; β = 0.17 [95% CI, -0.16 to 0.50]) or family-level SES (maternal education: 4 of 85 parcels [4.7%]; β range, 0.09 to 0.15; maternal occupation: 1 of 85 parcels [1.2%]; β = 0.06 [95% CI, 0.02 to 0.11] respectively). There were interactions between GA and both family-level and subjective SES measures on regional brain volumes. Birth GA was associated with cortical surface area (β = 0.10 [95% CI, 0.02 to 0.18]) and gyrification index (β = 0.16 [95% CI, 0.07 to 0.25]); no SES measure was associated with cortical measures.
Conclusions And Relevance:
In this cohort study of UK infants, birth GA and SES were associated with neonatal brain morphology, but low GA had more widely distributed associations with neonatal brain structure than SES. Further work is warranted to elucidate the mechanisms underlying the association of both GA and SES with early brain development.
