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Published on: August 25, 2014
Understanding the course of attention deficit hyperactivity disorder in children born after a threatened preterm
Julia Buesa1, Marta Lizaran2, Belén Almansa2
1Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco).
Insights
Children born after suspected preterm labor showed varying attention deficit hyperactivity disorder (ADHD) symptom trajectories. Late preterm infants improved, unlike very preterm infants, highlighting the need for targeted maternal mental health support.
Area of Science:
- Pediatric neurology
- Developmental psychology
- Maternal mental health
Background:
- Children born after suspected preterm labor may exhibit distinct attention deficit hyperactivity disorder (ADHD) features.
- The developmental course and predictors of ADHD symptoms in this population are not well understood.
Purpose of the Study:
- To investigate the ADHD symptom trajectories in children born after suspected preterm labor from ages 2 to 6 years.
- To compare these trajectories with controls and identify modifiable predictors of symptom evolution.
Main Methods:
- A prospective cohort study included 119 mother-child pairs with suspected preterm labor and 60 controls.
- Children were categorized by prematurity: full-term, late preterm, and very preterm.
- ADHD symptoms were assessed at ages 2 and 6 years using Bayesian mixed linear models to analyze trajectories and predictors, including maternal factors.
Main Results:
- Late preterm infants showed symptom improvement between ages 2 and 6 years, unlike other groups.
- Maternal anxiety and history of trauma were associated with increased symptom severity.
- Lower birthweight percentile and male sex also predicted higher symptom severity.
Conclusions:
- Late preterm infants demonstrate a unique improvement in ADHD symptoms, potentially due to less severe prematurity and closer monitoring.
- Maternal psychopathology significantly influences ADHD symptom course and severity.
- Targeted psychological interventions for pregnant individuals and enhanced monitoring for offspring are recommended.
Background:
Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population.
Objective:
This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis.
Study Design:
In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria).
Results:
An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98).
Conclusion:
Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.
