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Late-Preterm Birth by Delivery Circumstance and Its Association With Parent-Reported Attention Problems in Childhood

Talge, Nicole M. PhD*; Holzman, Claudia DVM, MPH, PhD*; Van Egeren, Laurie A. PhD; Symonds, Laura L. PhD; Scheid, Jeanette M. MD, PhD§; Senagore, Patricia K. MD; Sikorskii, Alla PhD

Journal of Developmental & Behavioral Pediatrics: June 2012 - Volume 33 - Issue 5 - p 405–415
doi: 10.1097/DBP.0b013e3182564704
Original Articles

Objective: Late-preterm birth (LPB, 34–36 wk) has been associated with an increased risk of attention problems in childhood relative to full-term birth (FTB, ≥37 wk), but little is known about factors contributing to this risk. The authors investigated the contributions of clinical circumstances surrounding delivery using follow-up data from the Pregnancy Outcomes and Community Health (POUCH) Study. Methods: Women who delivered late preterm or full term and completed the sex- and age-referenced Conners' Parent Rating Scales—Short Form: Revised were included in the present analysis (N = 762; children's age, 3–9 y). The Conners' Parent Rating Scales—Short Form: Revised measures dimensions of behavior linked to attention problems, including oppositionality, inattention, hyperactivity, and a global attention problem index. Using general linear models, the authors evaluated whether LPB subtype (medically indicated [MI] or spontaneous) was associated with these dimensions relative to FTB. Results: After adjustment for parity, sociodemographics, child age, and maternal symptoms of depression and serious mental illness during pregnancy and at the child survey, only MI LPB was associated with higher hyperactivity and global index scores (mean difference from FTB = 3.8 [95% confidence interval {CI}: 0.5, 7.0] and 3.1 [95% CI 0.0, 6.2]). These findings were largely driven by children between 6 and 9 years. Removal of women with hypertensive disorders during pregnancy (N = 85) or placental findings related to hypertensive conditions (obstruction, decreased maternal spiral artery conversion; N = 134) reduced the differences below significance thresholds. Conclusions: Among LPBs, only MI LPB was associated with higher levels of parent-reported childhood attention problems, suggesting that complications motivating medical intervention during the late-preterm period mark increased risk for such problems. Hypertensive disorders seem to play a role in these associations.

From the *Department of Epidemiology and Biostatistics; †Office of University Outreach and Engagement; ‡College of Human Medicine; §Departments of Psychiatry; ‖Physiology; ¶Statistics and Probability, Michigan State University, East Lansing, MI.

Received October 2011; accepted March 2012.

This study was supported by the Perinatal Epidemiological Research Initiative Program (Grant 20-FY04-37) from the March of Dimes Foundation, the National Institute of Child Health and Human Development and the National Institute of Nursing Research (Grant R01 HD34543), the Thrasher Research Foundation (Grant 02816-7), and the Centers for Disease Control and Prevention (Grant U01 DP000143-01) (to C.H.).

The principal investigator of the POUCH Study (C.H.) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Disclosure: The authors declare no conflict of interest.

Address for reprints: Nicole M. Talge, PhD, Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Road, Room B601, East Lansing, MI 48824; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.