Maternal social risk, gestational age at delivery, and cognitive outcomes among adolescents born extremely preterm

for the ELGAN Study Investigators

doi:10.1111/ppe.12893

Maternal social risk, gestational age at delivery, and cognitive outcomes among adolescents born extremely preterm

for the ELGAN Study Investigators

School of Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives: To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods: 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analysed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results: Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions: Greater maternal social disadvantage and lower gestational age are associated with less favourable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate the risk of poor cognitive outcomes among EP-born adolescents.

Original language	English (US)
Pages (from-to)	654-664
Number of pages	11
Journal	Paediatric and Perinatal Epidemiology
Volume	36
Issue number	5
DOIs	https://doi.org/10.1111/ppe.12893
State	Published - Sep 1 2022

Keywords

adolescent
cognition
cohort studies
extremely preterm birth
neuropsychological tests
risk factors

ASJC Scopus subject areas

Epidemiology
Pediatrics, Perinatology, and Child Health

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10.1111/ppe.12893

Cite this

@article{0bd8c2c0cf7a4efdb47097110cb5853f,

title = "Maternal social risk, gestational age at delivery, and cognitive outcomes among adolescents born extremely preterm",

abstract = "Background: Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives: To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods: 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analysed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results: Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions: Greater maternal social disadvantage and lower gestational age are associated with less favourable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate the risk of poor cognitive outcomes among EP-born adolescents.",

keywords = "adolescent, cognition, cohort studies, extremely preterm birth, neuropsychological tests, risk factors",

author = "{for the ELGAN Study Investigators} and Joseph, {Robert M.} and Hooper, {Stephen R.} and Tim Heeren and Santos, {Hudson P.} and Frazier, {Jean A.} and Lauren Venuti and Ann Foley and Rollins, {Caitlin K.} and Kuban, {Karl C.K.} and Fry, {Rebecca C.} and O{\textquoteright}Shea, {Thomas M.} and Bhavesh Shah and Rachana Singh and Ruben Vaidya and {Van Marter}, Linda and Camilla Martin and Janice Ware and Caitlin Rollins and Cynthia Cole and Ellen Perrin and Christina Sakai and Frank Bednarek and Richard Ehrenkranz and Jennifer Benjamin and Angela Montgomery and O{\textquoteright}Shea, {T. Michael} and Lisa Washburn and Semsa Gogcu and Carl Bose and Diane Warner and Steve Engelke and Amanda Higginson and Jason Higginson and Kelly Bear and Mariel Poortenga and Steve Pastyrnak and Padu Karna and Nigel Paneth and Madeleine Lenski and Michael Schreiber and Scott Hunter and Michael Msall and Danny Batton and Judith Klarr and Lee, {Young Ah} and Rawad Obeid and Karen Christianson and Deborah Klein and Katie Wagner and Maureen Pimental",

note = "Publisher Copyright: {\textcopyright} 2022 John Wiley & Sons Ltd.",

year = "2022",

month = sep,

day = "1",

doi = "10.1111/ppe.12893",

language = "English (US)",

volume = "36",

pages = "654--664",

journal = "Paediatric and Perinatal Epidemiology",

issn = "0269-5022",

publisher = "Wiley-Blackwell",

number = "5",

}

TY - JOUR

T1 - Maternal social risk, gestational age at delivery, and cognitive outcomes among adolescents born extremely preterm

AU - for the ELGAN Study Investigators

AU - Joseph, Robert M.

AU - Hooper, Stephen R.

AU - Heeren, Tim

AU - Santos, Hudson P.

AU - Frazier, Jean A.

AU - Venuti, Lauren

AU - Foley, Ann

AU - Rollins, Caitlin K.

AU - Kuban, Karl C.K.

AU - Fry, Rebecca C.

AU - O’Shea, Thomas M.

AU - Shah, Bhavesh

AU - Singh, Rachana

AU - Vaidya, Ruben

AU - Van Marter, Linda

AU - Martin, Camilla

AU - Ware, Janice

AU - Rollins, Caitlin

AU - Cole, Cynthia

AU - Perrin, Ellen

AU - Sakai, Christina

AU - Bednarek, Frank

AU - Ehrenkranz, Richard

AU - Benjamin, Jennifer

AU - Montgomery, Angela

AU - O’Shea, T. Michael

AU - Washburn, Lisa

AU - Gogcu, Semsa

AU - Bose, Carl

AU - Warner, Diane

AU - Engelke, Steve

AU - Higginson, Amanda

AU - Higginson, Jason

AU - Bear, Kelly

AU - Poortenga, Mariel

AU - Pastyrnak, Steve

AU - Karna, Padu

AU - Paneth, Nigel

AU - Lenski, Madeleine

AU - Schreiber, Michael

AU - Hunter, Scott

AU - Msall, Michael

AU - Batton, Danny

AU - Klarr, Judith

AU - Lee, Young Ah

AU - Obeid, Rawad

AU - Christianson, Karen

AU - Klein, Deborah

AU - Wagner, Katie

AU - Pimental, Maureen

PY - 2022/9/1

Y1 - 2022/9/1

N2 - Background: Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives: To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods: 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analysed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results: Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions: Greater maternal social disadvantage and lower gestational age are associated with less favourable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate the risk of poor cognitive outcomes among EP-born adolescents.

AB - Background: Children born extremely preterm (EP) are at increased risk of cognitive deficits that persist into adulthood. Few large cohort studies have examined differential impairment of cognitive function in EP-born adolescents in relation to early life risk factors, including maternal social disadvantage, gestational age at delivery, and neonatal morbidities prevalent among EP neonates. Objectives: To assess cognitive abilities in relation to early life risk factors in an EP-born cohort at 15 years of age. Methods: 681 of 1198 surviving participants (57%) enrolled from 2002 to 2004 in the Extremely Low Gestational Age Newborn Study returned at age 15 years for an assessment of cognitive abilities with the Wechsler Abbreviated Scale of Intelligence-II and the NIH Toolbox Cognition Battery (NTCB) verbal cognition and fluid processing composites, the latter of which measured executive functions and processing speed. Three cognitive outcomes, WASI-II IQ, NTCB verbal cognition, and NTCB fluid processing, were analysed for associations with maternal social disadvantage and gestational age. Mediation of maternal social disadvantage by gestational age and mediation of gestational age by neonatal morbidities were also examined. Results: Test scores were lower for NTCB fluid processing relative to IQ and NTCB verbal abilities. Social disadvantage and gestational age were associated with all three cognitive outcomes. Mediation analyses indicated partial mediation of gestational age associations with all three outcomes by neonatal morbidities but did not support mediation by gestational age of social risk associations with cognitive outcomes. Conclusions: Greater maternal social disadvantage and lower gestational age are associated with less favourable cognitive outcomes among EP-born adolescents at 15 years of age. Neonatal morbidities partially mediate associations between lower gestational age and cognitive outcomes. These findings highlight the need for improved medical and remedial interventions to mitigate the risk of poor cognitive outcomes among EP-born adolescents.

KW - adolescent

KW - cognition

KW - cohort studies

KW - extremely preterm birth

KW - neuropsychological tests

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=85130275171&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85130275171&partnerID=8YFLogxK

U2 - 10.1111/ppe.12893

DO - 10.1111/ppe.12893

M3 - Article

C2 - 36530363

AN - SCOPUS:85130275171

SN - 0269-5022

VL - 36

SP - 654

EP - 664

JO - Paediatric and Perinatal Epidemiology

JF - Paediatric and Perinatal Epidemiology

IS - 5

ER -

Maternal social risk, gestational age at delivery, and cognitive outcomes among adolescents born extremely preterm

Abstract

Keywords

ASJC Scopus subject areas

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