Browsing by Author "Metcalfe, Amy L"

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    Child Development for Children Born Too Soon: Identifying Mechanisms and Points for Early Intervention
    (2022-06-27) Stephenson, Nikki L; Metcalfe, Amy L; Tough, Suzanne C; McDonald, Sheila; McMorris, Carly, Williamson, Tyler
    Background: The distribution of gestational age at birth has shifted in the last 40 years, such that the incidence of late preterm (?34 but <37 weeks) and early term (?37 and <39 weeks) births have increased, accounting for 30% of all births. Infants born late preterm or early term have an increased risk of adverse health outcomes, developmental delays, social-emotional and behavioural problems; yet, gestational age at birth alone does not include these infants in routine developmental screening programs. The intersection between the increased incidence and increased risk of developmental challenges for children born late preterm and early term accentuates the importance of understanding their specific early childhood developmental outcomes for future intervention. Methods: Using data from the All Our Families cohort, these studies examined the association between gestational age at birth and trajectories of developmental delay throughout early childhood with social-emotional and behavioural problems at age 5. Patterns of developmental delay were explored using group-based trajectory modelling. Multivariable logistic regression was used to analyze social-emotional and behavioural problems at 5 years of age and the modifying effect of childcare.Results: Late preterm and early term birth increase the probability developmental delays, as does poor maternal mental health in pregnancy, identifying as an ethnic minority, advanced maternal age, or being a male child. However, the effects of decreasing gestational age on the risk of developmental delay differ between individual domains of development. Though decreasing gestational age was not independently associated with social-emotional or behavioural problems at age 5 years, there was a significant interaction between type of childcare and gestational age. Instability of childcare at 3 years of age was independently associated with increased behavioural problems at 5 years of age.Conclusion: This study found that late preterm and early term born children have an increased independent risk of developmental delay throughout early childhood, but not social-emotional or behavioural problems. Additional developmental monitoring may be warranted for children who are born <39 weeks gestation. Providing equitable access to high-quality, stable childcare, where routine developmental screening is often standard practice, may better support these children and their families.