Population Study Article | Published:

Early life antecedents of positive child health among 10-year-old children born extremely preterm

Pediatric Research (2019) | Download Citation

Subjects

Abstract

Background

To identify modifiable antecedents during pre-pregnancy and pregnancy windows associated with a positive child health at 10 years of age.

Methods

Data on 889 children enrolled in the Extremely Low Gestational Age Newborn (ELGAN) study in 2002–2004 were analyzed for associations between potentially modifiable maternal antecedents during pre-pregnancy and pregnancy time windows and a previously described positive child health index (PCHI) score at 10 years of age. Stratification by race was also investigated for associations with investigated antecedents.

Results

Factors associated with higher PCHI (more positive health) included greater gestational age, birth weight, multiple gestation, and medical interventions, including assisted reproduction and cervical cerclage. Factors associated with lower PCHI included correlates of lower socioeconomic status, pre-pregnancy chronic medical disorders in the mother such as pre-pregnancy body mass index (BMI), and maternal asthma. When stratified by race, variation in significant results was observed.

Conclusions

Among children born extremely preterm, medical interventions and higher socioeconomic status were associated with improved PCHI, while chronic illness and high BMI in the mother is associated with lower PCHI at 10 years of age. Knowledge of such antecedent factors could inform efforts to develop interventions that promote positive child health outcomes in future pregnancies.

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Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the ELGAN study are given below the Acknowledgments.

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Acknowledgments

We gratefully acknowledge the contributions of the ELGAN subjects the ELGAN subjects’ families, as well as the colleagues listed below. This study was supported by grants from the National Institute of Neurological Disorders and Stroke (5U01NS040069-05; 2R01NS040069-06A2), the National Institute of Child Health and Human Development (5R01HD092374-02 and 5P30HD018655-34), the Office of the NIH Director (1UG3OD023348-01), NIH training grant (T32-ES007018), and National Institute of Nursing Research (1K23NR017898-01).

ELGAN-2 Members

Project Lead for ELGAN-2: Julie V. Rollins, MA.

Site Principal Investigators

Baystate Medical Center, Springfield, MA: Bhahvesh Shah, MD; Rachana Singh, MD, MS. Boston Children’s Hospital, Boston, MA: Linda Van Marter, MD, MPH and Camilla Martin, MD, MPH; Janice Ware, Ph.D. Tufts Medical Center, Boston, MA: Cynthia Cole, MD; Ellen Perrin, MD. University of Massachusetts Medical School, Worcester, MA: Frank Bednarek, MD; Jean Frazier, MD. Yale University School of Medicine, New Haven, CT: Richard Ehrenkranz, MD; Jennifer Benjamin, MD. Wake Forest University, Winston-Salem, NC: T. Michael O’Shea, MD, MPH. Wake Forest University, Winston-Salem, NC: T. Michael O’Shea, MD, MPH. University of North Carolina, Chapel Hill, NC: Carl Bose, MD; Diane Warner, MD, MPH. East Carolina University, Greenville, NC: Steve Engelke, MD. Helen DeVos Children’s Hospital, Grand Rapids, MI: Mariel Poortenga, MD; Steve Pastyrnak, Ph.D. Sparrow Hospital, East Lansing, MI: Padu Karna, MD; Nigel Paneth, MD, MPH; Madeleine Lenski, MPH. University of Chicago Medical Center, Chicago, IL: Michael Schreiber, MD; Scott Hunter, Ph.D; Michael Msall, MC. William Beaumont Hospital, Royal Oak, MI: Danny Batton, MD; Judith Klarr, MD.

Site Study Coordinators

Baystate Medical Center, Springfield, MA: Karen Christianson, RN; Deborah Klein, BSM, RN. Boston Children’s Hospital, Boston MA: Maureen Pimental, BA; Collen Hallisey, BA; Taryn Coster, BA. Tufts Medical Center, Boston, MA: Ellen Nylen, RN; Emily Neger, MA; Kathryn Mattern, BA. University of Massachusetts Medical School, Worcester, MA: Lauren Venuti, BA; Beth Powers, RN; Ann Foley, EdM. Yale University School of Medicine, New Haven, CT: Joanne Williams, RN; Elaine Romano, APRN. Wake Forest University, Winston-Salem, NC: Debbie Hiatt, BSN (deceased); Nancy Peters, RN; Patricia Brown, RN; Emily Ansusinha, BA. University of North Carolina, Chapel Hill, NC: Gennie Bose, RN; Janice Wereszczak, MSN; Janice Bernhardt, MS, RN. East Carolina University, Greenville, NC: Joan Adams (deceased); Donna Wilson, BA, BSW. Nancy Darden-Saad, BS, RN. Helen DeVos Children’s Hospital, Grand Rapids, MI: Dinah Sutton, RN; Julie Rathbun, BSW, BSN. Sparrow Hospital, East Lansing, MI: Karen Miras, RN, BSN; Deborah Weiland, MSN. University of Chicago Medical Center, Chicago, IL: Grace Yoon, RN; Rugile Ramoskaite, BA; Suzanne Wiggins, MA; Krissy Washington, MA; Ryan Martin, MA; Barbara Prendergast, BSN, RN. William Beaumont Hospital, Royal Oak, MI: Beth Kring, RN.

Psychologists

Baystate Medical Center, Springfield, MA: Anne Smith, Ph.D.; Susan McQuiston, Ph.D. Boston Children’s Hospital: Samantha Butler, Ph.D.; Rachel Wilson, Ph.D.; Kirsten McGhee, Ph.D.; Patricia Lee, Ph.D.; Aimee Asgarian, Ph.D.; Anjali Sadhwani, Ph.D.; Brandi Henson, PsyD. Tufts Medical Center, Boston MA: Cecelia Keller, PT, MHA; Jenifer Walkowiak, Ph.D.; Susan Barron, Ph.D. University of Massachusetts Medical School, Worcester MA: Alice Miller, PT, MS; Brian Dessureau, Ph.D.; Molly Wood, Ph.D.; Jill Damon-Minow, Ph.D. Yale University School of Medicine, New Haven, CT: Elaine Romano, MSN; Linda Mayes, Ph.D.; Kathy Tsatsanis, Ph.D.; Katarzyna Chawarska, Ph.D.; Sophy Kim, Ph.D.; Susan Dieterich, Ph.D.; Karen Bearrs, Ph.D. Wake Forest University Baptist Medical Center, Winston-Salem NC: Ellen Waldrep, MA; Jackie Friedman, Ph.D.; Gail Hounshell, Ph.D.; Debbie Allred, Ph.D. University Health Systems of Eastern Carolina, Greenville, NC: Rebecca Helms, Ph.D.; Lynn Whitley, Ph.D. Gary Stainback, Ph.D. University of North Carolina at Chapel Hill, NC: Lisa Bostic, OTR/L; Amanda Jacobson, PT; Joni McKeeman, Ph.D.; Echo Meyer, Ph.D. Helen DeVos Children’s Hospital, Grand Rapids, MI: Steve Pastyrnak, Ph.D. Sparrow Hospital, Lansing, MI: Joan Price, EdS; Megan Lloyd, MA, EdS. University of Chicago Medical Center, Chicago, IL: Susan Plesha-Troyke, OT; Megan Scott, Ph.D. William Beaumont Hospital, Royal Oak, MI: Katherine M. Solomon, Ph.D.; Kara Brooklier, Ph.D.; Kelly Vogt, Ph.D.

Author information

Author notes

  1. These authors contributed equally: Jacqueline T. Bangma, Evan Kwiatkowski

Affiliations

  1. Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    • Jacqueline T. Bangma
    •  & Rebecca C. Fry
  2. Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    • Evan Kwiatkowski
    •  & Matt Psioda
  3. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    • Hudson P. Santos Jr.
  4. Department of Allied Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    • Stephen R. Hooper
  5. Department of Pediatrics, Boston Medical Center, Boston, MA, USA

    • Laurie Douglass
  6. Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA

    • Robert M. Joseph
  7. Eunice Kennedy Shriver Center, Department of Psychiatry, University of Massachusetts Medical School/University of Massachusetts Memorial Health Care, Worcester, MA, USA

    • Jean A. Frazier
  8. Department of Pediatrics, Division of Pediatric Neurology, Boston University Medical Center, Boston, MA, USA

    • Karl C. K. Kuban
  9. Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA

    • Thomas M. O’Shea

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Consortia

  1. for the ELGAN Investigators

    Contributions

    All authors listed on this manuscript contributed to all three types of substantial contributions listed in Pediatric Research instructions to authors. Bi-weekly conference calls were held throughout the processes of brainstorming, method development, writing, and reviewing of this manuscript in which all authors participated.

    Competing interests

    The authors declare no competing interests.

    Corresponding author

    Correspondence to Jacqueline T. Bangma.

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    DOI

    https://doi.org/10.1038/s41390-019-0404-x