Elsevier

Early Human Development

Volume 132, May 2019, Pages 45-51
Early Human Development

A longitudinal study of antenatal and perinatal risk factors in early childhood cognition: Evidence from Growing Up in New Zealand

https://doi.org/10.1016/j.earlhumdev.2019.04.001Get rights and content

Highlights

  • 4587 children of a longitudinal study who had adverse perinatal environments had an increased likelihood of poor cognitive abilities at 4.5 years.

  • Smoking during pregnancy, no folate intake during first trimester and low birth weight were risk factors for poor executive control.

  • Perceived stress during pregnancy, no folate intake during first trimester and low birth weight were all risk factors for poor motor ability.

  • Smoking pre-pregnancy, antenatal anxiety and no folate intake during first trimester were risk factors for poor receptive language ability.

Abstract

Background

Poor maternal health, disadvantageous exposures during pregnancy and unfavourable perinatal events are associated with adverse trajectories in offspring cognitive development.

Aim

To examine longitudinal associations between antenatal maternal, perinatal and maternal health characteristics and children's early cognitive development across executive control, motor ability and receptive language domains.

Study design, subjects and outcome measures

Analyses comprised interview and observational data from 4587 children and their mothers enrolled in the longitudinal Growing Up in New Zealand cohort study. Children's executive control (Luria hand clap task), motor skills (mothers' report) and receptive language ability (Peabody Picture Vocabulary Test) were assessed at age 4.5 years. Multivariate logistic regression analyses were conducted, controlling for sociodemographic factors.

Results

Smoking pre- and during pregnancy, no folate intake during first trimester and low birth weight were risk factors for poorer executive control. Perceived stress during pregnancy, no folate intake during first trimester and low birth weight were all risk factors for poorer motor ability. Smoking pre-pregnancy, antenatal anxiety and no folate intake during first trimester were risk factors for poorer receptive language ability.

Conclusion

Adverse ante- and perinatal environments are associated with poorer executive control, motor and receptive language abilities in early childhood. Improving maternal education and support especially for more disadvantaged mothers during pregnancy may reduce the potential deleterious impact of adverse ante- and perinatal conditions on children's early cognition.

Introduction

Cognitive inequalities probably begin in utero. The antenatal environment is a critical period for foetal brain development with a variety of risk factors potentially altering or hindering developmental processes which is known as the Developmental Origins of Health and Disease (DOHaD) approach [1,2]. By identifying those conditions, adverse factors that may hinder optimal cognitive development and educational life course early on could be prevented more targeted alongside promoting those factors with a beneficial potential for offspring cognitive functioning. Established research details how foetal exposure to various elements during gestation and the early postnatal period may affect physical and mental health development with persisting consequences [2,3].

There is substantial research on the negative influence of teratogenic exposure, especially alcohol and nicotine, during pregnancy on offspring cognition, i.e. reductions in executive functioning, working memory, verbal ability and motor skills [4,5]. Recent research suggests that not only heavy but any alcohol consumption throughout pregnancy can impact the development of the foetus [6,7]. Likewise, findings have emerged suggesting passive cigarette smoke exposure has similar detrimental effects as maternal smoking during pregnancy [8]. The link between BMI and offspring cognition is tenuous, with some evidence suggesting that maternal overweight and obesity during pregnancy has detrimental effects on cognitive abilities in offspring [9].

Maternal stress, anxiety and depression are the most commonly experienced mental health issues in women of childbearing age and these factors are often negatively associated with offspring cognitive functioning [10,11]. Furthermore, maternal nutrition appears to have critical implications for the development of the foetus with folic acid or folate being among the most important vitamins during pregnancy [12].

Regarding the role of adverse perinatal events, infants born preterm show an increased risk for poorer cognitive status and language development at school age, compared to offspring born at term [13]. Related, children born at a low birth weight appear to have poorer outcomes in cognitive abilities during early to middle childhood compared to average birth weight infants [14]. Some research suggests that medically assisted births (e.g. planned and emergency caesarean section) are associated with lower cognitive abilities in offspring [15]. Complications during and shortly after birth (e.g. asphyxia) have been found to have significant negative impacts on offspring cognitive development [16].

In summary, while numerous associations between adverse antenatal and perinatal conditions and offspring cognitive functioning have been found, most of the research has focused on observing the effects of risk factors separately. As such, the multivariable and longitudinal perspective of effects on various cognitive domains in early childhood requires further investigation. This is crucial in order to be able to draw conclusions about individual influences since adverse antenatal and perinatal conditions are likely to co-occur and interrelate with each other. Our research therefor aims to investigate the impact of various antenatal and perinatal factors including teratogens, maternal mental and physical health as well as perinatal aspects on the cognitive domains of receptive language, executive functioning and motor development in preschool children at 4.5 years of age. We hypothesise that poorer maternal mental and physical health during pregnancy and adverse perinatal events will be associated with an increased risk of poorer cognitive performance. Our results will help develop our understanding of some of the factors that are significant predictors of below average cognitive performance while accounting for some key potentially confounding social-demographic aspects. Our research is well placed in our current longitudinal study comprising comprehensive antenatal information as well as observations on early childhood cognition in a large, diverse and representative sample of NZ births.

Section snippets

Participants

Study participants were enrolled in the longitudinal, Growing Up in New Zealand cohort study. Details of the study's design and recruitment procedure can be found elsewhere [17]. Briefly summarized, the study's cohort comprises a socioeconomically and ethnically diverse sample of births recruited via 6822 pregnant woman from three contiguous District Health Board regions in New Zealand who had expected delivery dates between 25th April 2009 and 25th March 2010 [17]. The cohort has subsequently

Results

Compared with complete cases, child participants with missing data were more likely to have younger mothers (≤31 years), to live in an urban and highly deprived area, to be of male gender and that the pregnancy was planned; their mothers were less likely to be of European ethnicity and to have higher education (Chi-square test p < .01). Of the complete cases, 882 children (19.2%) showed a performance below average in the executive control task, 719 children (15.7%) demonstrated lower motor

Discussion

Our study revealed that below average performance in three cognitive domains in 4.5 year-old children was associated with a variety of antenatal and perinatal risk factors. A total of 19.2% performed below average in the executive control task, 15.7 could not hop on one foot, and 20% performed below average in receptive language ability. It should be noted that we are not using clinical markers of cognitive delay. We have simply identified the lowest end of the normal distribution of cognitive

Conclusion

The current study revealed that the ante- and perinatal environment has substantial effects on early childhood language, executive control and motor abilities. We found that both maternal physical and mental health during pregnancy are relevant for cognitive abilities in offspring at 4.5 years. Particularly, smoking pre- and during pregnancy increase the risk for cognitive underperformance in preschool children. We also confirm the crucial role of folate intake during first trimester of

Acknowledgements

Growing Up in New Zealand has been funded by the New Zealand Ministries of Social Development, Health, Education, Justice and Pacific Island Affairs; the former Ministry of Science Innovation and the former Department of Labour (now both part of the Ministry of Business, Innovation and Employment); the former Ministry of Women's Affairs (now the Ministry for Women/-); the Department of Corrections; the Families Commission (now known as the Social Policy Evaluation and Research Unit); Te Puni

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