Page 66 - Sample Moderate prematurity, socioeconomic status, and neurodevelopment in early childhood

Chapter 7
depression, and parental history of CHD mortality. Full adjustment for lifestyle- associated factors largely attenuated the increased risk, and tests for mediation showed that the association between poor emotion regulation and CHD in the majority of the population was mainly through smoking, education, and cardiorespiratory fitness. Unexpectedly, we found that the association between poor emotion regulation and CHD was more pronounced in participants with a parental history of CHD than in those without, showing that the effect of poor emotion regulation on CHD goes beyond lifestyle-associated factors.
DISCUSSION OF THE MAIN FINDINGS
Neurodevelopmental problems in MP children with low SES: some possible explanations
In Chapters 2 and 4 we found that moderate prematurity and low SES had separate effects on most developmental and behavioural outcomes. In other words, MP children are at risk of neurodevelopmental problems and low family SES further increases this risk. This finding coincides with other recent population- based studies: the effects of moderate prematurity seem to be robust, with low SES acting as an additional risk factor that contributes significantly to poorer neurodevelopmental outcomes.1, 2
Moderate prematurity and low SES may lead to neurodevelopmental problems via the following three pathways: 1) prenatal influences, 2) parental well-being and parental involvement during the pre-school years, and 3) disruptive effects of moderate prematurity and low SES on brain development. Many of the factors involved in these pathways have been linked to moderate prematurity as well as to low SES, suggesting common aetiological grounds.
Prenatal influences
Several prenatal factors, such as smoking, poor nutrition, and inadequate use of prenatal care, may lead to poorer neurodevelopmental outcomes in preterm-born and low SES children. These socioeconomically graded factors increase the risk of spontaneous preterm birth and other adverse pregnancy outcomes.3, 4 We also know that antenatal maternal stress and anxiety contribute for approximately 15% to developmental and behavioural problems in offspring.5 Psychological stress during pregnancy is a strong and consistent risk factor for preterm birth, and
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