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Delivery at 37 weeks' gestation is associated with a higher risk for child behavioural problems

Authors

  • Monique Robinson,

    Corresponding author
    1. School of Psychology, The University of Western Australia, Perth, Western Australia, Australia
    • Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • Andrew J.O. Whitehouse,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
    2. School of Psychology, The University of Western Australia, Perth, Western Australia, Australia
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  • Stephen R. Zubrick,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • Craig E. Pennell,

    1. School of Women's and Infants' Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Western Australia, Australia
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  • Peter Jacoby,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • Neil J. McLean,

    1. School of Psychology, The University of Western Australia, Perth, Western Australia, Australia
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  • Wendy H. Oddy,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • Geoffrey Hammond,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • Fiona J. Stanley,

    1. Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
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  • John P. Newnham

    1. School of Women's and Infants' Health, The University of Western Australia at King Edward Memorial Hospital, Perth, Western Australia, Australia
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Correspondence: Dr Monique Robinson, Telethon Institute for Child Health Research, PO Box 855, West Perth, WA 6872 Australia. Email: moniquer@ichr.uwa.edu.au

Abstract

Background

Advances in obstetric care have been accompanied by increasing rates of intervention which often involve elective delivery at 37 weeks, soon after term gestation has been achieved.

Aim

The aim of this study was to examine the behavioural sequelae for children born at this early term gestational age compared with those born at later weeks.

Methods

The Western Australian Pregnancy Cohort (Raine) Study provided comprehensive obstetric data from 2900 pregnancies. Offspring were followed up at ages two, five, eight, 10, 14 and 17 years using the parent report Child Behaviour Checklist (CBCL) with clinical cutoffs for overall, internalising (withdrawn, somatic complaints, anxious/depressed) and externalising (delinquent, aggressive) behaviour (T-score ≥ 60). We used longitudinal logistic regression models incorporating generalised estimating equations (GEE) with step-wise adjustment for ante-, peri- and postnatal confounding factors.

Results

Approximately 9% of our cohort was born within the range of 370/7 and 376/7 weeks. Those born at 37 weeks' gestation were at increased risk for overall (OR = 1.43, 95% CI = 1.02, 2.01) and externalising (OR = 1.42, 95% CI = 1.01, 2.01) behavioural problems in the fully adjusted model when compared with infants born from 39 weeks onwards. Infants born late preterm (34–36 weeks) and at 38 weeks did not show a significantly increased risk for behavioural problems.

Conclusion

Infants born at 37 weeks' gestation are at increased risk for behavioural problems over childhood and adolescence compared with those born later in gestation. We suggest that 37 weeks' gestation may not be the optimal cutoff for defining perinatal risk as it applies to behavioural development.

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