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Prenatal risk phenotypes and neurodevelopmental outcomes among infants born very preterm

Fri, March 24, 12:00 to 1:30pm, Salt Palace Convention Center, Floor: 1, Meeting Room 150 G

Abstract

Adverse prenatal conditions contribute to risk of preterm birth and may exacerbate negative outcomes for infants born preterm (e.g., Hofheimer et al., 2020). Prior studies identified different groups of women who experience elevated physical (e.g., hypertension) or psychological (e.g., depression, anxiety) risk factors during pregnancy and found varied associations between these prenatal risk phenotypes and neonatal behavior (Walsh et al., 2019). We found similar prenatal risk phenotypes in our sample of very preterm infants (Camerota et al., 2021). What is unknown is how these prenatal risk phenotypes are associated with neurodevelopmental outcomes in very preterm infants. We hypothesized that infants born to mothers with elevated physical or psychological risk phenotypes will have worse neurodevelopmental outcomes compared to infants born to mothers with a low-risk phenotype.

We studied infants from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, a multi-site investigation of infants born < 30 weeks GA. There were 704 newborns enrolled in NOVI; of these 679 (96%) had neonatal outcome data and 556 (79%) had 24-month follow-up data. Using maternal report and medical record abstraction, we identified 24 prenatal risk factors including demographic, medical, substance use, and psychological variables. We previously conducted latent class analysis on these variables and found a three-class solution (Camerota et al., 2021). We found a typical/low-risk group (61%) with few prenatal risk factors, a physical risk group (26%) with elevated physical health problems, and a psychological risk group (13%) with elevated substance use and psychological problems (Figure 1).

At discharge, infants were examined using the NICU Network Neurobehavioral Scales (NNNS), a standardized neurobehavioral assessment. We previously applied latent profile analysis to the 12 NNNS summary scores and found two dysregulated profiles: a hypo-aroused (23%) and a hyper-aroused (7%) profile; McGowan et al., 2020). At 24 months, infants were evaluated using the Bayley Scales of Infant and Toddler Development (Bayley-III) and the Child Behavior Checklist (CBCL). Outcomes of interest included dysregulated NNNS profiles (hypo- or hyper-aroused), moderate (<1SD below mean) or severe (<2SD below mean) Bayley-III cognitive, motor, or language delay, and clinically-elevated (T>63) CBCL behavior problems. We used generalized estimating equations to examine associations between prenatal risk phenotypes and infant outcomes.

Associations between prenatal risk phenotypes and infant outcomes are summarized in Table 1. Infants born to mothers in the psychological risk group were at increased risk for dysregulated neonatal neurobehavior (OR = 2.04; 95% CI = 1.08 to 3.87), severe motor delay (OR = 3.80, 95% CI = 1.48 to 9.75), and clinically-elevated externalizing problems (OR = 2.54, 95% CI = 1.16 to 5.56) compared to infants born to mothers in the low-risk group. Infants born to mothers in the physical risk group were also more likely to have severe motor delay (OR = 2.70, 95% CI = 1.07 to 6.85) compared to infants born to mothers in the low-risk group.

High risk prenatal phenotypes are associated with adverse neurobehavioral outcomes for infants born extremely preterm. This information could help pinpoint preterm infants at risk for poor developmental outcome.

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