Association between prenatal maternal anxiety and/or stress and offspring's cognitive functioning : a meta‐analysis

This meta-analysis examined the relationship between prenatal maternal stress and/or anxiety and the outcomes of children aged 3 months to 9 years. Of the 8754 studies published before June 2021 that were synthesized, 17 conducted in Western countries were included in the meta-analysis (Ntotal = 23,307; Mmales 54%; Methnicity White 77%, Pacific 15%, African American/Black 10%, Middle Eastern 7%, Eastern 8%). Effect sizes ranged from −0.41 to 0.15. A weak negative association was found between prenatal stress and/or anxiety exposure and children's general intellectual development. Associations varied based on the type of exposure. Findings are limited to developed counties and cannot be generalized to low- and middle-income countries. Directions for maternal prenatal intervention and future studies are discussed

The interrelatedness of cognitive abilities in very preterm and full‐term born children at 5.5 years of age : a psychometric network analysis approach

Background Very preterm (VP) birth is associated with a considerable risk for cognitive impairment, putting children at a disadvantage in academic and everyday life. Despite lower cognitive ability on the group level, there are large individual differences among VP born children. Contemporary theories define intelligence as a network of reciprocally connected cognitive abilities. Therefore, intelligence was studied as a network of interrelated abilities to provide insight into interindividual differences. We described and compared the network of cognitive abilities, including strength of interrelations between and the relative importance of abilities, of VP and full-term (FT) born children and VP children with below-average and average-high intelligence at 5.5 years. Methods A total of 2,253 VP children from the EPIPAGE-2 cohort and 578 FT controls who participated in the 5.5-year-follow-up were eligible for inclusion. The WPPSI-IV was used to measure verbal comprehension, visuospatial abilities, fluid reasoning, working memory, and processing speed. Psychometric network analysis was applied to analyse the data. Results Cognitive abilities were densely and positively interconnected in all networks, but the strength of connections differed between networks. The cognitive network of VP children was more strongly interconnected than that of FT children. Furthermore, VP children with below average IQ had a more strongly connected network than VP children with average-high IQ. Contrary to our expectations, working memory had the least central role in all networks. Conclusions In line with the ability differentiation hypothesis, children with higher levels of cognitive ability had a less interconnected and more specialised cognitive structure. Composite intelligence scores may therefore mask domain-specific deficits, particularly in children at risk for cognitive impairments (e.g., VP born children), even when general intelligence is unimpaired. In children with strongly and densely connected networks, domain-specific deficits may have a larger overall impact, resulting in lower intelligence levels

Academic performance of children born preterm : a meta-analysis and meta-regression

Background: Advances in neonatal healthcare have resulted in decreased mortality after preterm birth but have not led to parallel decreases in morbidity. Academic performance provides insight in the outcomes and specific difficulties and needs of preterm children. Objective: To study academic performance in preterm children born in the antenatal steroids and surfactant era and possible moderating effects of perinatal and demographic factors. Design: PubMed, Web of Science and PsycINFO were searched for peer-reviewed articles. Cohort studies with a full-term control group reporting standardised academic performance scores of preterm children (<37 weeks of gestation) at age 5 years or older and born in the antenatal steroids and surfactant era were included. Academic test scores and special educational needs of preterm and full-term children were analysed using random effects meta-analysis. Random effects meta-regressions were performed to explore the predictive role of perinatal and demographic factors for between-study variance in effect sizes. Results: The 17 eligible studies included 2390 preterm children and 1549 controls. Preterm children scored 0.71 SD below full-term peers on arithmetic (p<0.001), 0.44 and 0.52 SD lower on reading and spelling (p<0.001) and were 2.85 times more likely to receive special educational assistance (95% CI 2.12 to 3.84, p<0.001). Bronchopulmonary dysplasia explained 44% of the variance in academic performance (p=0.006). Conclusion: Preterm children born in the antenatal steroids and surfactant era show considerable academic difficulties. Preterm children with bronchopulmonary dysplasia are at particular risk for poor academic outcome

Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT)

Background Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants’ neural plasticity. Methods/design The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. Discussion Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. Trial registration Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov)

Behavioural and educational outcomes following extremely preterm birth : current controversies and future directions

As a consequence of improved survival rates for extremely preterm (EP; <28 weeks of gestation) births, there is a growing body of evidence detailing the impact of extreme prematurity on outcomes throughout childhood and adolescence. Historically, attention first focused on documenting rates of sensory impairments and severe neurodevelopmental disabilities. However, over recent years, there has been growing interest in the impact of EP birth on long term mental health and educational outcomes. In this chapter we review literature relating to the impact of EP birth on attention, social and emotional problems, psychiatric disorders and educational outcomes. We also outline current controversies in the field. In particular, we present emergent research exploring developmental trajectories to determine whether the sequelae associated with EP birth represent a developmental delay or persistent deficit, and we consider what approaches to intervention may be most fruitful in improving behavioural and educational outcomes in this population

Need for Further Analysis in Cognitive Outcomes of Children Born Preterm-Reply

We appreciate the responses by Chen and Li and Chen and Liu to our meta-analysis. Chen and Li suggest that the databases we searched may have resulted in selection bias and possibly false conclusions. We carefully chose PubMed, Web of Science, and PsycINFO for our search. These databases cover biomedical, social, behavioral, and mental health research. This is important because our research question is not solely medical but rather has a multidisciplinary character. Despite considerable overlap, we agree EMBASE is a valuable addition to PubMed for biomedical research. However, because of the multidisciplinary research question, we deemed a search across multiple disciplines more important than searching multiple database in the same field. An earlier meta-analysis searched both EMBASE and PubMed but identified no additional unique cohorts compared with ours. A 2018 meta-analysis covering the same research question included 44 studies compared with 71 studies in our meta-analysis while searching the same databases. Altogether, we believe we did as much as possible to minimize risk of selection bias and we feel confident our study covered the most relevant studies available. Moreover, our results are in line with previous meta-analyses. Nevertheless, we acknowledge that selection bias is an important concern in meta-analysis that received our full attention

Neurocognitive processes underlying academic difficulties in very preterm born adolescents

Very preterm birth is associated with academic difficulties, but the underlying neurocognitive mechanisms of these difficulties remain largely unclear. The present study aimed to assess the role of working memory (WM), attentional processes, and processing speed in academic difficulties of very preterm born adolescents at 13 years. Participants included 55 very preterm and 61 full-term adolescents. Academic performance, visuospatial WM, alerting, orienting, executive attention, sustained attention, and processing speed (simple and choice reaction time [RT]) were compared between groups. Mediation analyses with multiple, parallel mediators were performed to examine whether these functions mediate the relation between very preterm birth and academic performance. Very preterm born adolescents showed poorer reading comprehension, arithmetic, visuospatial WM, alerting, sustained attention, and choice RT than full-term controls. The relationship between very preterm birth and arithmetic was mediated by visuospatial WM, sustained attention, and choice RT. The relationship between very preterm birth and reading comprehension was mediated by visuospatial WM and choice RT. The findings indicate that very preterm birth affects arithmetic and reading comprehension through its negative effect on visuospatial WM, sustained attention, and processing speed. These neurocognitive processes may identify very preterm born children at risk for academic difficulties and could serve as targets for interventions

Neurocognitive processes underlying academic difficulties in very preterm born adolescents

Very preterm birth is associated with academic difficulties, but the underlying neurocognitive mechanisms of these difficulties remain largely unclear. The present study aimed to assess the role of working memory (WM), attentional processes, and processing speed in academic difficulties of very preterm born adolescents at 13 years. Participants included 55 very preterm and 61 full-term adolescents. Academic performance, visuospatial WM, alerting, orienting, executive attention, sustained attention, and processing speed (simple and choice reaction time [RT]) were compared between groups. Mediation analyses with multiple, parallel mediators were performed to examine whether these functions mediate the relation between very preterm birth and academic performance. Very preterm born adolescents showed poorer reading comprehension, arithmetic, visuospatial WM, alerting, sustained attention, and choice RT than full-term controls. The relationship between very preterm birth and arithmetic was mediated by visuospatial WM, sustained attention, and choice RT. The relationship between very preterm birth and reading comprehension was mediated by visuospatial WM and choice RT. The findings indicate that very preterm birth affects arithmetic and reading comprehension through its negative effect on visuospatial WM, sustained attention, and processing speed. These neurocognitive processes may identify very preterm born children at risk for academic difficulties and could serve as targets for interventions

Neurocognitive processes underlying academic difficulties in very preterm born adolescents

Very preterm birth is associated with academic difficulties, but the underlying neurocognitive mechanisms of these difficulties remain largely unclear. The present study aimed to assess the role of working memory (WM), attentional processes, and processing speed in academic difficulties of very preterm born adolescents at 13 years. Participants included 55 very preterm and 61 full-term adolescents. Academic performance, visuospatial WM, alerting, orienting, executive attention, sustained attention, and processing speed (simple and choice reaction time [RT]) were compared between groups. Mediation analyses with multiple, parallel mediators were performed to examine whether these functions mediate the relation between very preterm birth and academic performance. Very preterm born adolescents showed poorer reading comprehension, arithmetic, visuospatial WM, alerting, sustained attention, and choice RT than full-term controls. The relationship between very preterm birth and arithmetic was mediated by visuospatial WM, sustained attention, and choice RT. The relationship between very preterm birth and reading comprehension was mediated by visuospatial WM and choice RT. The findings indicate that very preterm birth affects arithmetic and reading comprehension through its negative effect on visuospatial WM, sustained attention, and processing speed. These neurocognitive processes may identify very preterm born children at risk for academic difficulties and could serve as targets for interventions