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Buesa J, Lizaran M, Almansa B, Ghosn F, Campos-Berga L, Hervás D, Andreu J, Sierra P, Livianos L, Vento M, Diago V, García-Blanco A. Understanding the course of attention deficit hyperactivity disorder in children born after a threatened preterm labor: a 6-year cohort study. Am J Obstet Gynecol MFM 2024; 6:101289. [PMID: 38280551 DOI: 10.1016/j.ajogmf.2024.101289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Recent research suggests that children born after suspected preterm labor may observe a potential cluster with different attention deficit hyperactivity disorder features, depending on the time of birth. However, the evolution of symptoms and their predictors remain unknown in this population. OBJECTIVE This study aimed to examine the trajectories of attention deficit hyperactivity disorder symptoms of children born after suspected preterm labor, between ages 2 and 6 years, considering prematurity condition and comparing with controls. In addition, this study aimed to find potential modifiable predictors of evolution to enhance prognosis. STUDY DESIGN In this prospective cohort study, 119 mother-child pairs who experienced suspected preterm labor and 60 controls were included. Patients were divided according to prematurity condition in full term (n=27), late preterm (n=55), and very preterm (n=37). Attention deficit hyperactivity disorder symptoms were assessed at ages 2 and 6 years. The association between potential modifying factors (group, time of assessment, sex, birthweight percentile, maternal history of trauma, maternal anxiety at diagnosis, and maternal anxiety during the children's assessments) and disorder trajectories was assessed by adjusting the Bayesian mixed linear models. All analyses were performed in R (version 4.3.0; R Foundation for Statistical Computing, Vienna, Austria). RESULTS An interaction emerged between time and group, with late-preterm neonates born after suspected preterm labor being the only group to improve from ages 2 to 6 years (-2.26 points in Conners scale per percentile decrease and 0.98 probability of effect). Another interaction between time and maternal anxiety at postnatal time assessments intensified over time (0.07 and 0.84). Predictors of symptom severity included lower weight percentile at birth (-0.2 and 0.96), male sex (-2.99 and <0.99), higher maternal anxiety at diagnosis (+0.08 and 0.99), and maternal history of trauma (+0.23 and 0.98). CONCLUSION Unlike very-preterm and full-term children, those born late preterm showed an improvement over time, probably because late-preterm children do not carry the sequelae derived from severe prematurity but benefit from close monitoring. As maternal psychopathology emerged as a determinant modifier of course and severity, it is crucial to develop targeted psychological interventions for pregnant individuals and reevaluate monitoring programs for their offspring, regardless of prematurity.
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Affiliation(s)
- Julia Buesa
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco)
| | - Marta Lizaran
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco)
| | - Belén Almansa
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco)
| | - Farah Ghosn
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco)
| | - Laura Campos-Berga
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco)
| | - David Hervás
- Department of Applied Statistics, Operations Research, and Quality, Universitat Politècnica de Valencia, Valencia, Spain (Dr Hervás)
| | - Julia Andreu
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco)
| | - Pilar Sierra
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco)
| | - Lorenzo Livianos
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco)
| | - Máximo Vento
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Neonatology Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Vento)
| | - Vicente Diago
- Division of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Diago)
| | - Ana García-Blanco
- Mental Health Research Group, La Fe Health Research Institute, Valencia, Spain (Dr Buesa, Mses Lizaran, Almansa, and Ghosn, Drs Campos-Berga, Andreu, Sierra, Livianos, Vento, and García-Blanco); Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain (Dr Buesas, Campos-Berga, Andreu, Sierra, Livianos, and García-Blanco); University of Valencia, Valencia, Spain (Mses Lizaran, Almansa, and Ghosn and Drs Sierra, Livianos, and García-Blanco).
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Roberts JM, King TL, Barton JR, Beck S, Bernstein IM, Buck TE, Forgues-Lackie MA, Facco FL, Gernand AD, Graves CR, Jeyabalan A, Hauspurg A, Manuck TA, Myers JE, Powell TM, Sutton EF, Tinker E, Tsigas E, Myatt L. Care plan for individuals at risk for preeclampsia: shared approach to education, strategies for prevention, surveillance, and follow-up. Am J Obstet Gynecol 2023; 229:193-213. [PMID: 37120055 DOI: 10.1016/j.ajog.2023.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/01/2023]
Abstract
Preeclampsia is a multisystemic disorder of pregnancy that affects 250,000 pregnant individuals in the United States and approximately 10 million worldwide per annum. Preeclampsia is associated with substantial immediate morbidity and mortality but also long-term morbidity for both mother and offspring. It is now clearly established that a low dose of aspirin given daily, beginning early in pregnancy modestly reduces the occurrence of preeclampsia. Low-dose aspirin seems safe, but because there is a paucity of information about long-term effects on the infant, it is not recommended for all pregnant individuals. Thus, several expert groups have identified clinical factors that indicate sufficient risk to recommend low-dose aspirin preventive therapy. These risk factors may be complemented by biochemical and/or biophysical tests that either indicate increased probability of preeclampsia in individuals with clinical risk factors, or more importantly, identify increased likelihood in those without other evident risk. In addition, the opportunity exists to provide this population with additional care that may prevent or mitigate the short- and long-term effects of preeclampsia. Patient and provider education, increased surveillance, behavioral modification, and other approaches to improve outcomes in these individuals can improve the chance of a healthy outcome. We assembled a group with diverse, relevant expertise (clinicians, investigators, advocates, and public and private stakeholders) to develop a care plan in which providers and pregnant individuals at risk can work together to reduce the risk of preeclampsia and associated morbidities. The plan is for care of individuals at moderate to high risk for developing preeclampsia, sufficient to receive low-dose aspirin therapy, as identified by clinical and/or laboratory findings. The recommendations are presented using the GRADE methodology with the quality of evidence upon which each is based. In addition, printable appendices with concise summaries of the care plan's recommendations for patients and healthcare providers are provided. We believe that this shared approach to care will facilitate prevention of preeclampsia and its attendant short- and long-term morbidity in patients identified as at risk for development of this disorder.
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Affiliation(s)
- James M Roberts
- Magee-Womens Research Institute and Clinical and Translational Science Institute, Department of Obstetrics, Gynecology and Reproductive Sciences and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
| | - Tekoa L King
- School of Nursing, University of California, San Francisco, Oakland, CA
| | - John R Barton
- Maternal-Fetal Medicine, Baptist Health, Lexington, KY
| | - Stacy Beck
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, Burlington, VT
| | | | | | - Francesca L Facco
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alison D Gernand
- Nutritional Sciences, Pennsylvania State University, University Park, PA
| | - Cornelia R Graves
- Division of Maternal-Fetal Medicine, University of Tennessee College of Medicine, Nashville, TN
| | - Arundhati Jeyabalan
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Alisse Hauspurg
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Tracy A Manuck
- Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jenny E Myers
- Division of Developmental Biology and Medicine, University of Manchester, Manchester, United Kingdom
| | - Trashaun M Powell
- National Racial Disparity Taskforce, Preeclampsia Foundation and New Jersey Family Planning League, Somerset, NJ
| | | | | | | | - Leslie Myatt
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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Garon-Bissonnette J, Dubois-Comtois K, St-Laurent D, Berthelot N. A deeper look at the association between childhood maltreatment and reflective functioning. Attach Hum Dev 2023; 25:368-389. [PMID: 37131288 DOI: 10.1080/14616734.2023.2207558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/23/2023] [Indexed: 05/04/2023]
Abstract
Childhood maltreatment is theorized as impeding the development of reflective functioning (RF; ability to perceive and interpret oneself and others in terms of mental states). However, previous research typically failed to support this association or yielded small sized and mixed associations. This study aims to provide a deeper look at the association between childhood maltreatment and RF by characterizing two non-mentalizing categories. One-hundred-and-sixteen pregnant women (mean age = 27.62, SD = 4.52) from the community (48.3% with a university degree, 96.5% in a relationship with the other parent) retrospectively reported on childhood abuse and neglect using the Childhood Trauma Questionnaire. They also participated in the Adult Attachment Interview subsequently coded using the Reflective Functioning Scale. Participants with poor to low RF were allocated to one of two groups (disavowal-distancing or distorted-inconsistent) using indicators provided in the RF Scale. No association was found between childhood maltreatment and overall RF when controlling for education level. A multinomial logistic regression revealed that childhood maltreatment was strongly predictive of a disrupted, over-analytical and inconsistent reflection about mental states but not of a tendency to discourse little about mental states. This tendency was rather only predicted by education level. Findings suggest that childhood maltreatment would lead to specific impairments in RF and that not considering how individuals fail to mentalize about attachment relationships may mask strong associations between RF and its determinants and correlates, including childhood maltreatment.
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Affiliation(s)
- Julia Garon-Bissonnette
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- CERVO Brain Research Center, Québec, CAN
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse (CRIPCAS), Montréal, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
| | - Karine Dubois-Comtois
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Centre de recherche, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, CAN
| | - Diane St-Laurent
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Centre de recherche universitaire sur les jeunes et les familles (CRUJeF), Québec, CAN
| | - Nicolas Berthelot
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille (CEIDEF), Trois-Rivières, CAN
- CERVO Brain Research Center, Québec, CAN
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse (CRIPCAS), Montréal, CAN
- Groupe de recherche et d'intervention auprès des enfants vulnérables et négligés (GRIN), Trois-Rivières, CAN
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivières, CAN
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