Abstract
It remains unknown whether children born at different degrees of prematurity, early term, and post term might have a higher risk of developmental coordination disorder (DCD) compared with completely full-term children (39-40 gestational weeks). To differentiate between suspected DCD in children with different gestational ages based on a national representative sample in China. A retrospective cohort study was conducted in China from April 1, 2018, to December 31, 2019. A total of 152 433 children aged 3 to 5 years from 2403 public kindergartens in 551 cities of China were included in the final analysis. A multilevel regression model was developed to determine the strength of association for different gestational ages associated with suspected DCD when considering kindergartens as clusters. Children's motor performance was assessed using the Little Developmental Coordination Disorder Questionnaire, completed by their parents. Gestational age was determined according to the mother's medical records and divided into 7 categories: completely full term (39 to 40 weeks' gestation), very preterm (<32 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), early term (37-38 weeks), late term (41 weeks), and post term (>41 weeks). A total of 152 433 children aged 3 to 5 years (mean [SD] age, 4.5 [0.8] years), including 80 370 boys (52.7%) and 72 063 girls (47.3%), were included in the study. There were 45 052 children (29.6%) aged 3 years, 59 796 (39.2%) aged 4 years, and 47 585 (31.2%) aged 5 years. Children who were born very preterm (odds ratio [OR], 1.35; 95% CI, 1.23-1.48), moderately preterm (OR, 1.18; 95% CI, 1.02-1.36), late preterm (OR, 1.24; 95% CI, 1.16-1.32), early term (OR, 1.11; 95% CI, 1.06-1.16), and post term (OR, 1.17; 95% CI, 1.07-1.27) were more likely to be classified in the suspected DCD category on the Little Developmental Coordination Disorder Questionnaire than completely full-term children after adjusting for the same characteristics. Additionally, there was no association with suspected DCD in younger (aged 3 years) early-term and postterm children by stratified analyses. In this cohort study, every degree of prematurity at birth, early-term birth, and postterm birth were associated with suspected DCD when compared with full-term birth. These findings have important implications for understanding motor development in children born at different gestational ages. Long-term follow-up and rehabilitation interventions should be considered for children born early and post term.
Highlights
Children who were born very preterm, moderately preterm (OR, 1.18; 95% CI, 1.02-1.36), late preterm (OR, 1.24; 95% CI, 1.16-1.32), early term (OR, 1.11; 95% CI, 1.06-1.16), and post term (OR, 1.17; 95% CI, 1.07-1.27) were more likely to be classified in the suspected Developmental coordination disorder (DCD) category on the Little Developmental Coordination Disorder Questionnaire than completely full-term children after adjusting for the same characteristics
It has been reported that late preterm children (34-36 weeks) have more neonatal morbidities than full-term infants[18] and experience neuromotor delay during their first year of life,[19] few studies have explored the association between late preterm birth and DCD in preschool or school-aged children beyond the first year of life
When children in the suspected DCD and probably not DCD groups for each gestational age category were compared with the completely full-term category, adjusting for kindergarten, child, family, and maternal health characteristics, children with very preterm, moderately preterm (OR, 1.35; 95% CI, 1.21-1.50; P < .001), late preterm (OR, 1.29; 95% CI, 1.23-1.36; P < .001), early term (OR, 1.11; 95% CI, 1.07-1.15; P < .001), and postterm births (OR, 1.15; 95% CI, 1.08-1.23; P < .001) had increased risk of suspected DCD
Summary
Studies investigating the risk factors for DCD suggest that prenatal and perinatal influences may be associated with the development of later impairments.[5] Preterm infants are at a significantly higher risk of suboptimal brain development,[8] with the risk of DCD increasing with younger gestational age.[9,10] Children born very preterm (
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