Brain Development and Maternal Behavior in Relation to Cognitive and Language Outcomes in Preterm-Born Children

Abstract

Background: Children born very preterm (<=32 weeks gestational age) show poorer cognitive and language development compared to their term-born peers. The importance of positive maternal-child interactions for promoting neurodevelopment is well-established. However, little is known about whether sensitive maternal behaviors can buffer the association of early brain dysmaturation with cognitive and language performance. Methods: Infants born very preterm were recruited from the neonatal intensive care unit for a prospective, observational cohort study. Chart review was conducted prospectively from birth to discharge. MRI was acquired at ~32 weeks postmenstrual age and again at term-equivalent age, including diffusion tensor imaging. Fractional anisotropy, a quantitative measure of brain maturation, was obtained from 11 bilateral regions of interest in the cortical gray matter. At 3 years corrected age, neurodevelopmental testing (Bayley Scales of Infant & Toddler Development, Third Edition [Bayley-III]) was administered, and parent-child interaction was filmed. One hundred and forty-six infants with neonatal brain imaging and follow-up data were included for analysis. We examined whether maternal sensitivity interacted with mean fractional anisotropy values to predict Cognitive and Language scores at 3 years corrected age. Findings: Higher maternal sensitivity significantly moderated cortical fractional anisotropy values at term-equivalent age to predict higher Bayley-III Cognitive (s=1.72, P=0.05, R2=0.23), and Language Scores (s=1.91, P=0.03, R2=0.25). Interpretation: This suggests that positive parenting following early brain dysmaturation may provide an opportunity to support more optimal neurodevelopment in children born very preterm. Funding Information: Canadian Institutes for Health Research operating grant MOP-79262 (SPM) and MOP-86489 (REG). Declaration of Interests: The authors have no competing interests to disclose. Ethics Approval Statement: This study was approved by the Clinical Research Ethics Board at the University of British Columbia and BC Children’s and Women’s Hospitals. Parent written informed consent was obtained according to the Declaration of Helsinki.