Abstract
A preterm birth represents a stressful event having potentially negative long-term consequences. Thirty-three children born preterm (<33 weeks gestational age) and eleven full-term children participated in a nine-year longitudinal study. Perinatal Risk Inventory (PERI) was used at birth to assess the perinatal stress. Salivary cortisol, collected four times a day over two consecutive days, was measured with radioimmunoassay technique at six months and nine years to assess the hypothalamic-pituitary-adrenal (HPA) axis. Mothers reported post-traumatic symptoms on a self-report questionnaire 12 months after their child’s birth and children’s adjustment problems at 9 years of child age on the Child Behavior Checklist. Results showed a significant difference in cortisol regulation at nine years between preterm and full-term children but no differences in adjustment problems. Whereas biological factors (i.e., PERI, cortisol regulation at six months) explained cortisol at nine years, maternal post-traumatic symptoms were predictive of adjustment problems in their child. In conclusion, very preterm birth has some long-term consequences on the HPA-axis regulation at nine years. Although cortisol regulation is mostly influenced by biological factors, the presence of maternal post-traumatic symptoms predicts the manifestation of adjustment problems in both groups. This shows the importance of maternal psychological well-being for child development. Further research is needed to understand the exact consequences of premature birth on cortisol regulation and the implication for the child’s development and health.
Highlights
We examined the differences between preterm and full-term infants on neuroendocrine regulation by computing a repeated-measures analysis of covariance (RM-ANCOVA) by groups controlling for age differences whereas ANCOVAs was computed to assess the between-group differences in adjustment problems and AUCG
This study highlights that very preterm birth has long-term consequences on the cortisol regulation at nine years and that it is mostly influenced by perinatal stress (i.e., Perinatal Risk Inventory (PERI))
We show that the presence of maternal PSTSD’s symptoms contrary to biological factors is a predictor of the development of adjustment problems, underlying the importance of maternal psychological well-being and the negative impact of maternal post-traumatic stress disorder (PTSD) symptoms on the child’s adjustment development
Summary
Preterm birth is defined [1] by birth before 37 weeks of gestation (with sub-categories: moderate preterm—32 to 37 weeks, very preterm—28 to 32 weeks, and extremely preterm— less than 28 weeks). It represented 10% of all living births worldwide [1] and 6.4% in Switzerland, in 2020 [2]. It is nowadays well established that premature birth has an important impact on the infant and the family at birth and on long-term [6,7]. Preterm children are at higher risk for long-term medical and developmental difficulties [6,8,9]. It has been recognized that preterm-born children are more at risk of presenting maladaptive self-regulation skills including stress response system regulation such as the hypothalamicpituitary-adrenal (HPA) axis [10], as well as the development of behavioral (or externalizing) and emotional (or internalizing) problems [11]
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