Abstract
BackgroundChildren who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. Those exposed to multiple risk factors are more likely to exhibit problems in development than those exposed to a single or no risk factor. We examined the longitudinal associations between persistence and timing of exposure to cumulative risk (CR) on three occasions by age 2 and problems in development at age 4.5 in health, behavior, and education-related domains.MethodsData are from Growing Up in New Zealand (NZ), a prospective longitudinal study of a birth cohort first assessed during their last trimester in 2009–10 and followed at ages 9 months and 2 and 4.5 years. All women with an expected delivery date in a 12-month period who resided within a defined region were invited to participate, with no additional eligibility criteria. Exposure was measured for 12 sociodemographic and maternal health risk factors at third trimester and ages 9 months and 2 years, from which developmental trajectories were constructed capturing persistence and timing of CR exposure. Ten developmental outcomes were measured at age 4.5 to classify problems in overall health status, obesity, and injuries; internalizing and externalizing behavior problems; and letter naming, counting forward and backward, and expectations for starting school and completing education.ResultsAnalyses of data from 6156 children (49% female, 33% Non-European ethnicity) who participated in the 4.5-age assessment uniformly showed associations between exposure to more than consistently zero CR across early development and higher prevalence of being classified with problems for 9 of 10 outcomes. Persistent exposure to a CR ≥ 4 was generally associated with a higher prevalence of problems for 7 of 10 outcomes, whereas the timing of first exposure to CR ≥ 4 showed a less consistent association with problem outcomes.ConclusionsThese findings are concerning because over 50% of NZ children are exposed to at least one of these risk factors at some point in early development. Routine screening of most of these risk factors during pregnancy is feasible and can identify priority candidates for intervention.
Highlights
Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development
Longitudinal attrition analysis At age 4.5, 6156 of the Growing Up in New Zealand (GUiNZ) child cohort were assessed. Compared to those who completed the assessment at age 4.5 years, those cohort members who had been enrolled in GUiNZ but who did not complete this assessment, were over-represented with mothers who were teenagers when the child was born (17% vs. 37%), did not reside with a co-parent (33% vs. 51%), reported the child to have a non-European ethnicity (42% vs. 78%), and resided in neighborhoods with high deprivation (36% vs. 59%) [43]
Using longitudinal data that prospectively followed over 5800 children from the late antenatal period until 4.5 years of age, we examined how different patterns of timing and persistence of exposure to a high level of sociodemographic and maternal health risk factors in early childhood were associated with problems across health, behavior, and education-related developmental domains
Summary
Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. In comparison, when teenage motherhood is added to a combination of other risk factors (e.g., low maternal education, maternal depressive symptoms), identification of children at risk of poorer development improves substantially [8]. This argues for the utility of the cumulative risk (CR) model, which accounts solely for the number of risk factors to which a person is exposed rather than the intensity of or unique set of risk exposures [9]. The particular set of risk factors appear less important for developmental impact than the number of factors to which a child is exposed [9,10,11]
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