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Are Infants Born After an Episode of Suspected Preterm Labor at Risk of ADHD? A 30-Month Follow-up Study

  • Author Footnotes
    # Pablo Navalón and Farah Ghosn contributed equally to this work as first authors.
    Pablo NAVALÓN
    Footnotes
    # Pablo Navalón and Farah Ghosn contributed equally to this work as first authors.
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
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  • Author Footnotes
    # Pablo Navalón and Farah Ghosn contributed equally to this work as first authors.
    Farah GHOSN
    Footnotes
    # Pablo Navalón and Farah Ghosn contributed equally to this work as first authors.
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
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  • Maite FERRÍN
    Affiliations
    Haringey Children and Adolescent Mental Health Service, National Health Service, London, UK

    ReCognition Health, London, UK
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  • Belén ALMANSA
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
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  • Alba MORENO-GIMÉNEZ
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
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  • Laura CAMPOS-BERGA
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain
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  • Rosa SAHUQUILLO-LEAL
    Affiliations
    Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
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  • Vicente DIAGO
    Affiliations
    Division of Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain
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  • Máximo VENTO
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Division of Neonatology, La Fe University and Polytechnic Hospital, Valencia, Spain
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  • Ana GARCÍA-BLANCO
    Correspondence
    Corresponding Author: Ana García-Blanco, Health Research Institute La Fe, University and Polytechnic Hospital La Fe, Valencia, Avenida Fernando Abril Martorell, 106, 46026, Valencia, Spain; [email protected]
    Affiliations
    Neonatal Research Group, La Fe Health Research Institute (IISLAFE), Valencia, Spain

    Division of Psychiatry and Clinical Psychology, La Fe University and Polytechnic Hospital, Valencia, Spain

    Department of Personality, Evaluation, and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
    Search for articles by this author
  • Author Footnotes
    # Pablo Navalón and Farah Ghosn contributed equally to this work as first authors.
Published:June 04, 2022DOI:https://doi.org/10.1016/j.ajog.2022.05.065
Are Infants Born After an Episode of Suspected Preterm Labor at Risk of ADHD? A 30-Month Follow-up Study
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      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Background

      An episode of suspected preterm labor (SPL) may be by itself a pathological event that may alter the normal course of pregnancy and the offspring´s neurodevelopment. Certainly, the association between preterm birth and neurodevelopmental disorders can only be partially explained by the immaturity of the nervous system, as evidenced by the increased risk of ADHD in late-preterm infants without any neurological alteration.

      Objective

      This study examines if infants born after SPL may be at an increased risk of developing ADHD. Moreover, potential obstetric, perinatal, and psychosocial risk factors associated with ADHD in this population are examined.

      Study Design

      A prospective cohort study of 120 mother-infant pairs was conducted from the moment the mothers received a diagnosis of SPL until the infants’ 30 months of life. Infants were divided according to the prematurity status: Full-term SPL-infants (n = 28, born at ≥37 weeks of gestation), late preterm SPL-infants (n = 56, born between 32 and <37 weeks of gestation), very preterm SPL-infants (n = 36, born before <32 weeks of gestation). Non-SPL infants born at term served as a control group (n = 46). Infants’ ADHD symptoms were assessed at age 30-months. Obstetric, perinatal, and psychosocial risk factors were also recorded.

      Results

      All SPL groups showed more ADHD symptoms at age 30-months compared with non-SPL infants. Concretely, very preterm SPL-infants showed higher restless/impulsive behaviors, whereas full-term and late preterm SPL-infants showed higher emotional lability behaviors. Among potential risk factors, male sex and maternal experience of post-traumatic stress symptoms predicted the severity of ADHD symptoms in SPL-infants.

      Conclusions

      SPL-infants had a higher risk for developing ADHD symptoms, including those born at term. SPL-infants showed a distinctive phenotype and shared specific risk factors, suggesting that they conform an undescribed at-risk of ADHD population.

      Keywords

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      Article Info

      Publication History

      Accepted: May 31, 2022
      Received in revised form: May 30, 2022
      Received: December 23, 2021

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflicts of Interest

      The authors report no conflict of interest.

      Source of Funding

      This work was supported by the Health Institute Carlos III (ISCIII; Spanish Ministry of Economy and Innovation) and co-funded by the European Union [grant numbers: PN (CM19/00078), FG (FI19/00202), LC (CM20/00143) and AGB (JR17/00003, PI18/01352, PI21/00549)]. AMG is supported by NUTRISHIELD (grant agreement H2020 #818110) and BA by the Spanish Ministry of Education (FPU18/01997). The funding sources have not been implicated in the design or publication of the study.

      Condensation

      Infants born after an episode of suspected preterm labor show more ADHD symptoms with a distinctive phenotype and share specific risk factors, regardless of the gestational week at birth.

      AJOG at a Glance

      A. Why was this study conducted?

      Recent evidence suggests that an episode of suspected preterm labor might have long-term effects on infant neurodevelopment even if birth occurs at term. Thus, these infants may represent an undescribed “at-risk” population for neurodevelopmental disorders such as ADHD.

      B. What are the key findings?

      Infants born after an episode of suspected preterm labor, showed more ADHD symptoms at age 30-months, regardless of the gestational week at birth. Nevertheless, the week of delivery modulated the phenotype of ADHD in this population.

      C. What does this study add to what is already known?

      This is the first study that has specifically analyzed the risk for ADHD in infants born after an episode of suspected preterm labor by examining potential obstetric, perinatal, and psychosocial predictors.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2022.05.065

      Copyright

      © 2022 Elsevier Inc. All rights reserved.

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