Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation.

OBJECTIVE: To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation. STUDY DESIGN: This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18-21 months and 36 months corrected age with outcome data available were enrolled. RESULTS: Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62-71%) with a positive predictive value of 61% (95% CI 56-66%). CONCLUSION: In preterm neonates born <29 weeks gestation, the 18-21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.

Development of a prenatal psychosocial screening tool for post-partum depression and anxiety.

BACKGROUND: Post-partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10-15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post-partum period can be identified prenatally; however prenatal screening tools developed to date have had poor sensitivity and specificity. The objective of this study was to develop a screening tool that identifies women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post-partum period using information collected in the prenatal period. METHODS: Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer score-based prediction rule for the prevalence of PPD, as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4-months postpartum. RESULTS: The best fit model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety. CONCLUSION: This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post-partum period.

Utilization of the 2009 H1N1 vaccine by pregnant women in a pandemic year.

OBJECTIVE: To determine the proportion of pregnant women in a community-based cohort who received the H1N1 vaccine during the 2009-2010 influenza pandemic, and to identify sociodemographic factors that were associated with receiving the vaccine. METHODS: Women in Alberta from a cross-sectional community-based cohort who were participating in a study of prenatal care were asked about their receipt of the 2009 H1N1 and seasonal influenza vaccines and whether they had contracted influenza. Univariable and backwards multivariable logistic regression were used to identify the sociodemographic factors associated with receiving the 2009 H1N1 vaccine. RESULTS: Approximately 72% of women in this sample (n = 402) received an influenza vaccine in 2009; 29.4% received both H1N1 and seasonal influenza vaccines, 40.8% received only the 2009 H1N1 vaccine, 1.7% received only the seasonal influenza vaccine, and 28.1% did not receive either vaccine. Univariable analysis found that receiving the 2009 H1N1 vaccine was significantly associated with household income, education, current employment status, and contentment about the pregnancy. After multivariable analysis, education and having a planned pregnancy remained as independent predictors of vaccination status. CONCLUSION: During the 2009-2010 pandemic influenza season, over 70% of this cohort received influenza vaccinations, a much higher proportion than seen in previous influenza seasons. The majority of women who received the 2009 H1N1 vaccine were likely influenced by the increased media attention given to the 2009-2010 pandemic and the replacement of seasonal vaccine by the 2009 H1N1 vaccine.

All Our Babies Cohort Study: recruitment of a cohort to predict women at risk of preterm birth through the examination of gene expression profiles and the environment.

BACKGROUND: Preterm birth is the leading cause of perinatal morbidity and mortality. Risk factors for preterm birth include a personal or familial history of preterm delivery, ethnicity and low socioeconomic status yet the ability to predict preterm delivery before the onset of preterm labour evades clinical practice. Evidence suggests that genetics may play a role in the multi-factorial pathophysiology of preterm birth. The All Our Babies Study is an on-going community based longitudinal cohort study that was designed to establish a cohort of women to investigate how a women's genetics and environment contribute to the pathophysiology of preterm birth. Specifically this study will examine the predictive potential of maternal leukocytes for predicting preterm birth in non-labouring women through the examination of gene expression profiles and gene-environment interactions. METHODS/DESIGN: Collaborations have been established between clinical lab services, the provincial health service provider and researchers to create an interdisciplinary study design for the All Our Babies Study. A birth cohort of 2000 women has been established to address this research question. Women provide informed consent for blood sample collection, linkage to medical records and complete questionnaires related to prenatal health, service utilization, social support, emotional and physical health, demographics, and breast and infant feeding. Maternal blood samples are collected in PAXgene™ RNA tubes between 18-22 and 28-32 weeks gestation for transcriptomic analyses. DISCUSSION: The All Our Babies Study is an example of how investment in clinical-academic-community partnerships can improve research efficiency and accelerate the recruitment and data collection phases of a study. Establishing these partnerships during the study design phase and maintaining these relationships through the duration of the study provides the unique opportunity to investigate the multi-causal factors of preterm birth. The overall All Our Babies Study results can potentially lead to healthier pregnancies, mothers, infants and children.

Gauging knowledge of developmental milestones among Albertan adults: a cross-sectional survey.

BACKGROUND: Parental knowledge of child development has been associated with more effective parenting strategies and better child outcomes. However, little is known about what adults who interact with children under the age of 14 years know about child development. METHODS: Between September 2007 and March 2008, computer assisted telephone interviews were completed with 1443 randomly selected adults. Adults were eligible if they had interacted with a child less than 14 years of age in the past six months and lived in Alberta, Canada. RESULTS: Sixty three percent of respondents answered two (or more) out of four questions on physical development correctly. Fifteen percent of respondents answered two (or more) out of three questions on cognitive development correctly. Seven percent of respondents answered three (or more) out of five questions on social development correctly. Two percent of respondents answered three (or more) out of five questions on emotional development correctly. Parents and females were better able to identify physical developmental milestones compared to non-parents and males. 81% of adults correctly responded that a child's experience in the first year of life has an important impact on later school performance, 70% correctly responded that a child's ability to learn is not set from birth, 50% of adults correctly responded that children learn more from hearing someone speak than from television, and 45% recognized that parents' emotional closeness with a baby influences later achievement. Parents were most likely to use doctors/paediatricians, books, and nurses as resources. Among parents, there was no relationship between knowledge and parenting morale. CONCLUSIONS: The majority of adults were unable to correctly answer questions related to when children under six years of age typically achieve developmental milestones. Knowledge of physical development exceeded knowledge about cognitive, emotional and social development. Adults were aware of the importance of positive experiences in influencing children's development. Strategies to improve awareness of developmental milestones combined with information on how to support optimal development may improve child development outcomes. Given that parents seek information about child development from health care providers there is an opportunity to ensure that providers are well informed about child development.

Risk factors for cessation of breastfeeding prior to six months postpartum among a community sample of women in Calgary, Alberta.

OBJECTIVES: To describe the rates of breastfeeding initiation and breastfeeding for at least six months and identify risk factors for failing to breastfeed for six months among a community sample of mothers in Calgary, Alberta. METHODS: A cohort of women (n=1737) who participated in a longitudinal study of prenatal support and who could be contacted when their child was three-years-old (n=1147) were invited to participate in a follow-up telephone questionnaire. Of these 1147 women, 780 (69% participating rate) participated and provided breastfeeding data. Risk factors for early cessation of breastfeeding prior to six months were identified using bivariate and multivariable strategies. RESULTS: Of the 780 women, 95.6% initiated breastfeeding and 71.6% continued to breastfeed for at least six months. Risk factors identified for early cessation included younger maternal age, obesity prior to pregnancy, lower maternal education, working full-time or intending to within the first year, history of depression, depression or anxiety during pregnancy, poor social support, and smoking during pregnancy (all p<0.05). Multivariable analysis revealed that working full-time or intending to within the first year, lower maternal education, obesity prior to pregnancy and anxiety during pregnancy most increased a woman's risk of early cessation (all p<0.05). CONCLUSION: Nearly all mothers initiated breastfeeding and 70% continued to breastfeed for six months, although subgroups of women remained at an elevated risk of early cessation. Research to better understand breastfeeding decisions among women with the risk factors identified is needed to facilitate the development of more effective breastfeeding promotion strategies.

Trajectories of maternal distress and risk of child developmental delays: Findings from the All Our Families (AOF) pregnancy cohort.

BACKGROUND: Existing literature on the impact of the course of maternal distress symptoms in the perinatal period and beyond has mainly focused on one source of distress (e.g., anxiety or depression) and only selected aspects of child development. This study examined the relative impact of trajectories of maternal depression, anxiety, and stress symptoms from mid-pregnancy to early childhood on child communication, gross motor, fine motor, problem solving, and personal social development at three years of age. METHODS: Data were analyzed from 1983 mother-child dyads who participated in the three-year follow-up of the All Our Families (AOF) study. Maternal distress and child development across five domains were measured using validated tools. Latent class analysis (LCA) was conducted to identify trajectories of maternal distress over time. Multivariable logistic regression was used to explore the relationship between the trajectories and child development while adjusting for the covariates. RESULTS: At age three years, 5.2% of children were at risk communication delay; 12.7% for gross motor delay; 15.4% for fine motor delay; 11.2 for problem solving delay; and 5.6% for personal-social delay on ASQ-3 domains. Multivariable analysis showed children born to mothers with persistent high anxiety symptoms from pregnancy to 3-years postpartum had an increased risk of delays in communication and personal-social domains. LIMITATIONS: The use of self-reported maternal mental health symptoms and maternal reported child development are the study limitations. CONCLUSIONS: The impact of high levels of maternal anxiety symptoms on the increased risk of child developmental delay in communication and personal-social domains highlights the importance of early intervention and addressing maternal anxiety from pregnancy through early childhood.

Risk factors for delayed social-emotional development and behavior problems at age two: Results from the All Our Babies/Families (AOB/F) cohort.

BACKGROUND AND AIMS: Social-emotional delays and behavioral problems at preschool age are associated with negative outcomes at school age, including ongoing behavior problems, poorer social functioning, and academic difficulties. Understanding modifiable risk factors for suboptimal development requires consideration of contemporary family circumstances to determine areas for effective early intervention to optimize development. This study aimed to identify risk factors for delayed social-emotional development and behavior problems at age two among participants of the All Our Babies/Families cohort study. METHODS: Mothers (N = 1596) completed five comprehensive questionnaires spanning midpregnancy to 2 years postpartum. At child age two, behavior and competence outcomes were measured using the Brief Infant-Toddler Social and Emotional Assessment. Chi square analysis and multivariable logistic regression modeling was used to identify key risk factors for suboptimal child outcomes. Predicted probabilities for adverse outcomes in the presence of risk were calculated. RESULTS: Risk factors for possible delayed social-emotional development in children included maternal depression at 2 years postpartum (OR 2.46, 95% CI 1.63, 3.72), lower parenting self-efficacy at 2 years postpartum (OR 2.76, 95% CI 1.51, 5.06), non-daily play-based interaction when child was 1 and 2 years old (OR 1.43, 95% CI 1.02, 1.99), child delayed sleep initiation at 2 years of age (OR 1.58, 95% CI 1.05, 2.37), and playgroup non-attendance between 1 and 2 years postpartum (OR 1.43, 95% CI 1.03, 1.99). Risk factors for possible behavior problems included lower maternal optimism during pregnancy (OR 2.02, 95% CI 1.36, 2.99), maternal depression at 2 years postpartum (OR 2.19, 95% CI 1.46, 3.27), difficulty balancing responsibilities at 2 years postpartum (OR 2.32 95% CI 1.55, 3.47), child second language exposure at 2 years of age (OR 1.88, 95% CI 1.37, 2.58), child delayed sleep initiation at 2 years of age (OR 1.55 95% CI 1.06, 2.26), child frequent night wakings at 2 years of age (OR 2.95 95% CI 2.13, 4.10), and more screentime exposure at 2 years of age (OR 1.85 95% CI 1.34, 2.54). CONCLUSIONS: This study suggests that addressing maternal mental health and promoting parenting strategies that encourage play-based interaction, limiting screen time, preventing sleep problems, and engagement in informal playgroups would reduce the risk of behavior and social-emotional problems.

Trajectories of maternal stress and anxiety from pregnancy to three years and child development at 3 years of age: Findings from the All Our Families (AOF) pregnancy cohort.

BACKGROUND: Existing literature on maternal distress has focused on stress and anxiety during the pregnancy or postnatally and their relationship with child development. However, few studies have investigated the association between maternal stress and anxiety symptoms over time and child development in preschool children. The aim of this study was to examine the association between trajectories of maternal stress and anxiety symptoms from mid-pregnancy to three years postpartum and child development at age three years. METHODS: Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Latent class analysis (LCA) was conducted to identify trajectories of women's stress and anxiety across from mid-pregnancy to three years postpartum. Multivariate logistic regression was used to explore the relationship between the stress and anxiety trajectories and child developmental delays while adjusting for the covariates. RESULTS: LCA identified three distinct trajectories of maternal stress and anxiety symptoms over time. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ─ 5.51), p = 0.003) of having a child with developmental delays at 3 years. LIMITATIONS: The use of self-reported maternal mental health symptoms and no data on fathers' mental health are our study's limitations. CONCLUSIONS: The findings from a population-based Canadian sample provide empirical support for a relationship between maternal anxiety overtime and risk of child developmental delays. Identifying and supporting mothers experiencing high anxiety symptoms in the perinatal period may mitigate the risk of these delays in children.

Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years.

BACKGROUND: Most evidence of the association between maternal depression and children's development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors. METHODS: We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children's behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women's depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children's behavior, while adjusting for other significant maternal, child and psychosocial factors. RESULTS: 1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant. CONCLUSION: These findings suggest both externalizing and internalizing children's behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children's early social-emotional and behavior development.

Protective factors for child development at age 2 in the presence of poor maternal mental health: results from the All Our Babies (AOB) pregnancy cohort.

OBJECTIVE: To identify the combination of factors most protective of developmental delay at age 2 among children exposed to poor maternal mental health. DESIGN: Observational cohort study. SETTING: Pregnant women were recruited from primary healthcare offices, the public health laboratory service and community posters in Calgary, Alberta, Canada. PARTICIPANTS: 1596 mother-child dyads who participated in the All Our Babies study and who completed a follow-up questionnaire when their child was 2 years old. Among participants who completed the 2-year questionnaire and had complete mental health data (n=1146), 305 women (27%) were classified as high maternal mental health risk. PRIMARY MEASURES: Child development at age 2 was described and a resilience analysis was performed among a subgroup of families at maternal mental health risk. The primary outcome was child development problems. Protective factors were identified among families at risk, defined as maternal mental health risk, a composite measure created from participants' responses to mental health life course questions and standardised mental health measures. RESULTS: At age 2, 18% of children were classified as having development problems, 15% with behavioural problems and 13% with delayed social-emotional competencies. Among children living in a family with maternal mental health risk, protective factors against development problems included higher social support, higher optimism, more relationship happiness, less difficulty balancing work and family responsibilities, limiting the child's screen time to <1 hour per day and the child being able to fall asleep in <30 min and sleeping through the night by age 2. CONCLUSIONS: Among families where the mother has poor mental health, public health and early intervention strategies that support interpersonal relationships, social support, optimism, work-life balance, limiting children's screen time and establishing good sleep habits in the child's first 2 years show promise to positively influence early child development.

Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort.

BACKGROUND: Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies. AIMS: To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk). METHODS AND PROCEDURES: Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses. OUTCOMES AND RESULTS: At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction. CONCLUSIONS AND IMPLICATIONS: The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction.