Association of Preterm Birth and Socioeconomic Status With Neonatal Brain Structure

Key Points Question Are preterm birth, socioeconomic status (SES), and neonatal brain structure associated? Findings In this cohort study of 261 infants, after mutual adjustment, both low birth gestational age (GA) and SES were associated with brain structure. The nature of SES–brain structure associations varied depending how SES was operationalized; there were interactions between GA and measures of family-level SES on brain structure. Meaning In this study, low birth GA, and to a lesser extent SES, were associated with neonatal brain structure; further work is required to elucidate potential mechanisms underlying this association.

Preterm sample clinical features: from medical records.
-Sepsis: positive blood culture and/or physician decision to treat with five days of antibiotics; earlyonset is <72 hours after birth and late-onset is after 72 hours. -Retinopathy of prematurity: requiring treatment.
-Bronchopulmonary dysplasia: requirement for respiratory support and/or supplemental oxygen after 36 weeks' gestation. -Necrotising enterocolitis: medical (7 days nil by mouth) or surgical management.
-Antenatal steroids: at least one dose of maternal steroids given for fetal lung maturation.
-Antenatal magnesium sulphate: magnesium sulphate given to mother in the antenatal period.
-Postnatal steroids: dexamethasone given to ventilator-dependent infants to facilitate extubation.

eFigure 1. Flow Diagram of Participants
Study exclusion criteria 3 were major congenital malformation, chromosomal abnormality, congenital infection, cystic periventricular leukomalacia, hemorrhagic parenchymal infarction, and post-hemorrhagic ventricular dilatation. In individuals excluded following MRI, these lesions had not been identified on prior routine ultrasound in the neonatal unit. Anterior temporal lobe lateral part left gray matter 0.14 (0.06-0.23) <.001 .003

eTable 10. Regional Brain Volumes: Association With Gestational Age, Subjective Socioeconomic Status, and Interaction Effect (Fully Adjusted Ridge
Regression Model) Fully adjusted ridge regression model, including gestation at birth, subjective socioeconomic status, gestation at MRI, the interaction term (where significant), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, maternal final educational qualification, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, paternal final educational qualification, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, maternal occupation, gestation at MRI, the interaction term (where significant), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, paternal occupation, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, Scottish Index of Multiple Deprivation, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction, SIMD = Scottish Index of Multiple Deprivation. Fully adjusted ridge regression model, including gestation at birth, maternal final educational qualification, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, paternal final educational qualification, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, maternal occupation, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, paternal occupation, gestation at MRI, the interaction term (where significant -none were, so not included), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, maternal occupation, gestation at MRI, the interaction term (where significant), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction. Fully adjusted ridge regression model, including gestation at birth, subjective socioeconomic status, gestation at MRI, the interaction term (where significant), birth weight z-score, birth head circumference z-score, sex, smoking in pregnancy, and breast milk at discharge. Corrected for false discovery rate. BH = Benjamini-Hochberg correction.