A comparison of prematurity and small for gestational age as risk factors for age 6-13 year emotional problems

Background: Although both very preterm (VP) and small for gestational age (SGA) births are suggested to increase the likelihood of childhood emotional problems, there has been a lack of research comparing these effects. Aims: To investigate levels of emotional problems between 6-13. years of age and contrast the impact of being born either very premature (irrespective of birth weight) or small for gestational age. Study design: Prospective longitudinal cohort study. Subjects: 654 Bavarian children (born 1985-1986) who were followed from birth to age 12/13. years. Outcome measures: Emotional problems at ages 6.3 and 8.5. years were measured via the Child Behavior Check List (CBCL). Emotional problems were measured at age 12/13. years via the Strengths and Difficulties Questionnaire (SDQ). Trajectories of emotional problems were derived between 6.3 and 13. years. Results: Two distinctive patterns of age 6-13. year emotional problems were found: 1) a low and stable level of problems in 76% of children; 2) a high and stable level of problems in 24% of children. The high and stable pattern of emotional problems was significantly associated with a VP but not an SGA birth. Consistent additional determinants included male child gender and lower family socioeconomic status. Conclusions: The disparity between VP and SGA births as a predictor of age 6-13. year old emotional problems is considered in terms of fetal and/or glucocorticoid programming. The stability of emotional problems between 6 and 13. years reinforces the need for early childhood interventions aimed at children born very preterm.