Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
Int J Epidemiol. 2022 Jan 6;50(6):1814-1823. doi: 10.1093/ije/dyab134. Epub 2021 Jul 15.
Preterm birth is associated with lower neurocognitive performance. However, whether children's neurodevelopment improves with longer gestations within the full-term range (37-41 weeks) is unclear. Given the high rate of obstetric intervention in the USA, it is critical to determine whether long-term outcomes differ for children delivered at each week of term.
This secondary analysis included 39 199 live-born singleton children of women who were admitted to the hospital in spontaneous labour from the US Collaborative Perinatal Project (1959-76). At each week of term gestation, we evaluated development at 8 months using the Bayley Scales of Infant Development, 4 years using the Stanford-Binet IQ (SBIQ) domains and 7 years using the Wechsler Intelligence Scales for Children (WISC) and Wide-Range Achievement Tests (WRAT).
Children's neurocognitive performance improved with each week of gestation from 37 weeks, peaking at 40 or 41 weeks. Relative to those delivered at 40 weeks, children had lower neurocognitive scores at 37 and 38 weeks for all assessments except SBIQ and WISC Performance IQ. Children delivered at 39 weeks had lower Bayley Mental (β = -1.18; confidence interval -1.77, -0.58) and Psychomotor (β = -1.18; confidence interval -1.90, -0.46) scores. Results were similar for within-family analyses comparing siblings, with the addition of lower WRAT scores at 39 weeks.
The improvement in development scores across assessment periods indicates that each week up to 40 or 41 weeks of gestation is important for short- and long-term cognitive development, suggesting 40-41 weeks may be the ideal delivery window for optimal neurodevelopmental outcomes.
早产与较低的神经认知表现有关。然而，在足月范围内（37-41 周），胎儿的妊娠时间延长是否会改善神经发育尚不清楚。鉴于美国产科干预率较高，确定在每个足月周分娩的儿童的长期结局是否存在差异至关重要。
本二次分析纳入了 39 199 名在自然分娩中住院的美国合作围产期项目（1959-76 年）的单胎活产儿。在每个足月妊娠周，我们使用贝利婴幼儿发育量表评估 8 个月时的发育情况，使用斯坦福-比奈智商量表（SBIQ）评估 4 岁时的发育情况，使用韦氏儿童智力量表（WISC）和广泛成就测验（WRAT）评估 7 岁时的发育情况。
从 37 周开始，随着妊娠周数的增加，儿童的神经认知表现逐渐提高，在 40 或 41 周时达到峰值。与 40 周分娩的儿童相比，所有评估中除了 SBIQ 和 WISC 操作智商外，37 和 38 周分娩的儿童神经认知评分较低。39 周分娩的儿童贝利心理（β=-1.18；置信区间-1.77，-0.58）和精神运动（β=-1.18；置信区间-1.90，-0.46）评分较低。在比较兄弟姐妹的家内分析中，结果相似，此外，39 周时 WRAT 评分较低。
在整个评估期，发育评分的提高表明，妊娠时间延长至 40 或 41 周，对短期和长期认知发育都很重要，这表明 40-41 周可能是神经发育最佳结局的理想分娩窗口。
