Advertisement

Cumulative Social Risk Exposure, Infant Birth Weight, and Cognitive Delay in Infancy

      Abstract

      Objective

      To determine the effect of exposure to multiple social risks on cognitive delay at 9 months of age; and whether obstetric factors mediate the relationship between cumulative social risk and cognitive delay.

      Methods

      Data were from 8950 mother–child dyads participating in the first wave of the Early Childhood Longitudinal Study, Birth Cohort. Cognitive delay was defined as falling in the lowest 10% of mental scale scores from the Bayley Short Form–Research Edition. Five social risk factors were combined and categorized into a social risk index. Staged multivariable logistic regressions were used to investigate whether obstetric factors mediated the impact of social risk on the odds of cognitive delay.

      Results

      Infants with cognitive delay were more likely to live with social risks than infants without cognitive delay. The percentage of infants with cognitive delay increased with the number of social risks. In adjusted analyses, exposure to multiple social risk factors was associated with higher odds of cognitive delay at 9 months of age (adjusted odds ratio 2.11; 95% confidence interval 1.18–3.78 for 4 or more risks vs no risks). Accounting for birth weight attenuated this relationship (P < .001).

      Conclusions

      This population-based study investigated the independent and cumulative effects of social risk factors on cognitive delay in infancy. Findings revealed a significant cumulative relationship between exposure to social risk and cognitive delay, which was partly mediated by birth weight. Programs that address the social context of US infants are needed to improve their developmental trajectories.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brooks-Gunn J.
        • Duncan G.J.
        The effects of poverty on children.
        Future Child. 1997; 7: 55-71
        • Gennetian L.A.
        One or two parents? Half or step siblings? The effect of family structure on young children’s achievement.
        J Popul Econ. 2005; 18: 415-436
        • Altarac M.
        • Saroha E.
        Lifetime prevalence of learning disability among US children.
        Pediatrics. 2007; 119: S77-S83
        • Hillemeier M.M.
        • Morgan P.L.
        • Farkas G.
        • Maczuga S.A.
        Perinatal and socioeconomic risk factors for variable and persistent cognitive delay at 24 and 48 months of age in a national sample.
        Matern Child Health J. 2011; 15: 1001-1010
        • Bradley R.H.
        • Corwyn R.F.
        Socioeconomic status and child development.
        Ann Rev Psychol. 2002; 53: 371-399
        • Hackman D.A.
        • Farah M.J.
        Socioeconomic status and the developing brain.
        Trends Cogn Sci. 2009; 13: 65-73
        • McLoyd V.C.
        Socioeconomic disadvantage and child development.
        Am Psychol. 1998; 53: 185-204
        • Sirin S.R.
        Socioeconomic status and academic achievement: a meta-analytic review of research.
        Rev Educ Res. 2005; 75: 417-453
        • Cheng E.R.
        • Palta M.
        • Kotelchuck M.
        • Poehlmann J.
        • Witt W.P.
        Cognitive delay and behavior problems prior to school-age.
        Pediatrics. 2014; 134: e749-e757
        • High P.C.
        School readiness.
        Pediatrics. 2008; 121: e1008-e1015
        • Martin L.T.
        • Fitzmaurice G.M.
        • Kindlon D.J.
        • Buka S.L.
        Cognitive performance in childhood and early adult illness: a prospective cohort study.
        J Epidemiol Community Health. 2004; 58: 674-679
        • Lu M.C.
        • Halfon N.
        Racial and ethnic disparities in birth outcomes: a life-course perspective.
        Matern Child Health J. 2003; 7: 13-30
        • Halfon N.
        • Hochstein M.
        Life course health development: an integrated framework for developing health, policy, and research.
        Milbank Q. 2002; 80: 433-479
        • Elder Jr., G.H.
        The life course as developmental theory.
        Child Dev. 1998; 69: 1-12
        • Pickles A.
        • De Stavola B.
        An overview of models and methods for life course analysis.
        in: Pickles A. Maughan B. Wadsworth M. Epidemiological Methods in Life Course Research. Oxford University Press, Oxford, UK2007: 181-220
        • Kuh D.
        • Ben-Shlomo Y.
        • Lynch J.
        • et al.
        Life course epidemiology.
        J Epidemiol Community Health. 2003; 57: 778-783
        • Goldenberg R.
        • Culhane J.
        • Iams J.
        • Romero R.
        Epidemiology and causes of preterm birth.
        Lancet. 2008; 371: 75-84
        • Alexander G.R.
        • Slay M.
        Prematurity at birth: trends, racial disparities, and epidemiology.
        Ment Retard Dev Disabil Res Rev. 2002; 8: 215-220
        • Kramer M.S.
        Determinants of low birth weight: methodological assessment and meta-analysis.
        Bull World Health Org. 1987; 65: 663-737
        • Parker J.D.
        • Schoendorf K.C.
        • Kiely J.L.
        Associations between measures of socioeconomic status and low birth weight, small for gestational age, and premature delivery in the United States.
        Ann Epidemiol. 1994; 4: 271-278
        • Kogan M.
        Social causes of low birth weight.
        J R Soc Med. 1995; 88: 611
        • Hack M.
        • Klein N.
        • Taylor H.
        School-age outcomes of children of extremely low birth weight and gestational age.
        Semin Neonatol. 1996; 1: 277-288
        • Hack M.
        • Klein N.K.
        • Taylor H.G.
        Long-term developmental outcomes of low birth weight infants.
        Future Child. 1995; : 176-196
        • Shenkin S.D.
        • Starr J.M.
        • Deary I.J.
        Birth weight and cognitive ability in childhood: a systematic review.
        Psychol Bull. 2004; 130: 989
        • Sameroff A.J.
        Environmental risk factors in infancy.
        Pediatrics. 1998; 102: 1287-1292
        • Larson K.
        • Russ S.A.
        • Crall J.J.
        • Halfon N.
        Influence of multiple social risks on children’s health.
        Pediatrics. 2008; 121: 337-344
        • Sameroff A.J.
        • Bartko W.T.
        • Baldwin A.
        • et al.
        Family and social influences on the development of child competence.
        in: Lewis M. Feiring C. Families, Risk, and Competence. Lawrence Erlbaum, Mahwah, NJ1998: 161-185
        • Bauman L.J.
        • Silver E.J.
        • Stein R.E.
        Cumulative social disadvantage and child health.
        Pediatrics. 2006; 117: 1321-1328
        • Stevens G.D.
        Gradients in the health status and developmental risks of young children: the combined influences of multiple social risk factors.
        Matern Child Health J. 2006; 10: 187-199
      1. Early Childhood Longitudinal Study, Birth Cohort, Nine-Month Data Collection. US Dept of Education; National Center for Education Statistics, Washington, DC2001
        • Snow K.
        • Derecho A.
        • Wheeless S.
        • et al.
        Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), Kindergarten 2006 and 2007 Data File User’s Manual (2010-010).
        National Center for Education Statistics; Institute of Education Sciences; US Dept of Education, Washington, DC2009
        • Bayley N.
        Bayley Scales of Infant Development.
        2nd ed. Psychological Corp, San Antonio, Tex1993
        • Dale P.S.
        • Price T.S.
        • Bishop D.V.M.
        • Plomin R.
        Outcomes of early language delay: I. Predicting persistent and transient language difficulties at 3 and 4 years.
        J Speech Lang Hear Res. 2003; 46: 544-560
        • Hillemeier M.M.
        • Farkas G.
        • Morgan P.L.
        • et al.
        Disparities in the prevalence of cognitive delay: how early do they appear?.
        Paediatr Perinat Epidemiol. 2009; 23: 186-198
        • Webster R.I.
        • Majnemer A.
        • Platt R.W.
        • Shevell M.I.
        The predictive value of a preschool diagnosis of developmental language impairment.
        Neurology. 2004; 63: 2327
        • Bramlett M.D.
        • Blumberg S.J.
        Family structure and children’s physical and mental health.
        Health Aff. 2007; 26: 549-558
        • Montgomery L.E.
        • Kiely J.L.
        • Pappas G.
        The effects of poverty, race, and family structure on US children’s health: data from the NHIS, 1978 through 1980 and 1989 through 1991.
        Am J Public Health. 1996; 86: 1401-1405
        • Sameroff A.J.
        • Seifer R.
        • Barocas R.
        • et al.
        Intelligence quotient scores of 4-year-old children: social–environmental risk factors.
        Pediatrics. 1987; 79: 343-350
        • Imai K.
        • Keele L.
        • Tingley D.
        • Yamamoto T.
        Causal mediation analysis using R. Lecture notes in statistics.
        in: Vinod H.D. Advances in Social Science Research Using R. Springer, New York2010: 129-154
        • Bhutta A.T.
        • Cleves M.A.
        • Casey P.H.
        • et al.
        Cognitive and behavioral outcomes of school-aged children who were born preterm.
        JAMA. 2002; 288: 728-737
        • Resnick M.B.
        • Gueorguieva R.V.
        • Carter R.L.
        • et al.
        The impact of low birth weight, perinatal conditions, and sociodemographic factors on educational outcome in kindergarten.
        Pediatrics. 1999; 104: e74
        • Noble K.G.
        • McCandliss B.D.
        • Farah M.J.
        Socioeconomic gradients predict individual differences in neurocognitive abilities.
        Dev Sci. 2007; 10: 464-480
        • Sameroff A.J.
        • Seifer R.
        • Zax M.
        • Garmezy N.
        Early development of children at risk for emotional disorder.
        Monogr Soc Res Child Dev. 1982; 47: 1-82
        • Burchinal M.R.
        • Roberts J.E.
        • Hooper S.
        • Zeisel S.A.
        Cumulative risk and early cognitive development: a comparison of statistical risk models.
        Dev Psychol. 2000; 36: 793
        • Martin J.
        • Hamilton B.
        • Ventura S.
        • et al.
        Births: Final Data for 2010. National Vital Statistics Reports Vol. 61, no. 1.
        National Center for Health Statistics, Hyattsville, Md2012
        • Simpson G.A.
        • Colpe L.
        • Greenspan S.
        Measuring functional developmental delay in infants and young children: prevalence rates from the NHIS-D.
        Paediatr Perinat Epidemiol. 2003; 17: 68-80
        • Reichman N.E.
        • Corman H.
        • Noonan K.
        Impact of child disability on the family.
        Matern Child Health J. 2008; 12: 679-683
        • Russ S.A.
        • Larson K.
        • Tullis E.
        • Halfon N.
        A lifecourse approach to health development: implications for the maternal and child health research agenda.
        Matern Child Health J. 2014; 18: 497-510
        • Institute of Medicine
        Children's Health, the Nation's Wealth: Assessing and Improving Child Health.
        National Academies Press, Washington, DC:2004