Forecasting childhood adversities from conditions of birth

• DOI: 10.1111/ppe.12828
• Publication Date: 2022-02-02T14:27:11Z
• Authors: Melissa J. Green; Oliver J. Watkeys; Maina Kariuki; Gabrielle Hindmarsh; Tyson Whitten; Kimberlie Dean; Kristin R. Laurens; Felicity Harris; Vaughan J. Carr
• Keywords: Male; Social Determinants of Health; Maternal Health; 150; 32 Biomedical and Clinical Sciences; Reproductive health and childbirth; Low Birth Weight and Health of the Newborn; Cohort Studies; risk prediction; 0302 clinical medicine; Pre-Eclampsia; Pregnancy; Minority Health; familial risk; Child; Pediatric; Violence Research; 360; anzsrc-for: 42 Health Sciences; 4204 Midwifery; 3 Good Health and Well Being; 3215 Reproductive Medicine; anzsrc-for: 4204 Midwifery; 3. Good health; Health Disparities; Child, Preschool; child health; Premature Birth; Mental health; Female; social and economic factors; anzsrc-for: 3215 Reproductive Medicine; Adult; anzsrc-for: 1114 Paediatrics and Reproductive Medicine; 330; Adolescent; 610; Child Abuse and Neglect Research; Young Adult; 03 medical and health sciences; anzsrc-for: 32 Biomedical and Clinical Sciences; Preterm; Clinical Research; 2.3 Psychological; Behavioral and Social Science; Humans; Preschool; child development; perinatal adversity; Prevention; Australia; Infant, Newborn; Parturition; 42 Health Sciences; Infant; Perinatal Period - Conditions Originating in Perinatal Period; Newborn; Women's Health

AbstractBackgroundChildbirth presents an optimal time for identifying high‐risk families to commence intervention that could avert various childhood health and social adversities.ObjectiveWe sought to establish the minimum set of exposures required to accurately predict a range of adverse childhood outcomes up to the age of 13 years, from a set of 14 individual and familial risk exposures evident at the time of birth.MethodsParticipants were 72,059 Australian children and their parents drawn from a multi‐register population cohort study (data spanning 1994–2018). Risk exposures included male sex, young mother (aged ≤21 years), no (or late first; >16 weeks) antenatal visit, maternal smoking during pregnancy, small for gestational age, preterm birth, pregnancy complications (any of hypertension, diabetes mellitus, gestational diabetes or pre‐eclampsia), >2 previous pregnancies of ≥20 weeks, socio‐economic disadvantage, prenatal child protection notification, and maternal or paternal mental disorder or criminal offending history. Individual outcomes included early childhood developmental vulnerability (age 5 years), sustained educational underachievement (age 8 and 10 years), mental disorder diagnoses, substantiated childhood maltreatment, and contact with the police as a victim or person‐of‐interest up to age 13–14 years.ResultsRisk exposures at birth predicted individual childhood outcomes with fair to excellent accuracy: the area under the receiver operating characteristic curves ranged between 0.60 (95% CI 0.58, 0.62) for childhood mental disorder and 0.83 (95% CI 0.82, 0.85) for substantiated child maltreatment. The presence of five or more exposures characterised 12–25% of children with one or more adverse outcomes and showed high predictive certainty for models predicting multiple outcomes, which were apparent in 9% of the population.ConclusionsUp to a quarter of the neonatal population at risk of multiple adverse outcomes can be detected at birth, with implications for population health screening. However, cautious implementation of these models is warranted, given their relatively low positive predictive values.