Postterm birth linked to behavioral problems

Children born postterm are at increased risk for attention-deficit/hyperactivity disorder (ADHD) and other behavioral and emotional problems in early childhood, according to a new study from the Netherlands.

Using data embedded within the Generation R Study, a population-based, prospective cohort study of Dutch children from fetal life to young adulthood, researchers evaluated the relationship between postterm birth (ie, ≥42 weeks’ gestation) and problem behavior in early childhood after adjusting for socioeconomic and pregnancy-related confounders.

Of a cohort of 5,145 children born between 2001 and 2005, 4,537 (88%) were born at term, 382 (7%) were born postterm, and 226 (4%) were born preterm (before 37 weeks’ gestation). Parents completed a standardized behavioral checklist rating anxiety problems, affective problems, pervasive developmental problems, ADHD, and oppositional defiant problems when their children were aged 18 months and 36 months.

A quadratic relationship was found between gestational age at birth and problem behavior at 18 months and 36 months, indicating that children born preterm and postterm have higher behavioral and emotional problem scores than children born at term. Children born postterm were nearly twice as likely as those born at term to have clinical problem behavior and more than twice as likely to have ADHD.

The researchers suggest that the higher risk of behavioral problems in children born postterm may be due to uteroplacental insufficiency at full term or malfunctioning of the placental "clock" that controls the length of pregnancy. Longer follow-up is needed to determine whether behavioral problems persist.

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