BMJ paediatrics open · 2026
Preterm birth and the association with neurodevelopmental disorders (NDDs) in children born in Pakistan: a retrospective cross-sectional study.
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Tariq Arsalan, Saad Abdul
Аннотация
OBJECTIVE: This study aimed to assess the association between preterm birth and neurodevelopmental disorders (NDDs) in children born in Pakistan, aged 2-6 years.
METHODS: This retrospective cross-sectional study analysed medical and developmental records of 2634 Pakistani children aged 2-6 years, born between 2015 and 2020. Neurodevelopmental outcomes were assessed using Ages and Stages Questionnaire-3, Modified Checklist for Autism in Toddlers, Revised and Bayley-III, with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition confirmation where available. Preterm birth was defined as <37 weeks, with subcategories: extremely (<28), very (28-31) and late preterm (32-36 weeks). Multivariable logistic regression examined factors associated with NDDs, adjusting for sex, maternal age, maternal education, household income and neonatal intensive care unit (NICU) admission. Poisson regression estimated relative risks, and the interaction between prematurity and socioeconomic status (SES) was assessed.
RESULTS: Among 2634 children, 730 (27.7%) were preterm. NDD prevalence was higher in preterm compared with full-term children (25.8% vs 13.4%), including autism spectrum disorder (5.8% vs 2.0%), attention-deficit/hyperactivity disorder (7.9% vs 4.7%), cerebral palsy (2.6% vs 0.6%) and developmental delay risk (15.2% vs 9.6%). Prevalence increased with prematurity severity: extremely (55.6%), very (32.1%) and late preterm (23.9%). Multivariable analysis showed that preterm birth (adjusted OR (aOR)=1.91; 95% CI 1.48 to 2.47), low maternal education (aOR=1.44; 95% CI 1.17 to 1.78), male sex (aOR=1.34; 95% CI 1.08 to 1.66), low income (aOR=1.29; 95% CI 1.05 to 1.58) and NICU admission (aOR=1.52; 95% CI 1.18 to 1.95) were independently associated with NDDs. Children who were preterm and from low SES households had the highest odds (aOR=9.43; 95% CI 6.41 to 13.88).
CONCLUSION: Preterm birth and low SES were associated with a greater burden of NDDs in Pakistani children aged 2-6 years, with the highest prevalence observed when both were present.
METHODS: This retrospective cross-sectional study analysed medical and developmental records of 2634 Pakistani children aged 2-6 years, born between 2015 and 2020. Neurodevelopmental outcomes were assessed using Ages and Stages Questionnaire-3, Modified Checklist for Autism in Toddlers, Revised and Bayley-III, with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition confirmation where available. Preterm birth was defined as <37 weeks, with subcategories: extremely (<28), very (28-31) and late preterm (32-36 weeks). Multivariable logistic regression examined factors associated with NDDs, adjusting for sex, maternal age, maternal education, household income and neonatal intensive care unit (NICU) admission. Poisson regression estimated relative risks, and the interaction between prematurity and socioeconomic status (SES) was assessed.
RESULTS: Among 2634 children, 730 (27.7%) were preterm. NDD prevalence was higher in preterm compared with full-term children (25.8% vs 13.4%), including autism spectrum disorder (5.8% vs 2.0%), attention-deficit/hyperactivity disorder (7.9% vs 4.7%), cerebral palsy (2.6% vs 0.6%) and developmental delay risk (15.2% vs 9.6%). Prevalence increased with prematurity severity: extremely (55.6%), very (32.1%) and late preterm (23.9%). Multivariable analysis showed that preterm birth (adjusted OR (aOR)=1.91; 95% CI 1.48 to 2.47), low maternal education (aOR=1.44; 95% CI 1.17 to 1.78), male sex (aOR=1.34; 95% CI 1.08 to 1.66), low income (aOR=1.29; 95% CI 1.05 to 1.58) and NICU admission (aOR=1.52; 95% CI 1.18 to 1.95) were independently associated with NDDs. Children who were preterm and from low SES households had the highest odds (aOR=9.43; 95% CI 6.41 to 13.88).
CONCLUSION: Preterm birth and low SES were associated with a greater burden of NDDs in Pakistani children aged 2-6 years, with the highest prevalence observed when both were present.