Emotional and behavioural problems of children born preterm and maternal sensitivity: An individual participant data meta-analysis.

AIM: To examine whether dyadic maternal sensitivity is associated with emotion and behaviour regulation of children born preterm (< 37 weeks' gestation).

METHOD: We performed a systematic literature search and individual participant data (IPD) meta-analysis including seven cohorts (2469 mother-child dyads). Data were z-standardized according to contemporary cohort-specific term-born controls and harmonized. One-stage IPD meta-analyses were performed using mixed-effects linear regressions.

RESULTS

The fixed effects of maternal sensitivity (per SD: -0.08 [95% confidence interval = -0.16, -0.004], p = 0.039) and gestational age at birth (per week: -0.04 [-0.05, -0.03], p < 0.001) were both associated with lower emotional and behavioural difficulties after adjusting for known confounders. Postnatal maternal sensitivity mediated the effect of gestational age on children's emotional and behavioural problems (indirect effect: 0.003 [0.001, 0.004], p = 0.001; total effect: -0.04 [-0.05, -0.03], p < 0.001). There was no interaction effect (i.e. all children benefited equally from sensitive parenting, irrespective of their gestation at birth).

INTERPRETATION: High maternal sensitivity is associated with lower behavioural and emotional problems across the whole range of gestation. Clinical interventions supporting maternal sensitivity after preterm birth warrant further investigation and implementation.