Progress Report for SSCB
PhD Title: Preterm birth, neurodevelopment, and the socioeconomic determinants of outcome
Name: Dr Katie Mckinnon
Supervisors: Professor James Boardman, Dr Hilary Richardson
Thank you to Simpson Special Care Babies for your ongoing support of the fees for my research degree at the University of Edinburgh. My research is exploring the complex interaction between preterm birth, socioeconomic status and neurodevelopmental outcome with the Theirworld Edinburgh Birth Cohort (TEBC), a longitudinal study funded by Theirworld.
In Scotland, 6.4% of babies are born preterm
While there is variability in developmental trajectories and outcomes of people born preterm, there is increased likelihood of physical and cognitive impairment, and mental health diagnoses across their lifetime. Preterm birth is also associated with a range of changes to brain development, such as regional volume changes and other alterations to structures.
Socioeconomic status (SES)
19% of people in Scotland live in poverty, and those born in the most deprived areas have fewer years of their life in good health than those in the least deprived areas. In the general population, cognitive ability, educational attainment, and brain morphology are influenced by socioeconomic status (SES). SES is multifactorial, encompassing various aspects of the environment and access to material resources, and previous research has suggested there may be differences in the impact of these elements on different biological systems, and at different time points.
SES may confound the relationship between preterm birth and neurodevelopmental outcomes, so understanding this relationship, specifically the weighted contributions of deprivation and low gestational age to atypical brain development is important for designing rational therapies and support strategies for children born preterm.
Neonatal Brain Development
So far, I have mainly explored the relationship between SES and prematurity in neonatal brain morphology. The Theirworld Edinburgh Birth Cohort (www.tebc.ed.ac.uk) is a group of preterm- and term-born children, who are being followed up and assessed as they grow and develop. When they were born, we collected lots of data about them and their families, including SES. We looked at neighbourhood-level SES as the Scottish Index of Multiple Deprivation (SIMD) derived from the family’s postcode, family-level SES as parental education and occupation, and subjective SES (how parents feel about their own SES and opportunities). They had MRI brain scans when they were around their due date, and from these scans we could calculate the regional volumes and other brain structural measurements.
I ran statistical models to see how these measurements were associated with prematurity and SES, measured in the different ways. We found that both gestational age at birth and SES were associated with brain structures, but prematurity was more important. We also found that how SES was associated with brain structures varied depending what measure we used. Family measures of the parent’s education and occupation were associated with more brain structures. There were also interaction effects between prematurity and family- and subjective-level SES, meaning that how SES impacted brain development was different in more preterm children.
This suggests that the impacts of SES on brain development, as seen by others primarily in later childhood, is predominantly in the postnatal environment, rather than in the antenatal period or neonatal unit, and that prematurity remains the primary influence on brain development in the neonatal period. Future work will be needed to discover how preterm birth and level-specific SES is embedded into the developing brain. It also means strategies could be developed to mitigate the adverse effects of family socioeconomic disadvantage on brain development during neonatal intensive care.
Theirworld Edinburgh Birth Cohort (TEBC)
I will continue to explore this relationship between prematurity and SES. My next project will look at epigenetic data from the TEBC babies – this looks at how behaviours and environmental exposures change the way your genes work.
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