Published online September 1, 2004
PEDIATRICS Vol. 114 No. 3 September 2004, pp. 736-743 (doi:10.1542/peds.2003-1150-L)
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Prevalence, Stability, and Predictors of Clinically Significant Behavior Problems in Low Birth Weight Children at 3, 5, and 8 Years of Age

Ronald F. Gray, MB, ChB, MPH, Alka Indurkhya, PhD and Marie C. McCormick, MD, ScD

From the Department of Maternal and Child Health, Harvard School of Public Health, Boston, Massachusetts

Objectives. To examine the prevalence, stability, and predictors of clinically significant behavior problems in 869 preterm low birth weight (LBW) infants at 3, 5, and 8 years of age.

Methods. A prospective cohort study was conducted. Clinically significant behavior problems were assessed using dichotomized total problem Child Behavior Checklist scores in LBW children at ages 3, 5, and 8 years. Baseline sociodemographic and obstetric data were collected. Maternal General Health Questionnaire performed at 40 weeks' gestation was dichotomized at a score of 12 to give a measure of maternal psychological distress. Prevalence and stability of behavior problems at ages 3, 5, and 8 were determined and potential predictors of behavior problems at age 3, 5, and 8 were examined using multiple logistic regression.

Results. Prevalence of behavior problems remained at ~20% at 3, 5, and 8 years. Stability of behavior problems between different ages was ~50%. Significant behavior problems at ages 3, 5, and 8 were predicted by maternal psychological distress at 40 weeks (odds ratio [OR]: 1.59; 95% confidence interval [CI]: 1.21–2.09), maternal cigarette smoking during pregnancy (OR: 1.57; 95% CI: 1.20–2.04), Hispanic ethnicity (OR: 2.00; 95% CI: 1.24–3.24), and maternal age (OR: 0.97; 95% CI: 0.94–0.99).

Conclusions. This sample had double the prevalence of behavior problems expected in the general child population. These problems showed stability over time. Cigarette smoking in pregnancy, maternal psychological distress at 40 weeks' gestation, maternal age, and Hispanic ethnicity all were significant predictors of the development of behavior problems from ages 3 to 8. These findings have implications for health policies on smoking and postnatal depression.

Key Words: infant • premature • low birth weight • Child Behavior Checklist • prevalence • stability • outcome predictors

Abbreviations: LBW, low birth weight • IHDP, Infant Health and Development Program • GHQ, General Health Questionnaire • CBCL, Child Behavior Checklist • OR, odds ratio • CI, confidence interval

Accepted Apr 26, 2004.




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