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Die langfristigen Auswirkungen von Frühgeburtlichkeit auf kognitive Entwicklung und Schulerfolg

Gibt es einen protektiven Effekt mütterlicher Responsivität?

Published Online:August 31, 2017https://doi.org/10.1026/0942-5403/a000235

Abstract

Zusammenfassung. In einer prospektiven Längsschnittstudie wurde der Zusammenhang zwischen früher Responsivität der Mutter und kognitiver Entwicklung ihrer früh- bzw. reifgeborenen Kinder untersucht. Im Alter von drei Monaten wurde dafür die Mutter-Kind-Interaktion mittels Verhaltensbeobachtung erfasst. Bei n=351 der teilnehmenden Kinder (101 frühgeboren) wurde die allgemeine Intelligenz (IQ) im Alter von 11 Jahren und bei n=313 (85 frühgeboren) zusätzlich der höchste erreichte Schulabschluss bis 25 Jahren erhoben. Frühgeborene wiesen mit 11 Jahren einen signifikant niedrigeren IQ als Reifgeborene auf, nachdem für mögliche konfundierende Faktoren kontrolliert worden war. Nur bei Früh-, nicht aber bei Reifgeborenen zeigte sich ein signifikanter positiver Zusammenhang zwischen mütterlicher Responsivität und IQ. Für die Wahrscheinlichkeit einen höheren Schulabschluss (mind. Fachabitur) zu erreichen, fand sich weder ein signifikanter Effekt von Frühgeburtlichkeit noch von mütterlicher Responsivität.


Long-Term Consequences of Preterm Birth on Cognitive Development and Academic Achievement: Is There a Protective Effect of Maternal Responsiveness?

Abstract. Preterm birth is associated with adverse long-term consequences regarding cognitive development. Whereas children born very preterm represent a subgroup at special risk, so-called late preterms are also affected to a lesser degree. Effects of prematurity can be observed until adulthood. For example, decreased wealth was reported in adults born preterm, which was mediated by decreased intelligence during childhood and lower educational qualifications during young adulthood. Hence, it is highly relevant to examine whether certain factors can buffer against the adverse effects of preterm birth on cognitive development. Parenting might play an important role here. There is evidence suggesting a protective effect of sensitive parenting during childhood on later cognitive outcome in preterms. In the current study, we examined whether early responsive maternal care was associated with later intelligence and academic achievement in children born preterm versus full term. As part of an ongoing cohort study, early maternal responsiveness was assessed at the child’s age of 3 months (adjusted for gestational age) during a nursing and playing situation. At age 11 years, general intelligence (IQ) was determined in n = 351 children (101 born preterm; 168 male). Until age 25 years, educational qualification was assessed in n = 313 participants (85 born preterm; 145 male). IQ at age 11 was significantly lower in preterms compared with full-term subjects after adjusting for potential confounders like maternal educational background and early psychosocial risk. A significant interaction between preterm birth and early maternal responsiveness was detected. In preterms only, higher levels of early maternal responsiveness were significantly associated with higher child IQ. Lower IQs in children born preterm as compared with those born full term were observed in the subaverage-to-average range of maternal responsiveness. Interestingly, preterms exposed to very high levels of maternal responsiveness showed slightly higher IQs when compared with children born at term. With regard to academic achievement, neither a significant effect of preterm birth nor of early maternal responsiveness occurred after adjusting for potential confounders. The results of the current study replicate and extend earlier findings with regard to a protective effect of sensitive parenting on childhood cognitive outcome in preterms. The lacking impact of prematurity on academic achievement may be explained by the exclusion of participants with IQs outside the normal range in the current study. Interventions enhancing early responsive care in parents of preterms may be advisable. More studies on long-term outcomes of such interventions on cognitive development are encouraged.

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