Post-term birth and the risk of behavioural and emotional problems in early childhood

Background Post-term birth, defined as birth after pregnancy duration of 42 weeks, is associated with increased neonatal morbidity and mortality. The long-term consequences of post-term birth are unknown. We assessed the association of post-term birth with problem behaviour in early childhood. Methods The study was performed in a large population-based prospective cohort study in Rotterdam, The Netherlands. Pregnant mothers enrolled between 2001 and 2005. Of a cohort of 5145 children, 382 (7%) were born post-term, and 226 (4%) were born preterm. Parents completed a standardized and validated behavioural checklist (Child Behavior Checklist, CBCL/1.5-5) when their children were 1.5 and 3 years old. We examined the relation between gestational age (GA) at birth, based on early fetal ultrasound examination, and problem behaviour with regression analyses, adjusting for socio-economic and pregnancy-related confounders. Results A quadratic relationship between GA at birth and problem behaviour indicates that both preterm and post-term children have higher behavioural and emotional problem scores than the term born children. Compared with term born children, post-term born children had a higher risk for overall problem behaviour [ odds ratio (OR) 2.10, 95% confidence interval (CI) 1.32-3.36] and were almost two and a half times as likely to have attention deficit / hyperactivity problem behaviour (OR 2.44, 95% CI 1.38-4.32). Conclusions Post-term birth was associated with more behavioural and emotional problems in early childhood, especially attention deficit / hyperactivity problem behaviour. When considering expectant management, this aspect of post-term pregnancy should be taken into account.