Language Abilities of Infants Born Preterm to Mothers With Diabetes

Transcription

1 Language Abilities of Infants Born Preterm to Mothers With Diabetes Diane Frome Loeb a, Caitlin Imgrund a, & Steven M. Barlow b a The University of Kansas b The University of Nebraska-Lincoln Disclosure: Diane Loeb, Caitlin Imgrund, and Steven Barlow have no relevant financial or nonfinancial relationships in the products or services described, reviewed, evaluated or compared in this presentation. 1

2 We Extend Our Gratitude to Christine Kosirog Sarah Orr The families who participated. Supported by grants NIH R01 DC (SM Barlow), NIH P30 HD02528, and the Sutherland Family Foundation (SM Barlow). 2

3 Diabetes Body cannot process sugar effectively and results in too much sugar (glucose) in one s blood. Insulin helps regulate the body s blood sugar. Gestational diabetes is the result of the mother s body inability to produce insulin, which serves to regulate blood sugar. 3

4 Maternal Diabetes 9% of women have diabetes in US. 9.2% of women develop gestational diabetes during their pregnancy (International Diabetes Federation, 2013; CDC, 2014; National Institute for Health and Care Excellence, 2009). 4

5 Possible Cause of Gestational Diabetes Hormones from the placenta block the action of the mother's insulin in her body (insulin resistance). Insulin resistance reduces efficient use of insulin for the mother, leading to an need for more insulin. The lack of insulin results in an overabundance of glucose. Hyperglycemia is when glucose is found in high amounts in the blood. 5

6 Negative Impact of Maternal Diabetes on Infant Additional glucose crosses over the placenta to the baby. Uncontrolled glucose levels may lead to abnormal brain development (Nold & Georgiff, 2004). respiratory difficulties birth defects jaundice 6

7 Maternal Diabetes Maternal diabetes is a risk factor for preterm birth Preterm birth is defined as birth before 37 weeks Being born preterm is a risk factor for having a language disorder (Harrison & McLeod, 2010). 7

8 Previous Research Compared 18 months olds born VLBW preterm to mothers with diabetes with VLBW children born preterm whose mothers did not have diabetes. Developmental quotient (adaptive, language, and motor skills) 9% of infants with infants born to mothers with diabetes who were VLBW displayed impaired neurodevelopmental outcomes at 18 months of age. (Rehan, Moddemann, & Casiro, 2002). 8

9 Previous Research 221 children born to mothers with diabetes and 2,612 controls Mean GA was 38 weeks post-menstrual age Children born earlier than 32 weeks were excluded (Dionne et al., 2008) 9

10 Previous Research McArthur Communicative Developmental Inventory at 18 & 30 months of age Peabody Picture Vocabulary Test at 4 years of age Expressive and receptive vocabulary at 5 years of age Early Development Instrument teacher-assessed communication at 7 and 8 years of age 10 (Dionne et al., 2008)

11 Previous Research 26% of children who were infants born to mothers with diabetes were identified with language impairment compared to 13% of the control group. Gestational diabetes predicted expressive vocabulary outcome at 18 months and 30 months; expressive grammar at 30 months; communication at 7 and 8 years of age. However, effect sizes of these results were small. 11 (Dionne et al., 2008)

12 Previous Research National cohort of children born preterm in New Zealand 301 children who were born preterm to mothers had gestational diabetes during pregnancy. Several factors, including gestational diabetes, were assessed as potential predictors of language impairment when the children were 18 months of age. (Schjølberg, Eadie, Daae Zachrisson, Øyen, & Prior, 2011) 12

13 Previous Research No significant predictive value between gestational diabetes and increased risk of language impairment. Limitation of study due to method of assessing language impairment. (Schjølberg, Eadie, Daae Zachrisson, Øyen, & Prior, 2011) 13

14 Previous Research Mothers with diabetes, whether gestational, or Type 1, or 2, were significantly more likely to give birth to a child diagnosed with ASD compared to mothers without diabetes. (Xu, Jing, Bowers, Liu, & Bao, 2013) 14

15 Summary Previous research is inconsistent on the effect of maternal diabetes upon the preterm with respect to language impairment. 15

16 Research Question Do the language skills of children who were born preterm to mothers with diabetes differ from children who were born preterm and healthy at 30 months of age? Areas of language evaluated Broad measure- expressive and receptive (standardized test) Vocabulary- expressive and receptive (standardized tests) Pragmatic skills (parent report) 16

17 Participants Children born preterm to mothers with diabetes Children born preterm with a healthy infant diagnosis No specific diagnosis who were otherwise medically stable and who had minimal or no oxygen history ( 5 days of ventilator, CPAP, and nasal cannula). 17

18 Participants 26 children participated at 30 months of age 13 children who were born preterm to mothers with diabetes 13 children born preterm who were healthy infants and whose mothers did not have diabetes Participants were matched by gender and maternal education 6 males, 7 females 7 High School 2 BA degree 4 Graduate degree 18

19 Ethnicity Gestational Age* (p= 0.01) Infants of Mothers with Diabetes 11 Caucasian 1 More than one race 1 African American 30.2 weeks (2.5) Range= Very Preterm 2 Late Preterm Infants that were Healthy Preterm 9 Caucasian 3 More than one race 1 Asian American 32.1 weeks (1.76) Range= Very Preterm 3 Late Preterm Birth Weight ( ) grams Range= grams 4 were ELBW < 1000 g 1 VLBW 7 LBW 1829 ( ) grams Range= grams 0 ELBW 3 VLBW 9 LBW Days in NICU* (p= 0.009) Cognitive Subtest Bayley III days (31.86) Range= days (10.66) Range= (12.01) 90.8 (4.49) 19

20 NICU Follow-Up Clinic Procedure Assessment protocol Bayley Scales of Infant & Toddler Development III or Test of Early Language Development-4 Receptive One-Word Picture Vocabulary Test-4 Expressive One-Word Picture Vocabulary Test-4 Conversational Rating Scale (Girolametto, 1997) 20

21 Conversational Rating Scale (Girolametto, 1997) The CRS has 10 items to assess responsiveness and 15 targeting assertiveness. Parents were asked to rate their child s assertiveness and responsiveness in conversations on a 5-point scale consisting of (1) never, (2) almost never, (3) sometimes, (4) often, and (5) always. Girolametto (1997) recommended facilitation of responsiveness and/or assertiveness in children who displayed scores below 3.0 on the CRS. 21

22 Conversational Rating Scale An example of a statement from the responsiveness portion of the scale is: When I ask a question, my child answers. An example from the assertive portion of the scale is: When something new or unusual happens, my child asks me about it. 22

23 Results 23

24 Results Broad Language Measure Receptive subtest- p=.007, d=.87 38% (5) born to mothers with diabetes scored in clinical range of language impairment, compared to 7% (1) in HI group Expressive subtest- p.=.02, d=.78 15% (2) born to mothers with diabetes scored in clinical range of language impairment, compared to 7% (1) in HI group Combined- p=.004, d=.94 38% (5) born to mothers with diabetes scored in clinical range of language impairment, compared to 7% (1) in HI group 24

25 Results 25

26 Results Vocabulary Measures Receptive - p=.33 ns 23% (3) born to mothers with diabetes scored in clinical range of language impairment, compared to 7% (1) in group with HI Expressive - p=.17 ns 15% (2) born to mothers with diabetes scored in clinical range of language impairment, compared to 15% (2) in group with HI 26

27 Results 27

28 Results Conversational Measures Responsiveness- p=.40 ns 7% (1) born to mothers with diabetes scored in clinical range of language impairment, compared to 0 in group with HI Assertiveness- p=.46 ns 7% (1) born to mothers with diabetes scored in clinical range of language impairment, compared to 15% (2) in group with HI 28

29 Discussion Comparison with Dionne et al. (2008) results Similarly, we found expressive language to be impaired in children born to mothers with diabetes. In contrast, expressive vocabulary was not found to be impaired in current study. Different assessment measures (MCDI- parent report vs labeling pictures- EOWPVT) 29

30 Discussion New Information Deficits present on broad measure of receptive language. No significant difference on receptive vocabulary. No significant difference between assertiveness and responsiveness skills. 30

31 Clinical Implications Assessment Following directions and sentence development may be problematic. Maternal diabetes and risk status Share this information with local infant-toddler programs. NICU followup programs, & pediatricians. 31

32 Questions? 32

33 Selected References American Diabetes Association. (2013). Diagnosis and classification of diabetes mellitus. Diabetes Care, 36(Suppl 1), S67 S74. Barre, N., Morgan, A., Doyle, L.W., & Anderson, P.J. (2010). Language abilities in children who were very preterm and/or very low birth weight: A meta-analysis. The Journal of Pediatrics, 158 (5), Blencowe, H., et al. (2013). Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health 2013, 10(Suppl 1):S2. doi: / s1-s2 Centers for Disease Control and Prevention (2011). National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States. Atlanta, GA: U.S. Department of Health and Human Services. Girolametto, L. (1997). Development of a parent report measure for profiling the conversational skills of preschool children. American Journal of Speech-Language Pathology, 6, American Speech, Language, and Hearing Convention, Orlando November 22, 2014

34 Harrison, L.J., & McLeod, S. (2010). Risk and protective factors associated with speech and language impairment in a nationally representative sample of 4- to 5-year-old children. Journal of Speech, Language, and Hearing Research, 53, Dionne, G., Boivin, M., Seguin, J., Perusse, D., & Tremblay, R. (2008). Gestational diabetes hinders language development in offspring. Pediatrics. 122, e1073 e1079. National Institute for Health and Care Excellence. (2009). NICE clinical guidelines 63: Diabetes in pregnancy: Management of diabetes and its complications from pre-conception to the postnatal period. Nold, J.L, & Georgieff, M.K. (2004). Infants of diabetic mothers. Pediatric Clinics of North America, 51, Rehan, V.K., Moddemann, D., & Casiro, O.G. (2002). Outcome of verylow-birthweight (<1,500 grams) infants born to others with diabetes. Clinical Pediatrics, 41, American Speech, Language, and Hearing Convention, Orlando November 22, 2014

35 Schjølberg, S., Eadie, P., Daae Zachrisson, H., Øyen, A.S., & Prior, M. (2011). Predicting language development at age 18 months: Data from the Norwegian mother and child cohort study. Journal of Developmental and Behavioral Pediatrics, 32, Xu,G., Jing, J., Bowers, K., Liu, B., & Bao, W. (2013). Maternal diabetes and the risk of autism spectrum disorders in the offspring: A systematic review and meta-analysis. J Autism Dev Disord DOI /s American Speech, Language, and Hearing Convention, Orlando November 22, 2014