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The challenges of heterogeneity in gestational age and birthweight inclusion criteria for research synthesis on very preterm birth and childhood cognition: An umbrella review and meta‐regression analysis
Author(s) -
Sentenac Mariane,
Chaimani Anna,
Twilhaar Sabrina,
Benhammou Valérie,
Johnson Samantha,
Morgan Andrei,
Zeitlin Jennifer
Publication year - 2022
Publication title -
paediatric and perinatal epidemiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 88
eISSN - 1365-3016
pISSN - 0269-5022
DOI - 10.1111/ppe.12846
Subject(s) - medicine , gestational age , low birth weight , birth weight , confidence interval , pediatrics , meta analysis , premature birth , obstetrics , pregnancy , genetics , biology
Background Meta‐analyses of studies on very preterm (VPT) birth and childhood cognition select primary studies using gestational age inclusion criteria only, while others also include birthweight criteria. The consequences of this choice are unknown. Objective The objective of this study was to describe the gestational age (GA) and birthweight (BW) criteria used in studies of VPT birth and cognition and to investigate whether meta‐analysis results differ based on these criteria. Data sources Five systematic reviews on VPT birth and childhood IQ. Study selection and data extraction Country, birth years, GA‐BW selection criteria and participant IQ were extracted from 156 studies representing 103 birth cohorts. Synthesis Pooled standardised mean differences (SMD) in IQ between children born VPT and term‐born controls were estimated by sub‐group based on GA‐BW criteria (GA, BW and GA‐BW combined) and degree of preterm birth‐low birthweight combinations: extremely preterm (EPT, <28 weeks) and extremely low BW (ELBW, <1000 g); VPT (<32 weeks) and very low BW (VLBW, <1500 g); and moderately MPT (<34 weeks) and moderately low BW (MLBW, <1800 g). Results Cohorts used 27 distinct GA‐BW inclusion criteria. Most common criteria were BW <1500 g (24 cohorts), BW <1000 g (12), GA <32 weeks (12) and GA <33 weeks (12); 23 studies used GA‐BW combinations. BW‐only criteria were more frequent in North America than Europe (63% versus 24%) and for cohorts before than after 1990 (67% vs 26%). Pooled SMD in IQ varied: SMD EPT/ELBW −0.94, 95% confidence interval [CI] −1.07, −0.82; SMD VPT/VLBW −0.78, 95% CI −0.85, −0.71; SMD MPT/MLBW −0.68, 95% CI −0.79, −0.57; however, there was no difference in SMD across cohorts using BW compared to GA criteria after adjustment on risk group. Conclusions These findings support the inclusion of studies using GA and/or BW criteria in meta‐analyses on VPT birth and cognition to increase the geographical and temporal generalisability of the results and to allow investigation of the impact of the heterogeneous inclusion criteria in this literature on outcomes.