Sociocultural risk factors for developmental delay in children aged 3–60 months: a nested case-control study
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Identifying children at risk for developmental delay (DD) is important for improving prognosis. In this sense, we estimated sociocultural factors that may be associated with DD in early childhood. In our nested case-control study, 95 were included in the case group and 190 were randomly selected to control group. To identify the risk factors, we conducted a backward conditional logistic regression and a final multivariable model was developed. Maternal age of ≥35 years, low maternal and paternal education level, low socioeconomic level, consanguineous marriage, and delivery by cesarean section increased the risk of DD. After adjustment, the risk of DD was significantly increased by maternal age ≥ 35 years (odds ratio (OR) 3.04, 95%CI 1.38–6.70), maternal education level of primary school or lower (OR 14.56, 95%CI 5.40–39.24), consanguineous marriage (OR 3.99, 95%CI 1.69–9.40), and delivery by cesarean section (OR 3.34, 95%CI 1.80–6.18).
What is known:
• The causes of DD may be classified into prenatal, perinatal, and postnatal factors.
• Early identification may improve later outcomes of DD. Most studies conducted on this topic have focused on prematurity.
What is new:
• This study focused on maternal, paternal, and sociocultural factors that may be associated with DD in early childhood in this study that was conducted on a community-based sample.
• The risk of DD was increased by maternal age ≥ 35 years, maternal education level of primary school or lower, consanguineous marriage and delivery by cesarean section.
KeywordsDevelopmental delay Ages and Stages Questionnaires Risk factors Child
Ages and Stages Questionnaire-Turkish Version
Primary healthcare centers
We thank the executive support of the Ministry of Health, the Dokuz Eylul University School of Medicine, and Maya Academia. The ASQ-TR was provided by Maya Academia. We also acknowledge the sincere cooperation of Dr. Dilek Guldal, Dr. Nilgun Ozcakar, and Dr. Ferhat Demirci and all the family physicians who helped in this study.
Aylin Demirci, Mehtap Kartal conceived the project, prepared the questionnaires, analyzed the data, and wrote the paper. Aylin Demirci applied the ASQ-TR and the prepared questionnaires to mothers on a voluntary basis via face-to-face interview.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The Non-Interventional Research Ethics Committee of Dokuz Eylul University School of Medicine (resolution number 2012/41–01 dated 17.12.2012) approved the study. Necessary permissions were also obtained from the Ministry of Health, Turkish Public Health Institution, and the Governorship of Izmir, Director of Public Health, to conduct the study in primary healthcare centers (PHC). The families and/or primary care physicians of children who were found to be at risk for DD at the end of the evaluation were given additional information about monitoring and further examination. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Due to the nature of the research present, however, no informed consent was required from the individual participating in the study.
- 2.Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, Saade GR, Eddleman KA, Klugman S, Dugoff L, Timor-Tritsch IE, Craigo SD, Carr SR, Wolfe HM, Bianchi DW, DʼAlton M (2005) Impact of maternal age on obstetric outcome. Obstet Gynecol 105(5, Part 1):983–990. https://doi.org/10.1097/01.AOG.0000158118.75532.51 CrossRefPubMedGoogle Scholar
- 6.Gottlieb CA, Maenner MJ, Cappa C, Durkin MS (2009) Child disability screening, nutrition, and early learning in 18 countries with low and middle incomes: data from the third round of UNICEF’s multiple indicator cluster survey (2005–06). Lancet 28 374(9704):1831–1839. https://doi.org/10.1016/S0140-6736(09)61871-7 CrossRefPubMedGoogle Scholar
- 8.Kapci EG, Kucuker S, Uslu RI (2010) How applicable are Ages and Stages Questionnaires for use with Turkish children? Topics early child. Special Education 30(3):176–188Google Scholar
- 9.Kerstjens JM, de Winter AF, Sollie KM, Bocca-Tjeertes IF, Potijk MR, Reijneveld SA, Boss AF (2013) Maternal and pregnancy-related factors associated with developmental delay in moderately preterm–born children. Obstet Gynecol 121(4):727–733. https://doi.org/10.1097/AOG.0b013e3182860c52 CrossRefPubMedGoogle Scholar
- 16.Paulson RJ, Boostanfar R, Saadat P, Mor E, Tourgeman DE, Slater CC, Francis MM, Jain JK (2002) Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. JAMA 13;288(18):2320–2323Google Scholar
- 18.Resnick MB, Gueorguieva RV, Carter RL, Ariet M, Sun Y, Roth J, Bucciarelli RL, Curran JS, Mahan CS (1999) The impact of low birth weight, perinatal conditions and sociodemographic factors on educational outcome in kindergarten. Pediatrics 104(6):e74. https://doi.org/10.1542/peds.104.6.e74 CrossRefPubMedGoogle Scholar
- 19.Shevell M, Ashwal S, Donley D, Flint J, Gingold M, Hirtz D, Majnemer A, Noetzel M, Sheth RD, Quality Standards Subcommittee of the American Academy of Neurology; Practice Committee of the Child Neurology Society (2003) Practice parameter: evaluation of the child with global developmental delay: report of the Quality Standards Subcommittee of the American Academy of Neurology and The Practice Committee of the Child Neurology Society. Neurology 60(3):367–380. https://doi.org/10.1212/01.WNL.0000031431.81555.16 CrossRefPubMedGoogle Scholar
- 20.Simeonsson RJ, Sharp MC (1992) Developmental delays. In: Hoekelman RA, Friedman SB, Nelson NM et al (eds) Primary pediatric care. Mosby-Year Book, St Louis, pp 867–870Google Scholar
- 21.Simon GR, Baker C, Barden GA 3rd, Brown OW, Hardin A, Lessin HR, Meade K, Moore S, Rodgers CT, Committee on Practice and Ambulatory Medicine, Curry ES, Dunca PM, Hagan JF Jr, Kemper AR, Shaw JS, Swanson JT, Bright Futures Periodicity Schedule Workgroup (2014) 2014 recommendations for pediatric preventive health care. Pediatrics 133(3):568–570. https://doi.org/10.1542/peds.2013-4096 CrossRefGoogle Scholar