Outcome studies of effects of interventions in early life: 1. Outcome of children born to mothers with renal disease inudpregnancy-PORD study: 2. Outcome of children born after preimplantation genetic diagnosis/screening- PGD/S study

摘要

Objectives: To assess two cohorts of children exposed to adverse/atypical in utero environments. The first group was born to mothers with chronic renal diseaseudin pregnancy (PORD). The second group was born after pre implantation genetic diagnosis/screening (PGD/PGS). The aim was to describe the health of these two groups of children in terms of physical/neurodevelopmental andudbehavioural well being (in relation to a matched control group of children born to healthy mothers).udTo assess any impact from having a child whilst undergoing treatment for chronic renal disease on the psychological health of the mother and/or maternal child bonding/relationships. To consider specific factors in the management of maternal renal disease which may have deleterious effects on the child's outcome (e.g. fetal drug exposure)udTo assess any impact of the difficulties of having a child after PGD/PGS,udwhich can often be stressful for couples, on the psychological health of theudparents / or parent-child bonding/ relationships.udMethods: Two population based case control studies of 176 children (and theirudfamilies): One of 24 children born to mothers with chronic renal disease inudpregnancy and one of 49 children born after preimplantation geneticuddiagnosis/screening.Controls were 37 children born to well mothers withoutudrenal disease and 66 children born after natural conception.udOutcome measures included: A full physical examination of the child, which included assessment ofudgrowth and general health. An assessment of development using Griffiths Mental Development Scales. Questionnaire-based to assessment of parent child relationships.udResults: Study and control children in both cohort studies were comparable for growthudparameters and neurodevelopmental scores as assessed by the Griffiths Scales of Mental Development.udThe children showed no between group differences in the temperamentaludcharacteristics perceived by mothers. There was no evidence of more stressudamongst study group mothers or evidence of impaired bonding between mother and child in comparison with controls.udThe PGD group had a significantly higher score on the warmth-affection subscale,udand significantly lower score on the aggression-hostility and rejectionudsub-scales than the control group.udThe PORD group demonstrated more externalising behavioural difficulties.udalthough the study reported that families (with renal disease) were more likelyudto be from lower socio-economic backgrounds. Significantly fewer vaginaluddeliveries were reported for mothers with renal disease and their infants wereudmore likely to experience neonatal morbidity.udSummary of findings from the PORD and PGD/S studies.udPORD studyudThe results of this study were generally reassuring for the families where the motherudhave chronic renal disease and have had children.udStudy and control children were comparable for growth parameters andudneurodevelopmental scores as assessed by the Griffiths scales of mental development.udNumbers were small. However the data does provide reassurance to a group ofudmothers with a variety of renal disease that there was no effect related to maternaluddisease or medications used on growth and development of the children.udThe study highlights significant differences in externalising behaviour (e.g. ruleudbreaking and aggressive behaviour) between the study and the control groups. Theudnumbers involved were small and further studies would be needed to establish this.udThe result might relate to the comparative social disadvantage (as assessed by the social class classification) seen in a higher proportion of PORD mothers than controludmothers.udThere was no difference in the temperamental characteristics perceived by mothers inudstudy and control groups. There was no evidence of more stress amongst mothersudwith renal disease or evidence of impaired bonding between mother and child inudcomparison with controls.udThe number of cases in the study was insignificant to provide strong evidence aboutudthe relation of severity of renal failure and outcome of the children. This was furtherudcompounded by difficulties in gathering maternal data from case notes.udEven though there were only eight mothers post transplant and the study providedudsome preliminary data to suggest that the well-being of these children wereudcomparable with that of children born to well mothers. However, further largerudstudies are needed in the future.udPGD studyudThis study is the first detailed study of children born after PGD world wide who wereudover a year of age and provides provisional reassurance that these children are healthyudin comparison to naturally conceived children.udGrowth parameters and neurodevelopmental scores were comparable in the study andudthe control group, providing reassuring information for couples who have undergoneudthe procedure and also future couples who will be undergoing the procedure. Theudchildren studied did not show any temperamental, behavioural or emotionaluddifficulties.udThe PGD group had significantly higher scores on the warmth-affection sub-scale,udand significantly lower scores on the aggression-hostility and rejection sub-scalesudthan the control group. There was also no indication of increased levels of stressudrelated to parenting.udConclusion: udThe studies in this thesis are reassuring in terms of physical andudneurodevelopmental health of children born to mothers after chronic renal disease in pregnancy and of children conceived following pre implantation geneticuddiagnosis/screening and their family relationships.