Banerjee, I; (2011) Outcome studies of effects of interventions in early life: 1. Outcome of children born to mothers with renal disease in pregnancy-PORD study: 2. Outcome of children born after preimplantation genetic diagnosis/screening- PGD/S study. Doctoral thesis , UCL (University College London).

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Abstract

Objectives: To assess two cohorts of children exposed to adverse/atypical in utero environments. The first group was born to mothers with chronic renal disease in 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 and behavioural well being (in relation to a matched control group of children born to healthy mothers). To 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) To assess any impact of the difficulties of having a child after PGD/PGS, which can often be stressful for couples, on the psychological health of the parents / or parent-child bonding/ relationships. Methods: Two population based case control studies of 176 children (and their families): One of 24 children born to mothers with chronic renal disease in pregnancy and one of 49 children born after preimplantation genetic diagnosis/screening.Controls were 37 children born to well mothers without renal disease and 66 children born after natural conception. Outcome measures included: A full physical examination of the child, which included assessment of growth and general health. An assessment of development using Griffiths Mental Development Scales. Questionnaire-based to assessment of parent child relationships. Results: Study and control children in both cohort studies were comparable for growth parameters and neurodevelopmental scores as assessed by the Griffiths Scales of Mental Development. The children showed no between group differences in the temperamental characteristics perceived by mothers. There was no evidence of more stress amongst study group mothers or evidence of impaired bonding between mother and child in comparison with controls. The PGD group had a significantly higher score on the warmth-affection subscale, and significantly lower score on the aggression-hostility and rejection sub-scales than the control group. The PORD group demonstrated more externalising behavioural difficulties. although the study reported that families (with renal disease) were more likely to be from lower socio-economic backgrounds. Significantly fewer vaginal deliveries were reported for mothers with renal disease and their infants were more likely to experience neonatal morbidity. Summary of findings from the PORD and PGD/S studies. PORD study The results of this study were generally reassuring for the families where the mother have chronic renal disease and have had children. Study and control children were comparable for growth parameters and neurodevelopmental scores as assessed by the Griffiths scales of mental development. Numbers were small. However the data does provide reassurance to a group of mothers with a variety of renal disease that there was no effect related to maternal disease or medications used on growth and development of the children. The study highlights significant differences in externalising behaviour (e.g. rule breaking and aggressive behaviour) between the study and the control groups. The numbers involved were small and further studies would be needed to establish this. The result might relate to the comparative social disadvantage (as assessed by the social class classification) seen in a higher proportion of PORD mothers than control mothers. There was no difference in the temperamental characteristics perceived by mothers in study and control groups. There was no evidence of more stress amongst mothers with renal disease or evidence of impaired bonding between mother and child in comparison with controls. The number of cases in the study was insignificant to provide strong evidence about the relation of severity of renal failure and outcome of the children. This was further compounded by difficulties in gathering maternal data from case notes. Even though there were only eight mothers post transplant and the study provided some preliminary data to suggest that the well-being of these children were comparable with that of children born to well mothers. However, further larger studies are needed in the future. PGD study This study is the first detailed study of children born after PGD world wide who were over a year of age and provides provisional reassurance that these children are healthy in comparison to naturally conceived children. Growth parameters and neurodevelopmental scores were comparable in the study and the control group, providing reassuring information for couples who have undergone the procedure and also future couples who will be undergoing the procedure. The children studied did not show any temperamental, behavioural or emotional difficulties. The PGD group had significantly higher scores on the warmth-affection sub-scale, and significantly lower scores on the aggression-hostility and rejection sub-scales than the control group. There was also no indication of increased levels of stress related to parenting. Conclusion: The studies in this thesis are reassuring in terms of physical and neurodevelopmental health of children born to mothers after chronic renal disease in pregnancy and of children conceived following pre implantation genetic diagnosis/screening and their family relationships.

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