Efeito de experiências adversas na infância (ACE) no desenvolvimento aos 18 meses de vida de crianças com vulnerabilidade social e biológica

Abstract

Introduction: Adverse events in childhood (ACE) are experiences capable of negatively affect a child’s health throughout life. The impact on the development of infants is still uncertain. Objective: To analyze the effect of ACE on the development at 18 months of life of children born in a public maternity hospital of reference for high-risk births and the moderating role of the participants’ characteristics in this relationship. Methods: The thesis consists of a systematic review that analyzed the impact of ACE on child development and/or behavior in the first three years of life, according to the PRISMA protocol. Articles published between 2010 and 2020 in English, Spanish or Portuguese, available in Pubmed, Psychnet, ASSIA, and Scielo databases were included. The methodological quality of the articles was assessed by the STROBE Checklist. Data from a retrospective cohort involving 97 children followed up for 18 months at the Outpatient Clinic for High-Risk Newborn Development Follow-up at Sofia Feldman Hospital was also analyzed. Data were obtained over the first 18 months of children’s lives, and development was assessed by Bayley-III at 18 months. We analyzed 10 ACEs that reflect the child’s exposure to mental health problems, family dysfunction, poverty, and violence in the neighborhood were analyzed. The effect of ACE on development was assessed by multiple linear regression and the moderator effect of variables by ANOVA. Results: In the systematic review, 14 articles were analyzed, of which 12 (85,7%) found a direct association between exposure to multiple ACEs and negative outcomes in various domains of behavior and/or development. The methodological quality of 12 (85.7%) articles was considered moderate. 74 mothers included in the cohort study studied for more than 8 years (n= (77%), and 70 children were born preterm (72%). The most prevalent ACE was violence in the neighborhood reported by 53 mothers (59%), and the least prevalent was food insecurity, present in 10 families (10%). Among the analyzed ACEs, only maternal depressive symptoms directly affected the children’s overall development (b = -3.63; p = 0.01). This effect was moderated by the characteristics of the children and mothers. Conclusion: The literature review confirmed the negative impact of adverse experiences on infants’ development and behavior. Besides, maternal depression negatively affected the development of young infants and nullified the protective effect of breastfeeding, attendance to daycare, and high maternal education. Children with predisposing factors for developmental delays, such as been males and born preterm, were affected more intensely than their peers.