Journal of Perinatology https://doi.org/10.1038/s41372-018-0118-7 ARTICLE Do preterm infants with a birth weight ≤1250 g born to single- parent families have poorer neurodevelopmental outcomes at age 3 than those born to two-parent families? Abhay Lodha 1,2,3,4 ● Jahan Lakhani 1 ● Krystyna Ediger 3 ● Selphee Tang 1 ● Arijit Lodha 5 ● Vardhil Gandhi 5 ● Dianne Creighton 1,2 Received: 2 October 2017 / Revised: 17 March 2018 / Accepted: 26 March 2018 © Nature America, Inc., part of Springer Nature 2018 Abstract Objective Investigate neurodevelopmental outcomes at 3 years corrected age in infants with a birth weight ≤1250 g born to single parents. Study Design Infants born between 1995 and 2010 with a birth weight ≤1250 g were considered eligible. Primary outcome was neurodevelopmental impairment; considered present if a child had any of the following: cerebral palsy, cognitive delay, visual impairment, or deafness/neurosensory hearing impairment. Univariate and multivariate analyses were performed. Result A total of 1900 infants were eligible for inclusion. Follow-up data were available for 1395; 88 were born to a single parent. Infants in the single-parent group had higher mortality (18% vs. 11%, p = 0.009), IQ ≥1 SD below the mean (40% vs. 21%, p = 0.001) and any neurodevelopmental impairment (47% vs. 29%, p = 0.003). Single-parent family status, maternal education, bronchopulmonary dysplasia and severe neurological injury were significant predictors of intellectual impairment at 3 years corrected age. Conclusion Preterm infants with a birth weight ≤1250 g born to single parents at birth have poorer intellectual functioning at 3 years corrected age. Introduction Preterm infants with a birth weight (BW) ≤1250 g are at an increased risk for developing neurological, cognitive and behavioral problems in childhood, including cerebral palsy [1–3]. Parental anxiety and depression often contribute to behavioral problems in these children [4, 5]. Infants born to single parents have also been shown to have a greater risk for mortality [6] and adverse neurodevelopmental impairment (NDI) [7, 8]. However, there are limited data on the combined risk of being a preterm infant with ≤1250 g BW and having a single parent on long-term intellectual outcomes. Since 1960 to 2016, the incidence of non-marital child- bearing in the United States has increased from 8 to 23% in 2017 [9, 10]. In Canada, 19.2% of families are headed by single parents based on living arrangements, 81.3% of which are headed by single mothers and 18.7% by a single father [11, 12]. Single mothers often face financial barriers that limit access to prenatal care, with lack of medical insurance being more common in single-parent homes in the United States [13]. Lower socioeconomic status, lower income and poorer healthcare access contribute to increased parental stress and adverse pregnancy outcomes [14–16]. Studies have shown that increased parental stress, in both single and two-parent homes, contribute to poorer neurodevelopmental outcomes in childhood [17, 18]. Prenatal, intrauterine and perinatal environments are very important time periods during which the fetal brain’s rapid growth and plasticity render the brain sensitive to the effects of environmental changes. Any * Abhay Lodha aklodha@ucalgary.ca 1 Alberta Health Services, University of Calgary, Calgary, AL, Canada 2 Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AL, Canada 3 Department of Pediatrics, University of Calgary, Calgary, AL, Canada 4 Department of Community Health Sciences, University of Calgary, Calgary, AL, Canada 5 Graduate Department, University of Calgary, Calgary, AL, Canada 1234567890();,: 1234567890();,: