Summary of CPP Study Design And Baseline Data Collection The Collaborative Perinatal Project (CPP) was initiated 40 years ago to investigate prospectively the prenatal and familial antecedents of pediatric, neurological and psychological disorders of childhood. Twelve university-affiliated medical centers participated in this national study, two in New England (Harvard Medical School and Brown University). The Project entailed a single study design involving the systematic collection of data through the prospective observation and examination of over 50,000 pregnancies through the first seven years of life. Obstetrical intake occurred between January 2, 1959 and December 31, 1965. Cases were selected on the basis of a sampling frame defined for each study center (Broman et al., 1987). Women in the study were representative of the patients receiving prenatal care in each participating center. At the conclusion of the study, a total of 55,908 births were recorded nationally, approximately 17,000 of which occurred in Boston/Providence. In the total population, follow-up rates for survivors were 88% at one years, 75% at 4 years and 79% at 7 years. Major findings from the National Project have been summarized by Niswander and Gordon (1972), Broman, Nichols and Kennedy (1975), Nichols and Chen (1981) and Broman, Bien and Shaughnessy (1985). Data from examinations and interviews were recorded by trained staff at each site beginning at the time of registration for prenatal care, using standardized protocols, forms, manuals and codes. At the time of the first prenatal visit, a complete reproductive and gynecological history, a recent and past medical history, a socioeconomic interview, and a family history was recorded. A socioeconomic index (SEI) was assigned to each pregnancy, adapted from the Bureau of the Census and derived from education and occupation of the head of household along with household income (Myrianthopolous and French, 1968). Prenatal clinic visits were scheduled every month during the first 7 months of pregnancy, every 2 weeks during the 8th month, and every week thereafter. An interval prenatal history was recorded at each prenatal visit (including repeat assessments of cigarette smoking), along with results of pertinent laboratory tests and physical exams. Blood samples were collected for serology and for storage of frozen sera, and are available from the NIH repository for 98% of the pregnancies of the New England cohort (17,502 pregnancies and 48,695 separate samples, approximately three time points per pregnancy). After admission for delivery, trained observers recorded the events of labor and delivery, and the obstetrician in charge completed a summary of labor and delivery protocols. For about 75% of subjects cord blood samples were drawn and stored. The neonate was observed in the delivery room and examined by a pediatrician at 24-hour intervals in the newborn nursery. A neurological examination was performed at 2 days. Nurses’ observations and results of laboratory tests were recorded and a diagnostic summary of the nursery period completed by a study physician. After the neonatal stage, the child was scheduled for at least five subsequent assessments at ages 4 months, 8 months, 12 months, 4 years and 7 years (assessments at 3 and 8 years were planned but discontinued). At each follow-up examination the mother was interviewed about the child’s interval history, records of medical treatment obtained if appropriate, and physical measurements taken. Pediatric-neurological examinations occurred at 4 months, 12 months and 7 years and psychological examinations at 8 months, 4 and 7 years. Interval histories were updated at 18 months, 2, 5 and 6 years. Family and social history information was obtained from the mother at intake and the 7th year. Diagnostic summaries were prepared by study physicians following the 1st and 7th year. Follow-up rates for the New England cohort surpassed the overall project rates; over 80% of the NE cohort completed the final full assessment at age 7. Broman et al. (1987) organize the 1000s of study variables according to six epochs. A partial list is presented. 1) Prenatal period: sociodemographic characteristics of the family, including: G1 Mother and G1 Father Race, Ethnicity, Birthplace, Age. Mother’s and Father’s parents’ birthplaces,

Maternal and Paternal Educational Attainment, Occupation, Annual Income, Income of family during first 3 months of pregnancy, Sources of Income, Number persons supported and producing income, income changes during first three months of pregnancy, Employment duration, Number jobs past year, type of residence, duration at current residence, number of moves past 5 years, persons and rooms in household. Detailed maternal medical and reproductive history, paternal medical/psychiatric history (including 1st degree relatives). Repeat prenatal assessments including laboratory tests, selfreports of smoking, accidents, illnesses. Course and complications of pregnancy. 2) Labor and Delivery. Variables include length of labor, fetal heart rate, type of delivery, administration of anesthetics (type, duration, amount). 3) Neonatal Period. Birthweight, head circumference, gestational age, size for dates (small for gestational age), intra-uterine growth retardation, Apgar scores, malformations, minor physical anomalies, genetic syndromes, breast/bottle feeding. 4) Infancy. Weight, height, head circumference (3 times), test scores and behavior ratings from the research version of the Bayley Scales of Infant Development, fine and gross motor development, neurological soft and hard signs, two pediatric-neurological examinations, diagnostic summary of first year of life. Infant and maternal behavioral observations and ratings. 5) Preschool Period. Speech, language and hearing examination (partial sample only). Physical measurements. Age 4 psychological examination assessing intellectual functioning (Stanford-Binet Intelligence Scale), motor skills, concept formation ability (Graham-Ernhart Block Sort Test) and behavioral observations. 6) Age 7. Reassessment of demographic, socioeconomic, medical/psychiatric, family composition, residence, moves, and other family characteristics obtained at intake assessment (see ‘Prenatal Period’ above). Child medical status, based on a pediatricneurological examination at age 7 and review of all medical records between 1 and 7 years. Neurological soft and hard signs. Intellectual, academic and perceptual motor functioning assessed by the Wechsler Intelligence Scale for Children (WISC), the Wide Range Achievement Test (WRAT) the Goodenough Harris Draw-a-Person Test, the Bender-Gestalt Test, the Auditory Vocal Association Test from the Illinois Test of Psycholinguistic Abilities and the Tactile Finger Recognition Test. Behavioral observations and ratings References Broman, S., Bien, E., & Shaughnessy, P. (1985). Low achieving children: The first seven years. Hillsdale: NJ: Lawrence Erlbaum Associates. Broman, S. H., Nichols. P. I., & Kennedy. W. A. (1975). Preschool IQ: Prenatal and early developmental correlates: New York: Halstead Press. Broman, S., Nichols, P. L., Shaughnesy, P., & Wallace, K. (1987). Retardation in young children: A developmental perspective. Hillsdale, NJ: Lawrence Erlbaum Associates. Myrianthopoulos, N. C, & French, K. S. (1968). An application of the U.S. bureau of the census socioeconomic index to a large diversified patient population. Social Science and Medicine, 2, 283-299. Nichols, P. L., & Chen, T. C. (1981). Minimal brain dysfunction: A prospective study. Hillsdale, NJ: Lawrence Erlbaum Associates. Niswander, K. R., & Gordon, M. (1972). The women and their pregnancies. Washington, DC: U.S. Government Printing Office.