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Neurodevelopmental disorders (NDD) in offspring are associated with a complex combination of pre-and postnatal factors. This study uses machine learning and population data to evaluate the association between prepregnancy or perinatal risk factors and the NDD of offspring. Population-based retrospective cohort data were obtained from Korea National Health Insurance Service claims data for 209,424 singleton offspring and their mothers who gave birth for the first time in 2007. The dependent variables were motor development disorder (MDD), cognitive development disorder (CDD) and combined overall neurodevelopmental disorder (NDD) from offspring. Seventeen independent variables from 2002 to 2007 were included. Random forest variable importance and Shapley Additive Explanation (SHAP) values were calculated to analyze the directions of its associations with the predictors. The random forest with oversampling registered much higher areas under the receiver-operating-characteristic curves than the logistic regression of interaction and non-linearity terms, 79% versus 50% (MDD), 82% versus 52% (CDD) and 74% versus 50% (NDD). Based on random forest variable importance, low socioeconomic status and age at birth were highly ranked. In SHAP values, there was a positive association between NDD and pre- or perinatal outcomes, especially, fetal male sex with growth restriction associated the development of NDD in offspring. [ABSTRACT FROM AUTHOR]

Objective: To evaluate long‐term adverse neurodevelopmental outcomes of discordant twins delivered at term. Design: Retrospective cohort study. Setting: Nationwide (Republic of Korea). Population: All twin children delivered at term between 2007 and 2010. Methods: The study population was divided into two groups according to inter‐twin birthweight discordancy: the 'concordant twin group', twin pairs with inter‐twin birthweight discordancy less than 20%; and the 'discordant twin group', twin pairs with inter‐twin birthweight discordancy of 20% or more. The risk of long‐term adverse neurodevelopmental outcomes was compared between the concordant twin group and the discordant twin group. Long‐term adverse neurodevelopmental outcomes between smaller and larger twin children within twin pairs were further analysed. The composite adverse neurodevelopmental outcome was defined as the presence of at least one of the following: motor developmental delay, cognitive developmental delay, autism spectrum disorders/attention deficit hyperactivity disorders, tics/stereotypical behaviour or epileptic/febrile seizure. Main Outcome Measures: Long‐term adverse neurodevelopmental outcome. Results: Of 22 468 twin children (11 234 pairs) included, 3412 (15.19%) twin children were discordant. The risk of composite adverse neurodevelopmental outcome was higher in the discordant twin group than in the concordant twin group (adjusted hazard ratio [HR] 1.13, 95% CI 1.03–1.24). The long‐term adverse neurodevelopmental outcomes were not significantly different between smaller and larger twin children in discordant twin pairs (adjusted HR 1.01, 95% CI 0.81–1.28). Conclusion: In twin pairs delivered at term, an inter‐twin birthweight discordancy of 20% or greater was associated with long‐term adverse neurodevelopmental outcomes; and long‐term adverse neurodevelopmental outcomes were not significantly different in smaller or larger twin children in discordant twin pairs. Linked article: This article is commented on by Enrico Lopriore, pp. 1379 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17523. [ABSTRACT FROM AUTHOR]