Gestational Age and Basic School Achievements: A National Follow-up Study in Denmark

Department of Neonatology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
PEDIATRICS (Impact Factor: 5.47). 11/2010; 126(6):e1553-61. DOI: 10.1542/peds.2009-0829
Source: PubMed


Children born at <32 weeks' gestation are at increased risk of intellectual impairment. Few studies have focused on the majority of preterm children born at 32 to 36 weeks' gestation. We aimed to investigate the association between the full range of gestational ages at birth and the risk of not completing basic school.
This longitudinal, register-based study included all live-born infants in Denmark from 1988 to 1989. Data were obtained from national registers. School achievements were evaluated by using the examination marks. The association between gestational age and not completing basic school was estimated, taking into account the effect of their parents' educational level, being small for gestational age, plurality, and cerebral palsy.
The cohort constituted 120,585 infants, of whom 118,281 (98.6%) were alive in 2007. Of these infants, 5.01% (n = 5.928) were born before 37 weeks' gestation. Of the subjects born before 37 weeks' gestation, 11.5% (95% confidence interval: 10.7-12.4) did not complete basic school compared with 7.5% (95% confidence interval: 7.3-7.6) of those born at term. The percentage of subjects who did not complete basic school increased with decreasing gestational age. The increase was steeper at <31 weeks (4.2% per week) than at 31 to 36 weeks' gestation (0.5% per week).
The risk of not completing basic school increased with decreasing gestational age. The risk was moderate at ≥31 weeks' gestation and increased steeply at <31 weeks' gestation. The increase at <31 weeks' gestation was only partly explained by cerebral palsy.

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    • "However, a number of recent studies from the United States and Europe show that babies born with 37 and 38 weeks of gestation also run increased risk, in comparison with those born with 39–41 weeks [9-15]. "
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    ABSTRACT: Background We assessed anthropometric status, breastfeeding duration, morbidity, and mortality outcomes during the first four years of life according to gestational age, in three population-based birth cohorts in the city of Pelotas, Southern Brazil. Methods Total breastfeeding duration, neonatal mortality, infant morbidity and mortality, and anthropometric measures taken at 12 and 48 months were evaluated in children of different gestational ages born in 1982, 1993 and 2004 in Southern Brazil. Results Babies born <34 weeks of gestation and those born between 34–36 weeks presented increased morbidity and mortality, were breastfed for shorter periods, and were more likely to be undernourished at 12 months of life, in comparison with the 39–41 weeks group. Children born with 37 weeks were more than twice as likely to die in the first year of life, and were also at increased risk of hospitalization and underweight at 12 months of life. Post-term infants presented an increased risk of neonatal mortality. Conclusion The increased risks of morbidity and mortality among preterm (<37 weeks of gestation) and post-term (>41 weeks) are well known. In our population babies born at 37 also present increased risk. As the proportion of preterm and early term babies has increased markedly in recent years, this is a cause for great concern.
    BMC Pediatrics 10/2012; 12(1):169. DOI:10.1186/1471-2431-12-169 · 1.93 Impact Factor
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    • "Yet, results concerning moderately to late preterm children are inconclusive . Although there is evidence that both preterm populations may differ in their risk for cognitive impairment [5], it remains unclear whether moderately to late premature birth is related to poorer cognitive functioning. "
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    ABSTRACT: Preterm birth is thought to have an adverse impact on cognitive development and self-regulation. Examining the effect of very vs. moderately to late premature birth on cognitive development and effortful control, as well as evaluating whether effortful control explains the link between preterm birth and poorer cognitive development. Fifty-eight very preterm children (<32 weeks gestation or <1500 g birth weight), 88 moderately to late preterm children (≥32 weeks gestation and ≥1500 birth weight) and 86 full-term children (≥38 weeks gestation and ≥2500 g birth weight) were examined at the corrected age of 24 months. Observational and parent-report measures of effortful control as well as the Bayley Scales of Infant Development II (BSID II, Mental Scale) as a measurement of cognitive development were analyzed. Very preterm and moderately to late preterm children showed significantly lower cognitive performance compared to full-term children. Lower effortful control scores (on observational measures, but not on parent-reports) were merely found for very preterm children compared to full-term children. Observational measures of effortful control partially mediated the effects of very preterm birth on cognitive performance, but did not explain the effects of moderately to late preterm birth on cognitive performance. Preterm birth in general is related to poorer cognitive performance in toddlerhood. In addition, effortful control mediates the effects of very preterm birth on cognitive development. Findings suggest that different mechanisms link moderately to late premature birth to poor cognitive development.
    Early human development 10/2011; 88(5):307-313. DOI:10.1016/j.earlhumdev.2011.09.001 · 1.79 Impact Factor
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    ABSTRACT: Objective To examine how cognitive ability is related to gestational age and the extent to which observed differences could be explained by socio-economic confounding.Methods The Millennium Cohort Study collected data on 18 818 children at 9 months and 3, 5 and 7 years. Cognitive development was assessed using Bracken School Readiness Assessment at age 3, British Ability Scales II at ages 3, 5 and 7 and progress in mathematics at 7 years. Z-scores were analysed by linear regression with adjustment for confounders.ResultsChildren born at
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