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Published on: June 20, 2020
Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren
Daniel F MacKay1, Gordon C S Smith, Richard Dobbie
1Section of Public Health, University of Glasgow, Glasgow, United Kingdom.
Insights
The risk of special educational needs (SEN) increases with earlier gestation, even in early term deliveries. Early term births contribute more SEN cases due to their higher frequency, impacting clinical practice for elective delivery timing.
Area of Science:
- Perinatal epidemiology
- Developmental pediatrics
- Public health
Background:
- Preterm delivery is linked to increased special educational needs (SEN).
- Previous research focused on extreme preterm births, not the full gestational range.
Purpose of the Study:
- To investigate the association between the full spectrum of gestational age and the risk of SEN.
- To quantify the contribution of different gestational age groups to the overall burden of SEN.
Main Methods:
- Population-based retrospective study linking school census and birth data for 407,503 children in Scotland.
- Analysis of SEN occurrence across gestational age categories from 24 to 40 weeks.
- Calculation of adjusted odds ratios (OR) and population attributable fractions.
Main Results:
- SEN risk increased progressively from 40 weeks down to 24-27 weeks gestation.
- Deliveries at 37-39 weeks (early term) had an adjusted OR of 1.16 for SEN.
- Deliveries at 24-27 weeks had a substantially higher adjusted OR of 6.92 for SEN.
- Early term deliveries accounted for 5.5% of SEN cases, while preterm deliveries (<37 weeks) accounted for 3.6%.
Conclusions:
- A dose-dependent relationship exists between gestation at delivery and SEN risk across all gestational ages.
- Early term deliveries, though less risky per case than extreme preterm births, contribute more to the overall SEN population due to higher incidence.
- Findings highlight the importance of considering gestational age in clinical decisions regarding timing of elective delivery.
Background:
Previous studies have demonstrated an association between preterm delivery and increased risk of special educational need (SEN). The aim of our study was to examine the risk of SEN across the full range of gestation.
Methods And Findings:
We conducted a population-based, retrospective study by linking school census data on the 407,503 eligible school-aged children resident in 19 Scottish Local Authority areas (total population 3.8 million) to their routine birth data. SEN was recorded in 17,784 (4.9%) children; 1,565 (8.4%) of those born preterm and 16,219 (4.7%) of those born at term. The risk of SEN increased across the whole range of gestation from 40 to 24 wk: 37-39 wk adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 1.12-1.20; 33-36 wk adjusted OR 1.53, 95% CI 1.43-1.63; 28-32 wk adjusted OR 2.66, 95% CI 2.38-2.97; 24-27 wk adjusted OR 6.92, 95% CI 5.58-8.58. There was no interaction between elective versus spontaneous delivery. Overall, gestation at delivery accounted for 10% of the adjusted population attributable fraction of SEN. Because of their high frequency, early term deliveries (37-39 wk) accounted for 5.5% of cases of SEN compared with preterm deliveries (<37 wk), which accounted for only 3.6% of cases.
Conclusions:
Gestation at delivery had a strong, dose-dependent relationship with SEN that was apparent across the whole range of gestation. Because early term delivery is more common than preterm delivery, the former accounts for a higher percentage of SEN cases. Our findings have important implications for clinical practice in relation to the timing of elective delivery.
