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Obstetric factors and different causes of special educational need: retrospective cohort study of 407,503
D F Mackay1, G C S Smith, R Dobbie
1Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Insights
Gestational age and birthweight significantly impact special educational needs (SEN), particularly sensory, physical, and intellectual impairments. These factors explain a substantial portion of these specific SEN diagnoses.
Area of Science:
- Developmental pediatrics
- Public health
- Epidemiology
Background:
- Special educational needs (SEN) encompass a range of learning and developmental challenges.
- Gestational age and birthweight are known risk factors for adverse child outcomes.
- Understanding the specific relationships between these perinatal factors and distinct SEN categories is crucial for early intervention and support.
Purpose of the Study:
- To investigate the association between gestational age and birthweight centile with specific causes of special educational need (SEN).
- To determine if these relationships differ across various types of SEN.
- To quantify the contribution of gestational age and birthweight to the risk of specific SEN.
Main Methods:
- A retrospective cohort study was conducted in Scotland.
- Data from 407,503 schoolchildren were analyzed.
- Polytomous logistic regression examined the risk of each SEN cause in relation to gestational age and birthweight centile, adjusting for confounders.
Main Results:
- Extreme preterm birth (24-27 weeks) and low birthweight (<3rd centile) were strongly associated with sensory impairments, physical/motor disabilities, and intellectual disabilities.
- These perinatal factors explained 24.0% of sensory impairments, 34.3% of physical/motor disabilities, and 26.6% of intellectual disabilities.
- Associations were weaker for specific learning difficulties and social/emotional problems, with no significant link to autistic spectrum disorder (ASD).
Conclusions:
- The overall link between gestational age, birthweight, and SEN risk is primarily driven by strong associations with sensory, physical/motor, and intellectual impairments.
- These findings highlight the critical role of perinatal factors in the development of specific SEN categories.
- Targeted interventions for infants born preterm or with low birthweight may mitigate risks for these developmental challenges.
Objective:
To determine whether relationships with gestational age and birthweight centile vary between specific causes of special educational need (SEN).
Design:
Retrospective cohort study.
Setting:
Scotland.
Population:
A cohort of 407,503 schoolchildren.
Methods:
Polytomous logistic regression was used to examine the risk of each cause of SEN across the spectrum of gestation at delivery and birthweight centile, adjusting for potential confounding factors.
Main Outcome Measures:
Crude and adjusted odds ratios and confidence intervals.
Results:
Of the 19,821 children with SEN, 557 (2.8%) had sensory impairments, 812 (4.1%) had physical or motor disabilities, 876 (4.4%) had language impairments, 2823 (14.2%) had social, emotional, or behavioural problems, 7018 (35.4%) had intellectual disabilities, 4404 (22.2%) had specific learning difficulties, and 1684 (8.5%) autistic spectrum disorder (ASD). Extreme preterm delivery (at 24-27 weeks of gestation) was a strong predictor of sensory (adjusted OR 23.64, 95% CI 12.03-46.45), physical or motor (adjusted OR 29.69, 95% CI 17.49-50.40), and intellectual (adjusted OR 11.67, 95% CI 8.46-16.10) impairments, with dose relationships across the range of gestation. Similarly, birthweight below the third centile was associated with sensory (adjusted OR 2.85, 95% CI 2.04-3.99), physical or motor (adjusted OR 2.47, 95% CI 1.82-3.37), and intellectual (adjusted OR 2.67, 95% CI 2.41-2.96) impairments. Together, gestation and birthweight centile accounted for 24.0% of SEN arising from sensory impairment, 34.3% arising from physical or motor disabilities, and 26.6% arising from intellectual disabilities. Obstetric factors were less strongly associated with specific learning difficulties and social or emotional problems, and there were no significant associations with ASD.
Conclusions:
The association between gestation and birthweight centile and overall risk of SEN is largely driven by very strong associations with sensory, physical or motor impairments, and intellectual impairments.
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