Attention problems in relation to gestational age at birth and smallness for gestational age

While it is well established that very preterm birth (gestational age at birth <32 weeks) is related to increased attention problems, there is still considerable uncertainty of the effects of moderate or late preterm birth or smallness for gestational age (SGA) on attention regulation.

To investigate the impact of gestational age at birth and SGA, birth on child attention problems.

Prospective longitudinal cohort study.

A total of 1435 children sampled from the Bavarian Longitudinal Study (BLS).

Main outcome variables were parent-reported attention problems and examiner-reported attention skills at 6 and 8 years. Predictors were linked to attention outcomes using hierarchical regression analyses.

Gestational age at birth ranged from 25 weeks to 41 weeks. We found a quadratic effect of gestational age on attention problems (β6 years=0.161, 95% CI=0.085; 0.236; β8 years=0.211, 95% CI=0.135; 0.287), and attention skills at 6 and 8 years (β6 years=-0.178, 95% CI=-0.252; -0.104; β8 years=-0.169, 95% CI=-0.243; -0.094). Elective caesarean birth did not predict child attention. In adjusted models, SGA was an additional risk factor for attention problems (β=0.080, 95% CI=0.026; 0.134), and attention skills (β=-0.091, 95% CI=-0.143; -0.039) at 6 years but not at 8 years after adjusting for child sex and family SES.

Adverse effects on attention are disproportionately higher at early gestations. In contrast, the impact of SGA status was found to be similar at all gestational ages but disappeared by 8 years.