Describing the Shape of the Relationship Between Gestational Age at Birth and Cognitive Development in a Nationally
Jennifer L Richards1, Carolyn Drews-Botsch1, Jessica M Sales2
1Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Insights
Children born preterm, especially early and moderate preterm, show lower cognitive and academic scores. Early term births (37-38 weeks) did not exhibit these deficits, suggesting specific risk periods for developmental outcomes.
Area of Science:
- Developmental Pediatrics
- Cognitive Neuroscience
- Educational Psychology
Background:
- Preterm birth is associated with increased risks for cognitive and academic challenges.
- Understanding the spectrum of gestational age impacts on child development is crucial for early intervention.
Purpose of the Study:
- To examine cognitive ability and academic achievement in relation to gestational age at birth.
- To describe developmental trajectories across the full range of gestational ages in a population-based cohort.
Main Methods:
- Longitudinal cohort study using data from the Early Childhood Longitudinal Study-Birth Cohort.
- Cognitive assessments at 2 years and academic achievement (reading, math) at kindergarten.
- Gestational age modeled continuously and categorically (individual weeks, clinical groups).
Main Results:
- Early preterm (24-27 weeks), moderate preterm (28-33 weeks), and late preterm (34-36 weeks) children scored significantly lower than full-term peers.
- No cognitive or academic deficits were found in early term (37-38 weeks) births.
- Clinical categories of preterm birth effectively stratified risk for adverse outcomes.
Conclusions:
- Gestational age is a critical determinant of early childhood cognitive and academic performance.
- Specific preterm birth categories identify children at higher risk for developmental deficits.
- Early term births appear to have developmental outcomes comparable to full-term births.
Background:
Preterm children face higher risk of cognitive and academic deficits compared with their full-term peers. The objective of this study was to describe early childhood cognitive ability and kindergarten academic achievement across gestational age at birth in a population-based longitudinal cohort.
Methods:
The study population included singletons born at 24-42 weeks gestation enrolled in the Early Childhood Longitudinal Study-Birth Cohort (n = 6150 for 2-year outcome, n = 4450 for kindergarten outcome). Home-based assessments measured cognitive ability at 2 years and reading and mathematics achievement at kindergarten age. Linear regression models estimated the association between gestational age and cognitive and academic scores using four different ways of modelling gestational age: continuous variable in linear and quadratic terms; categories for individual weeks; and clinical categories for early preterm, moderate preterm, late preterm, early term, full term, late term, and post-term.
Results:
Children born at early preterm (24-27 weeks), moderate preterm (28-33 weeks), and late preterm (34-36 weeks) scored significantly worse than full-term (39-40 weeks) peers on 2-year and kindergarten assessments; however, no deficits were observed for early term (37-38 weeks). These categories were a clinically useful and parsimonious approach to stratifying risk of adverse cognitive and academic outcomes.
Conclusions:
This study estimated the relative performance of children born at 24-42 weeks in a population-based birth cohort using multiple approaches to modelling gestational age, providing a more rigorous understanding of the relationships between the full spectrum of gestational age and cognitive and academic outcomes in early childhood and at school age.
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