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Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study
Emilie Pi Fogtmann Sejer1, Frederik Jager Bruun2, Julie Anna Slavensky2
1Department of Obstetrics and Gynaecology, Herlev University Hospital, Herlev, Denmark empifo@gmail.com.
Insights
Children born very preterm (before 34 weeks) show lower intelligence and executive function. Gestational age impacts cognitive abilities, independent of parental factors. Further research with larger cohorts is needed.
Area of Science:
- Neuroscience
- Developmental Psychology
- Pediatrics
Background:
- Preterm birth is a known risk factor for cognitive deficits.
- Few studies have adequately adjusted for confounding factors like parental education and intelligence.
Purpose of the Study:
- To investigate the impact of gestational age (GA) on intelligence, attention, and executive function in 5-year-old Danish children.
- To differentiate effects of very preterm birth (<34 weeks GA) versus late preterm birth (34 to <37 weeks GA).
Main Methods:
- Population-based prospective cohort study of 1776 children and mothers from the Danish National Birth Cohort.
- Neuropsychological assessments included intelligence (IQ), attention, and executive function at age 5.
- Analyses adjusted for potential confounders such as maternal intelligence and parental education.
Main Results:
- Children born very preterm (<34 weeks GA) had significantly lower full-scale IQ (-10.6 points) compared to term-born children.
- Very preterm birth was associated with increased executive function difficulties (Global Executive Composite difference of 5.3 points).
- Late preterm birth (34 to <37 weeks GA) showed no significant association with cognitive deficits.
Conclusions:
- Very preterm birth (<34 weeks GA) is linked to substantially lower intelligence and poorer executive function at age 5.
- Gestational age appears to be an independent factor influencing cognitive development.
- Larger studies are recommended to confirm findings due to the small proportion of preterm births in this cohort.
Objectives:
Preterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years.
Design:
Population-based prospective cohort study.
Setting:
Denmark 2003-2008.
Participants:
A cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5.
Primary Outcome Measures:
Wechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores.
Results:
For preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was -10.6 points (95% CI -19.4 to -1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown.
Conclusions:
This study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.
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