High school graduation among adolescents born preterm: A Canadian population-based cohort study

To evaluate the association between preterm birth (<37 weeks) and high school graduation.

Population-based cohort of adolescents born in Manitoba, Canada between 1986 and 2002 whose graduation data were available in the administrative database. High school graduation (primary outcome) was defined as completion of 30 course credits in grades 9-12 without needing a modified (M) course or an individualized education plan (IEP) and finishing high school within 4 years of entering grade 9. Logistic regression model tested the association between preterm birth and primary outcome.

Of 260,561 eligible adolescents, 9846 preterm (5.7 %; <28 wks = 238, 28-33 wks = 1997, 34-36 wks = 7611) and 162,660 term (≥37 weeks) adolescents were included. The median age at entering grade 9 was 14 years [13,14] among both preterm and term adolescents. The % of high school graduation was lowest among extremely preterm children (<28 wks-65 %, 28-33 wks-75 %, 34-36 wks-77 % and term-78 %). Only adolescents born <28 weeks and 28-33 wks, not 34-36 wks, had lower odds of high school graduation compared to term adolescents (<28 wks aOR: 0.49; 95 % CI: 0.37-0.66; 28-33 wks aOR: 0.78; 95 % CI: 0.69-0.88; 34-36 wks aOR: 0.96; 95 % CI: 0.90-1.02). Those needing a M course or IEP were 21 %, 7 %, 5 % and 4 % while the need for school assistance was 20 %, 5 %, 3 % and 2 % among <28 wks, 28-33 wks, 34-36 weeks and term respectively.

Adolescents born extremely and very-moderate preterm had lower high school graduation rates compared to those born term in this population-based cohort.