Early life exposures and school readiness: an observational cohort study using the Born in Bradford longitudinal...

To assess the associations of early life exposures with school readiness.

Using data from the Born in Bradford (BiB) birth cohort, we investigated the association of early life exposures and the likelihood of children achieving a 'Good Level of Development' (GLD) as measured by the Early Years Foundation Stage Profile at the end of their first school year. Multivariable logistic regression modelling was used to estimate associations of early life exposures with school readiness.

Outcome data were available for 10 589 of 13 858 BiB participants. 6272 (59%) children achieved a GLD. 17 variables were investigated, including child characteristics, maternal factors, family environment and socioeconomic exposures. In our multivariable model (n=7981), children with the following characteristics were significantly less likely to achieve a GLD: males (OR 0.43, 95% CI 0.39 to 0.47), Pakistani ethnicity (OR 0.76, 95% CI 0.66 to 0.89), younger children (OR 1.18 per month, 95% CI 1.16 to 1.19), preterm birth (gestational age<32 weeks OR 0.34, 95% CI 0.19 to 0.62; 32-36 weeks OR 0.64, 95% CI 0.51 to 0.80), younger maternal age (OR 1.01 per year of maternal age, 95% CI 1.00 to 1.02), lower maternal education (OR 0.27, 95% CI 0.20 to 0.37 with no qualifications, compared with higher degrees), never breastfed (OR 0.87, 95% CI 0.78 to 0.97), lower paternal employment status (OR 0.66, 95% CI 0.54 to 0.81, for unemployed, compared with non-manual employment), receiving benefits during pregnancy (OR 0.89, 95% CI 0.80 to 0.99) and eligible for free school meals (OR 0.71, 95% CI 0.62 to 0.81). A sensitivity analysis using multiple imputation (n=10 589) found consistent results.

The exposures most strongly associated with low school readiness were male sex, low maternal education and preterm birth (<32 weeks gestation). Greater understanding of the exposures associated with school readiness can inform a proportionate universal approach to policymaking to improve school readiness and subsequent life outcomes.