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Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study

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Abstract

Background

Early life exposures can have an impact on a child’s developmental trajectory and children born late preterm (34–36 weeks gestational age) are increasingly recognized to have health and developmental setbacks that extend into childhood.

Objectives

The purpose of this study was to assess whether late preterm birth was associated with poorer developmental and educational outcomes in the early childhood period, after controlling for health and social factors.

Methods

We conducted a retrospective cohort study using administrative databases housed at the Manitoba Centre for Health Policy, including all children born late preterm (34–36 weeks gestational age (GA)) and at full-term (39–41 weeks GA) between 2000 and 2005 in urban Manitoba (N = 28,100). Logistic regression was used to examine the association between gestational age (GA) and outcomes, after adjusting for covariates.

Results

Adjusted analyses demonstrated that children born late preterm had a higher prevalence of attention deficit hyperactivity disorder (ADHD) (aOR = 1.25, 95% CI [1.03, 1.51]), were more likely to be vulnerable in the language and cognitive (aOR = 1.29, 95% CI [1.06, 1.57]), communication and general knowledge (aOR = 1.24, 95% CI [1.01, 1.53]), and physical health and well-being (aOR = 1.27, 95% CI [1.04, 1.53]) domains of development at kindergarten, and were more likely to repeat kindergarten or grade 1 (aOR = 1.52, 95% CI [1.03, 2.25]) compared to children born at term. They did not differ in receipt of special education funding, in social maturity or emotional development at kindergarten, and in reading and numeracy assessments in the third grade.

Conclusions

Given that the late preterm population makes up 75% of the preterm population, their poorer outcomes have implications at the population level. This study underscores the importance of recognizing the developmental vulnerability of this population and adequately accounting for the social differences between children born late preterm and at term.

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Funding

LKC acknowledges funding from a Western Regional Training Centre studentship funded by Canadian Institutes of Health Research (CIHR) and Manitoba Health, Seniors and Active Living. LKC also acknowledges funding from Research Manitoba, the Children’s Hospital Research Institute of Manitoba, and the Evelyn Shapiro Award for Health Services Research. MDB acknowledges the financial support of the Government of Manitoba through the Manitoba Centre for Health Policy Population-Based Child Health Research Award.

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Authors and Affiliations

  1. Department of Community Health Sciences, Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 374(1) – 753 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada

    L. K. Crockett & M. D. Brownell

  2. Manitoba Centre for Health Policy, University of Manitoba, 408 – 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada

    C. A. Ruth & M. D. Brownell

  3. Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

    C. A. Ruth

  4. College of Nursing, Rady Faculty of Health Sciences, Helen Glass Centre for Nursing, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada

    M. I. Heaman

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Correspondence to L. K. Crockett.

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The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository under project #2014017 (HIPC#2013/2014-48). Ethical approval was obtained by the University of Manitoba Health Research Ethics Board (#H2013:413). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Seniors and Active Living, or other data providers is intended or should be inferred.

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Crockett, L.K., Ruth, C.A., Heaman, M.I. et al. Education Outcomes of Children Born Late Preterm: A Retrospective Whole-Population Cohort Study. Matern Child Health J 26, 1126–1141 (2022). https://doi.org/10.1007/s10995-022-03403-8

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