Background Approximately 5% of all live births in England are ‘late preterm’ (34–36 weeks gestation) and 18% are ‘early term’ (37–38 weeks gestation), yet there is little prospective research into the long-term outcomes in these groups. There is growing evidence that these groups have an increased risk of poorer health and cognitive development compared with children born at full-term (39–41 weeks). A recent study demonstrated that children born late preterm or early term had poorer school performance at age 5 years compared with their full-term counterparts. The objective of our study was to determine whether these effects persisted at age 7 years in the same cohort. School performance at 7 years is strongly associated with future qualifications, socio-economic status, and health.
Methods We analysed a population-based cohort (UK Millennium Cohort Study) with linked educational data. 6031 children born in 2000–2001 and attending school in England in 2008 were included. School performance was assessed using the statutory Key Stage 1 (KS1) teacher assessments which are performed in the third school year in England. The primary outcome was general performance, analysing whether the child performed to the expected level (≥ level 2) in all three key subjects (reading, writing and mathematics). Other outcomes investigated subject-specific performance. Modified poisson regression was used to estimate risk ratios for poor outcomes associated with each gestational group compared with the full-term group.
Results KS1 results were available in 77% of eligible children (6031/7842). 18% of full-term children did not perform to the expected level in KS1, and the risk of poor performance increased with prematurity: compared to children born at full-term, there was a statistically significant increased risk of poor performance in those born very preterm (≤32 weeks gestation, adjusted RR 1.70, 95% CI 1.18–2.44), moderately preterm (32–33 weeks gestation, adjusted RR 1.67, 95% CI 1.11–2.52) and late preterm (34–36 weeks gestation, adjusted RR 1.34, 95% CI 1.07–1.66). Early term children performed statistically significantly worse in 4 out of 5 individual subject domains compared with full-term children, but not in the primary outcome (adjusted RR 1.07, 95% CI 0.94–1.23).
Conclusion Late preterm, and to a lesser extent, early term birth negatively impact on school outcomes at 7 years. Although individual risks are small, late preterm and early term children comprise one quarter of all live births, thus the implications may be substantial through increased special educational needs, lower educational attainment and lower future income.
- preterm child development