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Maternal education and language development at 2 years corrected age in children born very preterm: results from a European population-based cohort study
  1. Mariane Sentenac1,
  2. Samantha Johnson2,
  3. Marie-Laure Charkaluk1,3,
  4. Anna-Veera Sëppanen1,
  5. Ulrika Aden4,
  6. Marina Cuttini5,
  7. Rolf Maier6,
  8. Mairi Mannamaa7,
  9. Jennifer Zeitlin1
  10. and the EPICE group
    1. 1 Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, F-75004 Paris, France
    2. 2 Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
    3. 3 Université Catholique de Lille, Lille, France ; Service de néonatologie, Hôpital Saint Vincent de Paul, Groupement des Hôpitaux de l'Institut Catholique Lillois/Faculté de Médecine et Maïeutique, Lille, France
    4. 4 Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
    5. 5 Clinical Care and Management Innovation Research Area, Bambino Gesù Pediatric Hospital, Roma, Lazio, Italy
    6. 6 Children’s Hospital, University Hospital, Philipps-University Marburg, Marburg, Germany
    7. 7 Department of Pediatrics, University of Tartu, Children’s Clinic of Tartu University Hospital, Tartu, Estonia
    1. Correspondence to Mariane Sentenac, Inserm 1153, Maternité Port-Royal, 53 Avenue de l'Observatoire, 75014 Paris, France; mariane.sentenac{at}


    Background Socioeconomic factors influence language development in the general population, but the association remains poorly documented in children born very preterm (VPT). We assessed the impact of maternal education on language development in children born VPT and effect modification by perinatal risk.

    Methods Data were from the Effective Perinatal Intensive Care in Europe (EPICE) population-based cohort of children born <32 weeks’ gestational age (GA) in 2011/2012. Regions from six countries (Estonia, France, Germany, Italy, Sweden and UK) used a validated short form MacArthur Developmental Communicative Inventories Checklist to assess language at 2 years corrected age. Perinatal variables were collected from clinical records. We assessed expressive language delay (ELD), defined as (a) not combining words; and (b) expressive vocabulary <10th percentile of norms for age and sex. Perinatal risk (low, moderate and high) was determined using GA, small for GA and neonatal morbidities. We estimated adjusted risk ratios (aRR) of ELD by maternal education with inverse weighting to account for non-response bias.

    Results Of 2741 children, 24.6% were not combining words and 39.7% had a low expressive vocabulary. Low maternal education (lower secondary or less compared with a bachelor’s degree or more) increased risks of ELD: not combining words: aRR=1.52 (95% CI 1.36 to 1.69); low expressive vocabulary: aRR=1.25 (1.04 to 1.51). For children with low perinatal risk, the aRR were 1.88 (1.26 to 2.80) and 1.44 (1.06 to 1.95), respectively, compared with those with high perinatal risks: 1.36 (1.10 to 1.67) and 1.11 (0.97 to 1.27), respectively.

    Conclusion Low maternal education affects ELD for children born VPT, although the association appears attenuated among those with highest perinatal risk.

    • child health
    • perinatal
    • social inequalities

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    • Collaborators EPICE Research group: BELGIUM: Flanders (E Martens, G Martens, P Van Reempts); DENMARK: Eastern Region (K Boerch, A Hasselager, LD Huusom, O Pryds, T Weber); ESTONIA (L Toome, H Varendi); FRANCE: Burgundy, Ile-de France and Northern Region (PY Ancel, B Blondel, A Burguet, PH Jarreau, P Truffert); GERMANY: Hesse (RF Maier, B Misselwitz, S Schmidt), Saarland (L Gortner); ITALY: Emilia Romagna (D Baronciani, G Gargano), Lazio (R Agostino, D DiLallo, F Franco), Marche (V Carnielli), M Cuttini, I Croci ; NETHERLANDS: Eastern & Central (C Koopman-Esseboom, A van Heijst, J Nijman); POLAND: Wielkopolska (J Gadzinowski, J Mazela); PORTUGAL: Lisbon and Tagus Valley (LM Graça, MC Machado), Northern region (Carina Rodrigues, T Rodrigues), H Barros; SWEDEN: Stockholm (AK Bonamy, M Norman, E Wilson); UK: East Midlands and Yorkshire and Humber (E Boyle, ES Draper, BN Manktelow), Northern Region (AC Fenton, DWA Milligan); INSERM, Paris (J Zeitlin, M Bonet, A Piedvache).

    • Contributors MS wrote the statistical analysis plan, analysed the data and drafted and revised the paper. JZ initiated the collaborative project, helped to design the statistical analysis plan, drafted and revised the paper. SJ and MLC helped to conceptualise the study and interpret the results, reviewed and revised the paper. AVS, UA, MC, RM and MM interpreted the results and revised the paper. All EPICE members designed data collection, monitored data collection for each region.

    • Funding The research received funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement No 259882 and from the European Union’s Horizon 2020 research and innovation programme under grant agreements No 633724 and No 733280.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approvals were obtained in each country as required by national legislation. The European study was also approved by the French Advisory Committee on Use of Health Data in Medical Research and the French National Commission for Data Protection and Liberties: CCTIRS, N° 13.020 and the French National Commission for Data Protection and Liberties (CNIL) DR-2013-194.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available.