Background Being born at an earlier gestational age is a risk factor for having neurodevelopmental impairment and special educational needs (SEN) at school. Most prior studies focused on children born preterm (<37 weeks) rather than across the entire gestational age continuum and have not examined specific types of SEN. Our aim was to examine the association between gestational age across the entire gestation spectrum and SEN at the age of 11 years.
Methods We analysed parent reported survey data from the UK Millennium Cohort Study, a nationally representative cohort of children born during the years 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected from mothers when children were 9 months old. Information about presence of SEN, whether the child has a statement of SEN which indicates more complex needs, and the reasons for SEN was collected from parents at age 11. Adjusted risk ratios (aRR) were estimated using modified Poisson regression while accounting for confounding.
Results The sample included 12,081 children with data at both time points. The proportion of children with SEN in the cohort was 11.2% and this proportion increased markedly as gestation decreased. The risk of having SEN was highest in children born before 32 weeks gestation who had a 3-fold higher risk than those born at 40 weeks (aRR=2.89; 95% CI 2.02, 4.13). The risk was also elevated in children born early term (37–38 weeks) (aRR=1.33; 95% CI 1.11, 1.59). The proportion of children with a statement of SEN was 4.9% in the overall cohort. There was a clear inverse association between gestational age and having a statement of SEN, which peaked at 15.3% in children born <32 weeks (aRR=3.96; 95% CI 2.24, 7.06). Gestational age was also inversely associated with having multiple reasons for SEN, reaching aRR=3.32 (95% CI 1.61, 6.84) at <32 weeks.
Conclusion Children born at earlier gestational age are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning at age 11. This increased likelihood of SEN was observed even among children born at early term gestation.
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