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School performance and educational achievement in children exposed to maternal cancer in utero
  1. Iben Katinka Greiber1,2,
  2. Jakob Hansen Viuff2,
  3. Mona Aarenstrup Karlsen1,
  4. Øjvind Lidegaard1,
  5. Anders Preztmann Mikkelsen1,
  6. Cristel Sørensen Hjortshøj3,
  7. Lone Storgaard1,
  8. Lene Mellemkjær2
  1. 1 Department of Gynecology and Obstetrics, Rigshospitalet, Juliane Marie Centre, Kobenhavn, Denmark
  2. 2 Danish Cancer Society Research Center, Kobenhavn, Denmark
  3. 3 Department of Pediatrics, Copenhagen University Hospital, Kobenhavn, Denmark
  1. Correspondence to Dr Iben Katinka Greiber, Department of Gynecology and Obstetrics, Rigshospitalet Juliane Marie Centre, Kobenhavn, Hovedstaden, Denmark; iben.katinka.greiber{at}


Background In utero exposure to maternal cancer and cancer treatment might influence the child’s cognitive development. This study investigated if exposure to maternal cancer during fetal life impacted school performance and educational achievement as adults.

Methods This nationwide retrospective cohort study identified all live-born children in Denmark between January 1978 and December 2013. Exposure was defined as maternal cancer diagnosis during pregnancy. Four partly overlapping birth cohorts were constructed depending on the outcome of interest: (1) receiving special educational support for birth years 2001–2013; (2) grade point average (GPA) at the final exams after 10th grade for 1986–2003; (3) educational achievement at 20 years for 1978–1998; and (4) education at 30 years for 1978–1988. Logistic and linear models were adjusted for birth year, maternal age, maternal education and maternal death.

Results The estimated probability of receiving special educational support was similar in the exposed group and the reference (adjusted OR 0.96; 95% CI 0.46 to 1.77, non-significant). The GPA did not statistically differ (0.13 grade points; 95% CI −0.18 to 0.45, non-significant). The achieved educational levels were similar for the exposed group and the reference at 20 years, with an adjusted OR of 1.07 (95% CI 0.82 to 1.40) for low versus medium educational level, and at 30 years with an adjusted OR of 0.73 (95% CI 0.35 to 1.50) for low versus high educational level and of 1.07 (95% CI 0.66 to 1.72) for medium versus high educational level.

Conclusion Our findings did not indicate poorer performance in compulsory school nor impairment of adult educational achievement after exposure to maternal cancer in utero.

  • Life course epidemiology

Data availability statement

No data are available. Data are available from Statistics Denmark ( and Danish Health Data Authority ( The corresponding author had full access to the included data.

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Data availability statement

No data are available. Data are available from Statistics Denmark ( and Danish Health Data Authority ( The corresponding author had full access to the included data.

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  • LS and LM contributed equally.

  • Contributors IKG, MAK, LS, CHS and LM conceptualised the study. LM obtained access to the data. JHV performed data management and statistical analyses in cooperation with IKG. IKG wrote the initial version of the manuscript. All authors participated in the interpretation of the data and critically reviewed the study. All authors had full access to the full suite of data used in the study and take full responsibility for the integrity and the accuracy of the data analysis. IKG is the guarantor and as the main author attests that all coauthors meet the authorship criteria and that no individuals meeting the criteria have been omitted.

  • Funding The current investigation was funded by a grant from the Research Fund of Rigshospitalet, Copenhagen University Hospital (grant number E-23669-01), the Novo Nordisk Foundation (grant number NNF18OC0052571), Helsefonden (grant number 20B-0350), the Danish Cancer Research Foundation and the Danish Cancer Society’s Scientific Committee - People and Society (KBVU-MS) (grant number R303-A17498). The funders had no role in the design of the study, in the collection, analysis, and interpretation of the data, in the writing of the report, or any decision related to the publication.

  • Competing interests None declared.

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

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