738: Maternal hypertension, small for gestational age and childhood educational outcomes

Abstract

Both small for gestational age (SGA) and maternal hypertensive disease (HTN) during pregnancy have been independently associated with poorer childhood learning outcomes, however the relative contribution of each remains unknown. A statewide retrospective cohort was created in which third grade Rhode Island Department of Education data for 2014-2017 were linked to Rhode Island Department of Health birth certificate data. Our study population was composed of children who were singleton births between 23 and 42 weeks gestation without congenital anomalies. Reading and math proficiency were compared among four groups: 1) appropriate for gestational age (AGA) without HTN (reference group), 2) AGA with HTN, 3) SGA without HTN and 4) SGA with HTN. We hypothesized that the cumulative effect of SGA with HTN would result in lower proficiency than AGA with HTN, SGA without HTN or AGA without HTN. Of the 23,096 third graders with available birth certificate data, 1,004 (4%) were AGA with HTN, 1,575 (7%) were SGA without HTN and 176 (1%) were SGA with HTN. Overall, only children born SGA without HTN had reduced odds of reading proficiency (Odds ratio (OR) 0.62 95% Confidence Interval (CI) 0.55, 0.69) and math proficiency (OR 0.65 95% CI 0.58, 0.72) compared to children born AGA without HTN. The differences between those born AGA without HTN and SGA without HTN persisted when gestational age, sex and socioeconomic factors were adjusted for (reading Adjusted odds ratio (aOR) 0.75 95% CI 0.67, 0.85 and math aOR 0.79 95% CI 0.71, 0.89 respectively). There was no difference in third grade reading and math proficiency between AGA pregnancies with and without HTN (Table). In a diverse, statewide cohort, SGA without HTN was associated with lower reading and math proficiency compared to uncomplicated pregnancies (AGA without HTN). SGA with HTN was not associated with lower proficiency in either subject area. This has important implications for patient counseling as well as early resource allocation in at-risk populations.