Abstract
Previous studies have demonstrated an association between preterm delivery and increased risk of special educational need (SEN). The aim of our study was to examine the risk of SEN across the full range of gestation. We conducted a population-based, retrospective study by linking school census data on the 407,503 eligible school-aged children resident in 19 Scottish Local Authority areas (total population 3.8 million) to their routine birth data. SEN was recorded in 17,784 (4.9%) children; 1,565 (8.4%) of those born preterm and 16,219 (4.7%) of those born at term. The risk of SEN increased across the whole range of gestation from 40 to 24 wk: 37-39 wk adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 1.12-1.20; 33-36 wk adjusted OR 1.53, 95% CI 1.43-1.63; 28-32 wk adjusted OR 2.66, 95% CI 2.38-2.97; 24-27 wk adjusted OR 6.92, 95% CI 5.58-8.58. There was no interaction between elective versus spontaneous delivery. Overall, gestation at delivery accounted for 10% of the adjusted population attributable fraction of SEN. Because of their high frequency, early term deliveries (37-39 wk) accounted for 5.5% of cases of SEN compared with preterm deliveries (<37 wk), which accounted for only 3.6% of cases. Gestation at delivery had a strong, dose-dependent relationship with SEN that was apparent across the whole range of gestation. Because early term delivery is more common than preterm delivery, the former accounts for a higher percentage of SEN cases. Our findings have important implications for clinical practice in relation to the timing of elective delivery.
Highlights
Infants delivered preterm are at increased risk of neurodevelopmental problems including impaired intelligence and school performance [1,2]
Because early term delivery is more common than preterm delivery, the former accounts for a higher percentage of special educational need (SEN) cases
The aim of our study was to investigate the risk of special educational need (SEN) across the whole spectrum of gestational age at delivery, and to use these results to determine the population attributable risks associated with delivery at different gestational ages
Summary
Infants delivered preterm are at increased risk of neurodevelopmental problems including impaired intelligence and school performance [1,2]. In the US, for example, more than half a million babies a year are born before 37 weeks of gestation (gestation is the period during which a baby develops in its mother) Babies born this early (premature babies) are more likely to die than babies delivered between 37 and 42 weeks of gestation (term babies) and many have short- and/or longterm health problems. They are more likely to have a ‘‘special educational need’’ (SEN) as children, a learning difficulty (for example, dyslexia or autism), or a physical difficulty such as deafness or poor vision that requires special educational help, than term babies. A baby born at 24 weeks of gestation is more likely to have an SEN later in life than one born at 36 weeks of gestation
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