Abstract
We investigated whether children born preterm are at risk for language delay using a sibling-control design in the Norwegian Mother and Child Cohort Study (MoBa), conducted by the Norwegian Institute of Public Health. Participants included 26,769 siblings born between gestational weeks 23 and 42. Language delay was assessed when the children were 1.5, 3, and 5 years old. To adjust for familial risk factors, comparisons were conducted between preterm and full-term siblings. Pregnancy-specific risk factors were controlled for by means of observed variables. Findings showed that preterm children born before week 37 had increased risk for language delays at 1.5 years. At 3 and 5 years, only children born before week 34 had increased risk for language delay. Children born weeks 29-33 and before week 29 had increased risk for language delay at 1.5 years (RR = 4.51, 95% CI [3.45, 5.88]; RR = 10.32, 95% CI [6.7, 15.80]), 3 years (RR = 1.50, 95% CI [1.02, 2.21]; RR = 2.78, 95% CI [1.09, 7.07]), and 5 years (RR = 1.63, 95% CI [1.06, 2.51]; RR = 2.98, 95% CI [0.87, 10.26]), respectively. In conclusion, children born preterm are at risk for language delays, with familial confounders only explaining a moderate share of the association. This suggests a cause-effect relationship between early preterm birth and risk for language delay in preschool children.
Highlights
Preterm birth is associated with neurodevelopmental risks, such as lower language skills in toddlers and preschoolers (Guarini et al, 2009; Menyuk, Liebergott, & Schultz, 1995; Palumbi et al, 2018; Ribeiro et al, 2011; Wolke, Samara, Bracewell, & Marlow, 2008; Zambrana, Vollrath, Sengpiel, Jacobsson & Ystrom, 2016)
The associations between gestational age and language delays may be caused by unmeasured family risk factors such as a common genetic risk or a genetic risk for language delay that is related to risk-related maternal behavior that affects the prenatal environment and risk for preterm birth (Bishop, Price, Dale, & Robert, 2003; Kovas et al, 2005)
The very early preterm group had an elevenfold increase in relative risk (RR) at 1.5 years compared with the reference term group, RR = 11.49, 95% CI [8.55, 15.49], while the RRs for the early preterm, the late preterm, and the early term groups were correspondingly 5.37, 95% CI [4.46, 6.48]; 2.56, 95% CI [2.29, 2.87]; and 1.81, 95% CI [1.65, 1.99], respectively, at this age
Summary
Preterm birth is associated with neurodevelopmental risks, such as lower language skills in toddlers and preschoolers (Guarini et al, 2009; Menyuk, Liebergott, & Schultz, 1995; Palumbi et al, 2018; Ribeiro et al, 2011; Wolke, Samara, Bracewell, & Marlow, 2008; Zambrana, Vollrath, Sengpiel, Jacobsson & Ystrom, 2016). This might be explained by the fact that the third trimester is crucial for fetal brain development, with rapid development of neurons and wiring. The current study builds on and extends previous work by examining the risks for language delays that are associated with preterm birth at a period when children are approaching school age, an age when language delays have been found to be associated with general learning challenges with potential effects on children’s well being
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