Dataset Information

The role of parental education on the relationship between gestational age and school outcomes.

ABSTRACT:

Background

Individuals born preterm may experience difficulties beyond the neonatal period, such as poorer school outcomes. However, whether these outcomes are modified by family factors is less well-known.

Objectives

To investigate whether parental educational level modify the relationship of gestational age with completion of final examinations and grade point average in compulsory education.

Methods

This nationwide register-based cohort study included singletons born in Denmark during 1995-2001. We investigated the differences in the associations between gestational age (24-44 weeks) and two school outcomes at 16 years according to parental educational level (lower (≤10 years), intermediate (11-13 years), and higher (>13 years)). Mixed-effect logistic regression and mixed-effect linear regression were used to model completion of final examination and grade point average, respectively.

Results

Of the 425 101 singletons, 4.7% were born before 37 weeks. The risk of not completing final examination increased with shorter gestational age and lower parental educational level. For instance, among adolescents whose parents had a lower educational level, the risk increased from 23.9% (95% CI, 23.1, 24.6) for those born in week 40 to 36.6% (95% CI, 31.5, 42.1) for those born in week 28. For adolescents whose parents had a higher educational level, the corresponding risk increase was 5.9% (95% CI, 5.7, 6.1) to 10.5% (95% CI, 8.6, 12.8), respectively. Grade point average decreased with shorter gestational age in adolescents born before 30 weeks and with lower parental educational level. The associations between gestational age and grade point average were similar across parental educational levels. For completions of final examination, the associations with gestational age were weaker with higher parental educational level.

Conclusions

Shorter gestational age and lower parental educational level were associated with poorer school outcomes. Our findings suggest that parental educational level mitigates the adverse effects of shorter gestational age on some school outcomes.

SUBMITTER: Bilsteen JF

PROVIDER: S-EPMC8597013 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Studies have reported a dose-dependent relationship between gestational age and poorer school readiness. The study objective was to quantify the risk of developmental vulnerability for children at school entry, associated with gestational age at birth and to understand the impact of sociodemographic and other modifiable risk factors on these relationships. Linkage of population-level birth registration, hospital, and perinatal datasets to the Australian Early Development Census (AEDC), enabled follow-up of a cohort of 64,810 singleton children, from birth to school entry in either 2009, 2012, or 2015. The study outcome was teacher-reported child development on the AEDC with developmental vulnerability defined as domain scores < 10th percentile of the 2009 AEDC cohort. We used modified Poisson Regression to estimate relative risks (RR) and risk differences (RD) of developmental vulnerability between; (i) preterm birth and term-born children, and (ii) across gestational age categories. Compared to term-born children, adjustment for sociodemographic characteristics attenuated RR for all preterm birth categories. Further adjustment for modifiable risk factors such as preschool attendance and reading status at home had some additional impact across all gestational age groups, except for children born extremely preterm. The RR and RD for developmental vulnerability followed a reverse J-shaped relationship with gestational age. The RR of being classified as developmentally vulnerable was highest for children born extremely preterm and lowest for children born late-term. Adjustment for sociodemographic characteristics attenuated RR and RD for all gestational age categories, except for early-term born children. Children born prior to full-term are at a greater risk for developmental vulnerabilities at school entry. Elevated developmental vulnerability was largely explained by sociodemographic disadvantage. Elevated vulnerability in children born post-term is not explained by sociodemographic disadvantage to the same extent as in children born prior to full-term.