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Early birth may impact academic achievement

Robin Wulffson MD's picture
preterm birth, prematurity, school performance, labor induction, C section

Premature birth is associated with a multitude of adverse effects; however, a new study has reported a possible complication from being born just a few weeks before full term: poor school performance. The findings were published article published online on July 2 in the journal Pediatrics.

The researchers designed a study to evaluate the degree to which children born within the “normal term” range of 37 to 41 weeks’ gestation vary in terms of school achievement. The study group was comprised of 128,050 infants born between 37 and 41 weeks’ gestation in New York City. All the infants were the product of a single birth. Data were extracted from city birth records; a number of obstetric, social, and economic variables were assessed at both the individual and community levels.

Birth data were then matched with public school records of standardized city-wide third-grade reading and math tests. The investigators evaluated: (1) whether children born within the normal term range of 37 to 41 weeks’ gestation show differences in reading and/or math ability eight years later as a function of gestational age; and (2) The degree to which a wide range of individual- and community-level social and biological factors mediate this effect.

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The researchers found that gestational age within the normal term range was significantly and positively related to reading and math scores in third grade; achievement scores for children born at 37 and 38 weeks were significantly lower than those for children born at 39, 40, or 41 weeks. This effect was independent of birth weight, as well as a number of other obstetric, social, and economic factors.

The authors concluded that earlier normal term birth may be a characteristic considered by researchers, clinicians, and parents to help identify children who may be at risk for poorer school performance. They recommend that further studies are indicated to elucidate the mechanisms underlying the findings; however, they note that the intrauterine environment likely supports typical brain development, which may be more likely to be disrupted when children are born early, even within the commonly defined period of term gestation.

Take home message:
This study reports that infants born slightly before term may suffer adverse outcomes. Poor lifestyle choices such as smoking increase the risk of a preterm birth. A preventable cause of preterm birth is an elective induction of labor or cesarean section. A miscalculation of the due date is sometimes the cause. An early ultrasound examination can prevent this error. Recently, significant attention has been focused on elective deliveries for non-obstetrical reasons (i.e., patient discomfort or the obstetrician having an upcoming vacation). The American Congress of Obstetricians and Gynecologists (ACOG) strongly discourages this practice.

Reference: Pediatrics