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Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study

Alterman, N., Johnson, S., Carson, C. , Petrou, S., Kurinzcuk, J. J., Macfarlane, A. J. ORCID: 0000-0003-0977-7214, Boyle, E. M. & Quigley, M. A. (2022). Gestational age at birth and academic attainment in primary and secondary school in England: Evidence from a national cohort study. PLOS ONE, 17(8), article number e0271952. doi: 10.1371/journal.pone.0271952


Preterm birth (<37 weeks’ gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000–2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child’s birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39–41 weeks) children, the strongest associations were among children born moderately (32–33 weeks; aRR = 2.13 (95% CI 1.44–3.13)) and very preterm (aRR = 2.06 (95% CI 1.46–2.92)). Children born late preterm (34–36 weeks) and early term (37–38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94–1.49) and aRR = 1.21 (95% CI 1.05–1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03–1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.

Publication Type: Article
Additional Information: © 2022 Alterman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Subjects: L Education > LB Theory and practice of education > LB1501 Primary Education
L Education > LB Theory and practice of education > LB1603 Secondary Education. High schools
R Medicine > RG Gynecology and obstetrics
R Medicine > RJ Pediatrics
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
SWORD Depositor:
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Available under License Creative Commons: Attribution International Public License 4.0.

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