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Gestational age at birth and child special educational needs: a UK representative birth cohort study

Alterman, N., Johnson, S., Carson, C. , Petrou, S., Rivero-Arias, O., Kurinczuk, J. J., Macfarlane, A. J. ORCID: 0000-0003-0977-7214, Boyle, E. M. & Quigley, M. A. (2021). Gestational age at birth and child special educational needs: a UK representative birth cohort study. Archives of Disease in Childhood, 106(9), pp. 842-848. doi: 10.1136/archdischild-2020-320213


To examine the association between gestational age at birth across the entire gestational age spectrum and special educational needs (SENs) in UK children at 11 years of age.

The Millennium Cohort Study is a nationally representative longitudinal sample of children born in the UK during 2000–2002. Information about the child’s birth, health and sociodemographic factors was collected when children were 9 months old. Information about presence and reasons for SEN was collected from parents at age 11. Adjusted relative risks (aRRs) were estimated using modified Poisson regression, accounting for confounders.

The sample included 12 081 children with data at both time points. The overall prevalence of SEN was 11.2%, and it was inversely associated with gestational age. Among children born <32 weeks of gestation, the prevalence of SEN was 27.4%, three times higher than among those born at 40 weeks (aRR=2.89; 95% CI 2.02 to 4.13). Children born early term (37–38 weeks) were also at increased risk for SEN (aRR=1.33; 95% CI 1.11 to 1.59); this was the same when the analysis was restricted to births after labour with spontaneous onset. Birth before full term was more strongly associated with having a formal statement of SEN or SEN for multiple reasons.

Children born at earlier gestational ages are more likely to experience SEN, have more complex SEN and require support in multiple facets of learning. This association was observed even among children born early-term and when labour began spontaneously.

What is already known on this topic?
 Preterm birth, especially extremely preterm birth, is a risk factor for neurodevelopmental sequelae and poor attainment in school.
 Special educational needs are more prevalent in children born at earlier gestational ages, even in children born at 37-38 weeks compared with 40 weeks.

What this study adds?
 Children born at 37-38 weeks of gestation are at moderately elevated risk of special educational needs even if labour began spontaneously.
 The risk of special educational needs following birth at earlier gestational ages is not only greater, but children’s needs tend to be more complex.
 Preterm birth is associated most strongly with special educational needs due to attention-deficit/hyperactivity disorder (ADHD) or health/physical difficulties.

Publication Type: Article
Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform
R Medicine > RG Gynecology and obstetrics
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments: School of Health & Psychological Sciences > Midwifery & Radiography
Text - Accepted Version
Available under License Creative Commons Attribution Non-commercial.

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