Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study

TY - JOUR

T1 - Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study

AU - Sejer, Emilie Pi Fogtmann

AU - Bruun, Frederik Jager

AU - Slavensky, Julie Anna

AU - Mortensen, Erik Lykke

AU - Kesmodel, Ulrik Schioler

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Preterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years. Design Population-based prospective cohort study. Setting Denmark 2003-2008. Participants A cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5. Primary outcome measures Wechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores. Results For preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was -10.6 points (95% CI -19.4 to -1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown. Conclusions This study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.

AB - Preterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years. Design Population-based prospective cohort study. Setting Denmark 2003-2008. Participants A cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5. Primary outcome measures Wechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores. Results For preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was -10.6 points (95% CI -19.4 to -1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown. Conclusions This study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.

KW - attention

KW - child development

KW - executive function

KW - gestational age

KW - intelligence

KW - preterm birth

U2 - 10.1136/bmjopen-2019-028982

DO - 10.1136/bmjopen-2019-028982

M3 - Journal article

C2 - 31501108

SN - 2044-6055

VL - 9

JO - BMJ Open

JF - BMJ Open

M1 - e028982

ER -