Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren

Mackay, D.F., Smith, G.C.S., Dobbie, R. and Pell, J.P. (2010) Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren. PLoS Medicine, 7(6), e1000289. (doi:10.1371/journal.pmed.1000289)

Mackay, D.F., Smith, G.C.S., Dobbie, R. and Pell, J.P. (2010) Gestational age at delivery and special educational need: retrospective cohort study of 407,503 schoolchildren. PLoS Medicine, 7(6), e1000289. (doi:10.1371/journal.pmed.1000289)

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Abstract

<STRONG>Background</STRONG> Previous studies have demonstrated an association between preterm delivery and increased risk of special educational need (SEN). The aim of our study was to examine the risk of SEN across the full range of gestation. <STRONG>Methods and Findings</STRONG> We conducted a population-based, retrospective study by linking school census data on the 407,503 eligible school-aged children resident in 19 Scottish Local Authority areas (total population 3.8 million) to their routine birth data. SEN was recorded in 17,784 (4.9%) children; 1,565 (8.4%) of those born preterm and 16,219 (4.7%) of those born at term. The risk of SEN increased across the whole range of gestation from 40 to 24 wk: 37–39 wk adjusted odds ratio (OR) 1.16, 95% confidence interval (CI) 1.12–1.20; 33–36 wk adjusted OR 1.53, 95% CI 1.43–1.63; 28–32 wk adjusted OR 2.66, 95% CI 2.38–2.97; 24–27 wk adjusted OR 6.92, 95% CI 5.58–8.58. There was no interaction between elective versus spontaneous delivery. Overall, gestation at delivery accounted for 10% of the adjusted population attributable fraction of SEN. Because of their high frequency, early term deliveries (37–39 wk) accounted for 5.5% of cases of SEN compared with preterm deliveries (<37 wk), which accounted for only 3.6% of cases. <STRONG>Conclusions</STRONG> Gestation at delivery had a strong, dose-dependent relationship with SEN that was apparent across the whole range of gestation. Because early term delivery is more common than preterm delivery, the former accounts for a higher percentage of SEN cases. Our findings have important implications for clinical practice in relation to the timing of elective delivery.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Pell, Professor Jill and Mackay, Dr Daniel
Authors: Mackay, D.F., Smith, G.C.S., Dobbie, R., and Pell, J.P.
Subjects:R Medicine > RG Gynecology and obstetrics
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Centre for Population and Health Sciences
Journal Name:PLoS Medicine
Journal Abbr.:PLoS Med
Publisher:Public Library of Science
ISSN:1549-1277
ISSN (Online):1549-1676
Published Online:08 June 2010
Copyright Holders:Copyright © 2010 The Authors
First Published:First published in Plos Medicine 7(6):e1000289
Publisher Policy:Reproduced under a Creative Commons License
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