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Gestational age and school achievement: a population study
  1. Amelia K Searle1,2,
  2. Lisa G Smithers1,
  3. Catherine R Chittleborough1,
  4. Tess A Gregory1,3,
  5. John W Lynch4
  1. 1 School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
  2. 2 School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  3. 3 Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
  4. 4 School of Social and Community Medicine, University of Bristol, Bristol, UK
  1. Correspondence to Dr Lisa Smithers, School of Public Health, Mail drop DX 650 550, The University of Adelaide, SA 5005, Australia; lisa.smithers{at}


Objective Academic achievement varies according to gestational age but it is unclear whether achievement varies within ‘term’ (37–41 weeks gestation) or for ‘post-term’ births (≥42 weeks). We examined gestational age from preterm to post-term against a national minimum standard for academic achievement in population data.

Design Literacy and numeracy data of 8-year-old South Australian grade 3 children in 2008–2010 were linked to routinely collected perinatal data (N=28 155).

Results Longer gestation from 23 to 45 weeks was associated with lower risk of poor literacy and numeracy. Adjusted relative risks for being at or below national minimum standard ranged from 1.12 (95% CI 1.03 to 1.22) for ‘late preterm’ (32–36 weeks) for numeracy, to 1.84 (95% CI 1.48 to 2.30) for ‘early preterm’ (23–31 weeks) for writing. Within term, every additional week of gestational age was associated with small decreased risks of poor literacy and numeracy (eg, relative risks for poor numeracy 1.10, 95% CI 1.01 to 1.20 for 37 weeks). Population-attributable fractions for poor achievement were highest among children born ‘early term’ (37–39 weeks) due to their higher population prevalence.

Conclusions Shorter gestational age was associated with increased risk of poor literacy/numeracy. While children born ‘early term’ experience only between 1% and 10% increased risk, they constitute a larger proportion of children with poor educational achievement than preterm children, and thus are important to consider for supportive interventions to improve population-level achievement gains. The seemingly lower risk for post-term children showed large error estimates and warrants further consideration within even larger populations.

  • gestational age
  • term birth
  • achievement
  • early childhood

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  • Contributors AKS analysed the data, critically interpreted the results and drafted the initial manuscript. LGS conceptualised and designed the study, analysed the data, assisted in interpreting the results, reviewed and revised the manuscript. CRC and JWL conceptualised and designed the study, assisted in interpreting the results, reviewed and revised the manuscript. TAG assisted with data analysis, reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Competing interests JWL is funded by a National Health and Medical Research Council of Australia Partnership Project Grant (1056888) and Centre of Research Excellence (1099422).

  • Ethics approval SA Department for Health and Ageing (377/06/2013) and The University of Adelaide (H-185-2011) ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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