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School performance at age 7 years in late preterm and early term birth: a cohort study
  1. Evelyn Chan,
  2. Maria A Quigley
  1. National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
  1. Correspondence to Maria Quigley, National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK; maria.quigley{at}


Objective To investigate the effect of gestational age, particularly late preterm birth (34–36 weeks gestation) and early term birth (37–38 weeks gestation) on school performance at age 7 years.

Design Population-based prospective UK Millennium Cohort Study, consisting of linked educational data on 6031 children.

Methods School performance was investigated using the statutory Key Stage 1 (KS1) teacher assessments performed in the third school year in England. The primary outcome was not achieving the expected level (≥level 2) of general performance in all three key subjects (reading, writing and mathematics). Other outcomes investigated subject-specific performance and high academic performance (level 3).

Results 18% of full-term children performed below the expected KS1 general level, and risk of poor performance increased with prematurity: compared to children born at full-term, there was a statistically significant increased risk of poor performance in those born very preterm (<32 weeks gestation, adjusted RR 1.78, 95% CI 1.24 to 2.54), moderately preterm (32–33 weeks gestation, adjusted RR 1.71, 95% CI 1.15 to 2.54) and late preterm (34–36 weeks gestation, adjusted RR 1.36, 95% CI 1.09 to 1.68). Early term children performed statistically significantly worse in 4 out of 5 individual subject domains than full-term children, but not in the primary outcome (adjusted RR 1.07, 95% CI 0.94 to 1.23).

Conclusions Late preterm, and to a lesser extent, early term birth negatively impact on academic outcomes at 7 years as measured by KS1 assessments.

  • Epidemiology
  • Neonatology
  • Neurodevelopment
  • preterm
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