Born too soon – new study shows how being born early might affect a child’s progress at school

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Published on Wednesday, 17 August 2022 Post

A new analysis indicates that being born prematurely can affect academic performance even up to age 16.

About 7% of babies are born preterm in the UK (before 37 weeks of pregnancy), meaning that a typical class of 30 schoolchildren might include two or three children who were born preterm. Although much is known about how premature birth affects the early weeks and months after birth, there is less evidence about the long-term impacts as these babies grow into young children and adolescents.

To address this, the National Perinatal Epidemiology Unit (NPEU) at Oxford Population Health have led TIGAR (Tracking the Impact of Gestational Age on health, educational and economic outcomes: a longitudinal Record linkage study).

TIGAR compared the health and school achievement of children born prematurely with those born after a full term pregnancy. The health study was based on hospital records in more than a million children. The school study used data from the Millennium Cohort Study, a nationally-representative longitudinal survey following the lives of about 18,800 babies born in the UK in the years 2000–2002.

Previously, TIGAR found that children born prematurely were more likely to be admitted to hospital during childhood, and were more likely to have special educational needs (SEN) at age 11 when they finish primary school. A new analysis, published today in PLOS ONE, investigated how being born early can affect their academic attainment at primary and secondary school.

The TIGAR school study followed around 7,000 children born in England in 2000 or 2001. It compared school 'SATs' results (standardised assessments) at age 11 and GCSE results at age 16 in children born early with children who were born at full term (39-41 weeks of pregnancy).

Key findings:

• The children took their SATs in 2012, and those who scored above a certain grade were considered as reaching 'the expected standard'. The more preterm the child was, the less likely they were to achieve the expected standard.
• For instance, 79% of all children in England achieved the expected standard in both English and Mathematics, but this figure was 84% for children born at 39-41 weeks of pregnancy, and 61% for children born before 32 weeks of pregnancy.
• When the children in the study were aged 16 years, 56% of the children born at 39-41 weeks of pregnancy achieved 5 GCSE passes (defined as a grade A*-C or a grade 9-4), including English and Mathematics. This figure was slightly lower in those born at 32-38 weeks (52 – 54%) and was lowest (at 40%) in children born before 32 weeks.
• For GCSE English, 73% of the children born at 39-41 weeks of pregnancy achieved a pass. This was slightly lower for those born at 32-38 weeks (69 – 71%) and was lower still (at 59%) for children born before 32 weeks.
• For GCSE Mathematics, 67% of the children born at 39-41 weeks of pregnancy achieved a pass. This figure was similar for those born at 32-38 weeks (66 – 69%), but was lower (at 51%) for children born before 32 weeks.
• The researchers also looked at the children's attainment 8 score, which is a combined score based on up to 8 GCSEs (including English and Mathematics), with higher scores indicating better performance. The average attainment 8 score was 46 for children born at 39-41 weeks. This figure was similar for those born preterm at 32-38 weeks (at 45) but was lower (at 39) in children born before 32 weeks of pregnancy

For these analyses, the researchers took into account potential reasons other than prematurity which may have explained the results, including the child's birth month, sex, whether firstborn and multiple birth, and mother's age, level of education and smoking during pregnancy. However, since the underlying reason for a preterm birth was often not available for each child, these results should be interpreted as reflecting what happened to the prematurely born children on average, acknowledging that individual children may have had very different birth experiences.

Maria Quigley, Professor of Statistical Epidemiology and Principal Investigator for TIGAR, said: 'Our findings show that although preterm children on average have worse attainment during primary school than children born at full term, those born at 32 weeks or more tend to have similar attainment at the end of secondary school. As the majority of premature children are born at 32 weeks or more, this finding may be reassuring for many parents.'

Dr Neora Alterman, researcher for TIGAR added: 'Our study showed that children born at less than 32 weeks, however, remain at higher risk of poor school attainment at the end of compulsory education. These children may benefit the most from screening for cognitive and learning difficulties prior to school entry to guide the provision of additional support from the outset of schooling.'

To raise awareness of the combined results on school performance, SEN, and hospital admissions, the TIGAR team have developed a new infographic and lay summary of their findings. They hope that this will help inform parents, schools, clinicians and others who support children born preterm of the possible long-term academic and health outcomes of UK children born prematurely.