Ahlsson Fredrik, Kaijser Magnus, Adami Johanna, Lundgren Maria, Palme Mårten
From the aDepartment of Women's and Children's Health, Uppsala University, Uppsala, Sweden; bClincial Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; cDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; and dDepartment of Economics, Stockholm University, Stockholm, Sweden.
Epidemiology. 2015 Jan;26(1):106-11. doi: 10.1097/EDE.0000000000000171.
An increased risk of poor school performance for children born preterm has been shown in many studies, but whether this increase is attributable to preterm birth per se or to other factors associated with preterm birth has not been resolved.
We used data from the Swedish Medical Birth Register, the Longitudinal Integration Database for Sickness Insurance and Labor Market Study, the Swedish Multigeneration Register, and the National School Register to link records comprising the Swedish birth cohorts from 1974 through 1991. Linear regression was used to assess the association between gestational duration and school performance, both with and without controlling for parental and socioeconomic factors. In a restricted analysis, we compared siblings only with each other.
Preterm birth was strongly and negatively correlated with school performance. The distribution of school grades for children born at 31-33 weeks was on average 3.85 (95% confidence interval = -4.36 to -3.35) centiles lower than for children born at 40 weeks. For births at 22-24 weeks, the corresponding figure was -23.15 (-30.32 to -15.97). When taking confounders into account, the association remained. When restricting the analysis to siblings, however, the association between school performance and preterm birth after week 30 vanished completely, whereas it remained, less pronounced, for preterm birth before 30 weeks of gestation.
Our study suggests that the association between school performance and preterm birth after 30 gestational weeks is attributable to factors other than preterm birth per se.
许多研究表明，早产儿童学习成绩不佳的风险增加，但这种增加是归因于早产本身还是与早产相关的其他因素尚未得到解决。
我们使用了瑞典医学出生登记册、疾病保险和劳动力市场研究纵向整合数据库、瑞典多代登记册以及国家学校登记册的数据，以链接1974年至1991年瑞典出生队列的记录。使用线性回归来评估孕周与学习成绩之间的关联，同时控制和不控制父母及社会经济因素。在一项受限分析中，我们仅比较了兄弟姐妹之间的情况。
早产与学习成绩呈强烈负相关。31 - 33周出生儿童的学校成绩分布平均比40周出生儿童低3.85个百分位（95%置信区间 = -4.36至 -3.35）。对于22 - 24周出生的情况，相应数字为 -23.15（-30.32至 -15.97）。考虑混杂因素后，这种关联仍然存在。然而，当将分析限制在兄弟姐妹时，30周后早产与学习成绩之间的关联完全消失，而对于妊娠30周前的早产，这种关联仍然存在，但不太明显。
我们的研究表明，妊娠30周后早产与学习成绩之间的关联归因于早产本身以外的因素。
