Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
Department of Economics, Emory University, Atlanta, GA; National Bureau of Economic Research, Cambridge, MA.
J Pediatr. 2019 Sep;212:159-165.e7. doi: 10.1016/j.jpeds.2019.04.055. Epub 2019 Jul 10.
To estimate the association between small for gestational age (SGA) at birth and educational performance on standardized testing and disability prevalence in elementary and middle school.
Through linked birth certificates and school records, surviving infants born at 23-41 weeks of gestation who entered Florida's public schools 1998-2009 were identified. Twenty-three SGA definitions (3rd-25th percentile) were derived. Outcomes were scores on Florida Comprehensive Assessment Test (FCAT) and students' disability classification in grades 3 through 8. A "sibling cohort" subsample included families with at least 2 siblings from the same mother in the study period. Multivariable models estimated independent relationships between SGA and outcomes.
Birth certificates for 80.2% of singleton infants were matched to Florida public school records (N = 1 254 390). Unadjusted mean FCAT scores were 0.236 SD lower among <10th percentile SGA infants compared with non-SGA infants; this difference declined to -0.086 SD after adjusting for maternal and infant characteristics. When siblings discordant in SGA status were compared within individual families, the association declined to -0.056 SD. For SGA <10th percentile infants, the observed prevalence of school-age disability was 15.0%, 7.7%, and 6.3% for unadjusted, demographics-adjusted, and sibling analyses, respectively. No inflection or discontinuity was detected across SGA definitions from 3rd to 25th percentile in either outcome, and the associations were qualitatively similar.
The associations between SGA birth and students' standardized test scores and well-being were quantitatively small but persisted through elementary and middle school. The observed deficits were largely mitigated by demographic and familial factors.
评估出生时小于胎龄儿（SGA）与标准化测试中的教育表现和小学及中学阶段残疾患病率之间的关系。
通过链接出生证明和学校记录，确定了 1998 年至 2009 年在佛罗里达州公立学校就读的 23-41 周龄存活婴儿。制定了 23 种 SGA 定义（第 3-25 百分位数）。结局为佛罗里达州综合评估测试（FCAT）的分数和学生在 3 至 8 年级的残疾分类。“同胞队列”子样本包括在研究期间同一母亲至少有 2 个兄弟姐妹的家庭。多变量模型估计了 SGA 与结局之间的独立关系。
80.2%的单胎婴儿的出生证明与佛罗里达州公立学校的记录相匹配（N=1 254 390）。与非 SGA 婴儿相比，<第 10 百分位数 SGA 婴儿的未调整 FCAT 平均分数低 0.236 个标准差；调整了母婴特征后，这一差异降至-0.086 个标准差。在个体家庭中比较 SGA 状态不一致的同胞时，相关性降至-0.056 个标准差。对于<第 10 百分位数的 SGA 婴儿，未调整、人口统计学调整和同胞分析的学龄残疾观察患病率分别为 15.0%、7.7%和 6.3%。在任何结局中，从第 3 百分位数到第 25 百分位数，SGA 定义之间都没有发现拐点或不连续，并且关联的性质相似。
SGA 出生与学生的标准化测试成绩和幸福感之间的关联虽然数量较小，但一直持续到小学和中学阶段。观察到的缺陷在很大程度上被人口统计学和家庭因素所缓解。
