Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Inserm, INRA, Paris, France.
Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
Int J Epidemiol. 2022 Jan 6;50(6):1824-1839. doi: 10.1093/ije/dyab170. Epub 2021 Sep 15.
Studies are sparse and inconclusive about the association between maternal education and cognitive development among children born very preterm (VPT). Although this association is well established in the general population, questions remain about its magnitude among children born VPT whose risks of medical and developmental complications are high. We investigated the association of maternal education with cognitive outcomes in European VPT birth cohorts.
We used harmonized aggregated data from 15 population-based cohorts of children born at <32 weeks of gestational age (GA) or <1500 g from 1985 to 2013 in 13 countries with information on maternal education and assessments of general development at 2-3 years and/or intelligence quotients between 4 and 15 years. Term-born controls (≥37 weeks of GA) were available in eight cohorts. Maternal education was classified as: low (primary/lower secondary); medium (upper secondary/short tertiary); high (bachelor's/higher). Pooled standardized mean differences (SMDs) in cognitive scores were estimated (reference: high educational level) for children assessed at ages 2-3, 4-7 and 8-15 years.
The study included 10 145 VPT children from 12 cohorts at 2-3 years, 8829 from 12 cohorts at 4-7 years and 1865 children from 6 cohorts at 8-15 years. Children whose mothers had low, compared with high, educational attainment scored lower on cognitive measures [pooled unadjusted SMDs: 2-3 years = -0.32 (95% confidence intervals: -0.43 to -0.21); 4-7 years = -0.57 (-0.67; -0.47); 8-15 years = -0.54 (-0.72; -0.37)]. Analyses by GA subgroups (<27 vs ≥27 weeks) in children without severe neonatal morbidity and term controls yielded similar results.
Across diverse settings and regardless of the degree of prematurity, low maternal education was associated with lower cognition.
关于母亲教育与极早产儿（VPT）儿童认知发展之间的关系，研究结果稀少且不一致。虽然这种关联在普通人群中已经得到很好的证实，但对于那些存在较高医疗和发育并发症风险的 VPT 儿童，其关联程度仍存在疑问。我们调查了母亲教育与欧洲 VPT 出生队列认知结果之间的关系。
我们使用了来自 1985 年至 2013 年间 13 个国家的 15 个基于人群的 VPT 队列的汇总数据，这些队列的婴儿出生时胎龄<32 周或体重<1500 克，其中包含母亲教育信息和 2-3 岁时的一般发育评估，以及 4-15 岁时的智商评估。8 个队列中都有足月出生的对照组（胎龄≥37 周）。母亲的教育程度分为：低（小学/初中）；中（高中/短期大专）；高（学士/硕士）。对 2-3 岁、4-7 岁和 8-15 岁接受评估的儿童，估计了认知评分的标准化平均差异（SMD）（参考：高教育水平）。
该研究纳入了来自 12 个队列的 10145 名 VPT 儿童（2-3 岁），12 个队列的 8829 名儿童（4-7 岁）和 6 个队列的 1865 名儿童（8-15 岁）。与高教育水平的母亲相比，母亲教育水平较低的儿童在认知测试中得分较低[未调整的汇总 SMD：2-3 岁= -0.32（95%置信区间：-0.43 至 -0.21）；4-7 岁= -0.57（-0.67；-0.47）；8-15 岁= -0.54（-0.72；-0.37）]。在没有严重新生儿发病率的胎龄<27 周与≥27 周亚组儿童和足月对照组中进行的 GA 分组分析得出了类似的结果。
在不同的环境中，无论早产程度如何，低母亲教育与认知能力较低有关。
