National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Department of Health Sciences, University of Leicester, Leicester, United Kingdom.
PLoS One. 2022 Aug 17;17(8):e0271952. doi: 10.1371/journal.pone.0271952. eCollection 2022.
Preterm birth (<37 weeks' gestation) is a risk factor for poor educational outcomes. A dose-response effect of earlier gestational age at birth on poor primary school attainment has been observed, but evidence for secondary school attainment is limited and focused predominantly on the very preterm (<32 weeks) population. We examined the association between gestational age at birth and academic attainment at the end of primary and secondary schooling in England. Data for children born in England from 2000-2001 were drawn from the population-based UK Millennium Cohort Study. Information about the child's birth, sociodemographic factors and health was collected from parents. Attainment on national tests at the end of primary (age 11) and secondary school (age 16) was derived from linked education records. Data on attainment in primary school was available for 6,950 pupils and that of secondary school was available for 7,131 pupils. Adjusted relative risks (aRRs) for these outcomes were estimated at each stage separately using modified Poisson regression. At the end of primary school, 17.7% of children had not achieved the expected level in both English and Mathematics and this proportion increased with increasing prematurity. Compared to full term (39-41 weeks) children, the strongest associations were among children born moderately (32-33 weeks; aRR = 2.13 (95% CI 1.44-3.13)) and very preterm (aRR = 2.06 (95% CI 1.46-2.92)). Children born late preterm (34-36 weeks) and early term (37-38 weeks) were also at higher risk with aRR = 1.18 (95% CI 0.94-1.49) and aRR = 1.21 (95% CI 1.05-1.38), respectively. At the end of secondary school, 45.2% had not passed at least five General Certificate of Secondary Education examinations including English and Mathematics. Following adjustment, only children born very preterm were at significantly higher risk (aRR = 1.26 (95% CI 1.03-1.54)). All children born before full term are at risk of poorer attainment during primary school compared with term-born children, but only children born very preterm remain at risk at the end of secondary schooling. Children born very preterm may require additional educational support throughout compulsory schooling.
早产（<37 周妊娠）是不良教育结局的一个危险因素。人们已经观察到出生时更早的胎龄与较差的小学学业成绩呈剂量反应关系，但关于中学学业成绩的证据有限，且主要集中在极早产（<32 周）人群。我们研究了英国出生时胎龄与小学和中学结束时学业成绩之间的关系。2000-2001 年在英格兰出生的儿童的数据来自基于人群的英国千禧年队列研究。从父母那里收集了关于孩子出生、社会人口因素和健康的信息。在小学（11 岁）和中学（16 岁）结束时的全国考试成绩来自于相关的教育记录。小学学业成绩数据可用于 6950 名学生，中学学业成绩数据可用于 7131 名学生。分别使用修正泊松回归对这些结果进行了单独调整后的相对风险（aRR）估计。在小学结束时，17.7%的儿童在英语和数学方面都没有达到预期水平，且这一比例随着早产的增加而增加。与足月（39-41 周）儿童相比，中度早产（32-33 周；aRR=2.13（95%CI 1.44-3.13））和极早产（aRR=2.06（95%CI 1.46-2.92））儿童的关联最强。晚期早产（34-36 周）和早期足月（37-38 周）儿童的风险也较高，aRR=1.18（95%CI 0.94-1.49）和 aRR=1.21（95%CI 1.05-1.38）。在中学结束时，45.2%的人至少有五门普通中等教育证书考试（包括英语和数学）没有通过。调整后，只有极早产出生的儿童风险显著增加（aRR=1.26（95%CI 1.03-1.54））。与足月出生的儿童相比，所有早产出生的儿童在小学期间学业成绩较差的风险都增加，但只有极早产出生的儿童在中学结束时仍存在风险。极早产出生的儿童可能在整个义务教育阶段需要额外的教育支持。
