Abstract
Importance: Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomesmay influence physician and patient decisions regarding optimal pregnancy length. Objective: To compare the cognitive and physical outcomes of school-aged children who were born full term or late term. Design, setting, and participants: We analyzed Florida birth certificates from 1994 to 2002 linked to Florida public school records from 1998 to 2013 and found 1 442 590 singleton births with 37 to 41 weeks' gestation in the Florida Bureau of Vital Statistics. Of these, 1 153 716 children (80.0%) were subsequently located in Florida public schools. Linear and logistic regression models were used to assess the association of gestational age with cognitive and physical outcomes at school age. Data analysis took place between April 2013 and January 2016. Exposures: Late-term (born at 41 weeks) vs full-term (born at 39 or 40 weeks) gestation. Main outcomes and measures: Therewere a number of measures used, including the average Florida Comprehensive Assessment Test mathematics and reading scores at ages 8 through 15 years; whether a child was classified as gifted, defined as a student with superior intellectual development and capable of high performance; poor cognitive outcome, defined as a child scoring in the fifth percentile of test takers or having a disability that exempted him or her from taking the Florida Comprehensive Assessment Test; and Exceptional Student Education placement owing to orthopedic, speech, or sensory impairment or being hospitalbound or homebound. Results: Of 1 536 482 children born in Florida from singleton births from 1994 to 2002 with complete demographic information, 787 105 (51.2%) were male; 338 894 (22.1%) of mothers were black and 999 684 (65.1%) were married at time of birth, and the mean (SD) age for mothers at time of birth was 27.2 (6.2) years. Late-term infants had 0.7%of an SD (95%CI, 0.001-0.013; P = .02) higher average test scores in elementary and middle school, 2.8% (95%CI, 0.4-5.2; P = .02) higher probability of being gifted, and 3.1% (95%CI, 0.0-6.1; P = .05) reduced probability of poor cognitive outcomes compared with full-term infants. These cognitive benefits appeared strongest for children with disadvantaged family background characteristics. Late-term infants were also 2.1% (95%CI, -0.3 to 4.5; P = .08) more likely to be physically impaired. Conclusions and relevance: There appears to be a tradeoff between cognitive and physical outcomes associated with late-term gestation. Children born late-term performed better on 3 measures of school-based cognitive functioning but worse on 1 measure of physical functioning relative to children born full term. Our findings provide longer-run information for expectant parents and physicians who are considering delivery at full term vs late term. These findings are most relevant to uncomplicated, low-risk pregnancies.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 758-764 |
| Number of pages | 7 |
| Journal | JAMA Pediatrics |
| Volume | 170 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2016 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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Long-term cognitive and health outcomes of school-aged children who were born late-term vs full-term. / Figlio, David N; Guryan, Jonathan E; Karbownik, Krzysztof; Roth, Jeffrey.
In: JAMA Pediatrics, Vol. 170, No. 8, 01.08.2016, p. 758-764.Research output: Contribution to journal › Article
TY - JOUR
T1 - Long-term cognitive and health outcomes of school-aged children who were born late-term vs full-term
AU - Figlio, David N
AU - Guryan, Jonathan E
AU - Karbownik, Krzysztof
AU - Roth, Jeffrey
PY - 2016/8/1
Y1 - 2016/8/1
N2 - Importance: Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomesmay influence physician and patient decisions regarding optimal pregnancy length. Objective: To compare the cognitive and physical outcomes of school-aged children who were born full term or late term. Design, setting, and participants: We analyzed Florida birth certificates from 1994 to 2002 linked to Florida public school records from 1998 to 2013 and found 1 442 590 singleton births with 37 to 41 weeks' gestation in the Florida Bureau of Vital Statistics. Of these, 1 153 716 children (80.0%) were subsequently located in Florida public schools. Linear and logistic regression models were used to assess the association of gestational age with cognitive and physical outcomes at school age. Data analysis took place between April 2013 and January 2016. Exposures: Late-term (born at 41 weeks) vs full-term (born at 39 or 40 weeks) gestation. Main outcomes and measures: Therewere a number of measures used, including the average Florida Comprehensive Assessment Test mathematics and reading scores at ages 8 through 15 years; whether a child was classified as gifted, defined as a student with superior intellectual development and capable of high performance; poor cognitive outcome, defined as a child scoring in the fifth percentile of test takers or having a disability that exempted him or her from taking the Florida Comprehensive Assessment Test; and Exceptional Student Education placement owing to orthopedic, speech, or sensory impairment or being hospitalbound or homebound. Results: Of 1 536 482 children born in Florida from singleton births from 1994 to 2002 with complete demographic information, 787 105 (51.2%) were male; 338 894 (22.1%) of mothers were black and 999 684 (65.1%) were married at time of birth, and the mean (SD) age for mothers at time of birth was 27.2 (6.2) years. Late-term infants had 0.7%of an SD (95%CI, 0.001-0.013; P = .02) higher average test scores in elementary and middle school, 2.8% (95%CI, 0.4-5.2; P = .02) higher probability of being gifted, and 3.1% (95%CI, 0.0-6.1; P = .05) reduced probability of poor cognitive outcomes compared with full-term infants. These cognitive benefits appeared strongest for children with disadvantaged family background characteristics. Late-term infants were also 2.1% (95%CI, -0.3 to 4.5; P = .08) more likely to be physically impaired. Conclusions and relevance: There appears to be a tradeoff between cognitive and physical outcomes associated with late-term gestation. Children born late-term performed better on 3 measures of school-based cognitive functioning but worse on 1 measure of physical functioning relative to children born full term. Our findings provide longer-run information for expectant parents and physicians who are considering delivery at full term vs late term. These findings are most relevant to uncomplicated, low-risk pregnancies.
AB - Importance: Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomesmay influence physician and patient decisions regarding optimal pregnancy length. Objective: To compare the cognitive and physical outcomes of school-aged children who were born full term or late term. Design, setting, and participants: We analyzed Florida birth certificates from 1994 to 2002 linked to Florida public school records from 1998 to 2013 and found 1 442 590 singleton births with 37 to 41 weeks' gestation in the Florida Bureau of Vital Statistics. Of these, 1 153 716 children (80.0%) were subsequently located in Florida public schools. Linear and logistic regression models were used to assess the association of gestational age with cognitive and physical outcomes at school age. Data analysis took place between April 2013 and January 2016. Exposures: Late-term (born at 41 weeks) vs full-term (born at 39 or 40 weeks) gestation. Main outcomes and measures: Therewere a number of measures used, including the average Florida Comprehensive Assessment Test mathematics and reading scores at ages 8 through 15 years; whether a child was classified as gifted, defined as a student with superior intellectual development and capable of high performance; poor cognitive outcome, defined as a child scoring in the fifth percentile of test takers or having a disability that exempted him or her from taking the Florida Comprehensive Assessment Test; and Exceptional Student Education placement owing to orthopedic, speech, or sensory impairment or being hospitalbound or homebound. Results: Of 1 536 482 children born in Florida from singleton births from 1994 to 2002 with complete demographic information, 787 105 (51.2%) were male; 338 894 (22.1%) of mothers were black and 999 684 (65.1%) were married at time of birth, and the mean (SD) age for mothers at time of birth was 27.2 (6.2) years. Late-term infants had 0.7%of an SD (95%CI, 0.001-0.013; P = .02) higher average test scores in elementary and middle school, 2.8% (95%CI, 0.4-5.2; P = .02) higher probability of being gifted, and 3.1% (95%CI, 0.0-6.1; P = .05) reduced probability of poor cognitive outcomes compared with full-term infants. These cognitive benefits appeared strongest for children with disadvantaged family background characteristics. Late-term infants were also 2.1% (95%CI, -0.3 to 4.5; P = .08) more likely to be physically impaired. Conclusions and relevance: There appears to be a tradeoff between cognitive and physical outcomes associated with late-term gestation. Children born late-term performed better on 3 measures of school-based cognitive functioning but worse on 1 measure of physical functioning relative to children born full term. Our findings provide longer-run information for expectant parents and physicians who are considering delivery at full term vs late term. These findings are most relevant to uncomplicated, low-risk pregnancies.
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U2 - 10.1001/jamapediatrics.2016.0238
DO - 10.1001/jamapediatrics.2016.0238
M3 - Article
VL - 170
SP - 758
EP - 764
JO - JAMA Pediatrics
JF - JAMA Pediatrics
SN - 2168-6203
IS - 8
ER -