Are the adverse academic outcomes seen in preterm children attenuated from first to third grade? An investigation using a Georgia-born cohort Open Access

Abstract

Introduction: Children born preterm are more susceptible to impaired cognitive function, potentially leading to impediment in school readiness, which can have a lasting impact on health and opportunity trajectory, and studies investigating whether or not children eventually "catch-up" are inconsistent and minimal. The objective of this study is to investigate whether the association of being born preterm with risk for adverse cognitive function is attenuated in third grade as compared to first grade.

Methods: The Georgia Birth to School Cohort, a retrospective cohort, consisting of singleton live births to Georgia resident mothers, deterministically linked these birth records, including the exposure of gestational age in weeks, to their respective Criterion-Referenced Competency Test (CRCT) data for first and third grade. CRCT linkage was considered as follow-up points, and the final dataset for analysis included 176,674 observations. Association between the outcome - change in first to third grade CRCT--and exposure were assessed using multinomial regression. A supplementary analysis using logistic regression was also performed, using third grade failure as the outcome of interest.

Results: Across all three outcome contrasts relative to pass-pass, extremely preterm births (compared to term births) had the strongest exposure-outcome relationships. Notably, the odds of failing, then passing the CRCT (i.e. catch-up) relative to passing in both first and third grades among extremely preterm births compared to term births across all components was: math [OR=1.9, 95% CI (1.3, 2.9)], ELA [OR= 2.0, 95% CI (1.5, 2.6)], and reading [OR= 2.2, 95% CI (1.7, 3.0)]. Extremely preterm births, relative to term births, had the highest odds of failing each third grade CRCT component - math [OR=2.1 95% CI (1.7, 2.6)], ELA [OR=1.9, 95% CI (1.4, 2.5)], and reading [OR=1.7, 95% CI (1.4, 2.2)]. First grade failure was also the strongest predictor of third grade failure for each component.

Conclusion: It is unknown if, or when, cognitive catch-up following preterm birth occurs. Generally speaking, there was an inverse dose-response relationship by the association of preterm status on CRCT outcome change and third grade outcome only.

Table of Contents

Chapter I: Literature Review 1

Introduction 1

Preterm Birth 2

Social and Demographic Patterns in Preterm Birth 3

Education and Health 9

Preterm Birth on Childhood Education 11

Research Aims 14

Chapter II: Manuscript 17

Abstract 17

Introduction 18

Methods 19

Results 23

Discussion 28

Tables 33

Table 1. Descriptive statistics of retrospective birth to school cohort 33

Table 2. Crude multinomial logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of exposure and selected characteristics with change of the CRCT math component from first to third grade 37

Table 3. Crude multinomial logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of exposure and selected characteristics with change of the CRCT English/Language Arts (ELA) component from first to third grade 39

Table 4. Crude multinomial logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of exposure and selected characteristics with change of the CRCT reading component from first to third grade 41

Table 5. Adjusted multinomial logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of exposure with change of CRCT components from first to third grade 43

Table 6. Tetrachoric correlation coefficients for first grade CRCT components 45

Table 7. Crude logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of failure of third grade math, English/Language Arts (ELA), and reading components of the CRCT for selected characteristics 45

Table 8. Adjusted logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of failure of third grade math, English/Language Arts (ELA), and reading components of the CRCT for selected characteristics 47

Figures 48

Figure 1. Adjusted multinomial logistic regression odds ratio (OR) estimates and 95% confidence intervals (CI) of exposure with change of CRCT components - math (top), ELA (middle), and reading (bottom) - from first to third grade 48

Figure 2. Directed acyclic graph for the relationship between preterm birth and third grade CRCT results, conditional on first grade CRCT results, considering the unmeasured impact of schooling 49

Chapter III: References 50

Chapter IV: Future Directions 58

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	cognitive development educational achievement preterm birth education
Committee Chair / Thesis Advisor	Kramer, Michael R, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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