Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm

Abstract

BackgroundTo determine if a key marker of socioeconomic status, maternal education, is associated with later neurocognitive and academic outcomes among children born extremely preterm (EP).MethodEight hundred and seventy-three children born at 23 to 27 weeks of gestation were assessed for cognitive and academic ability at age 10 years. With adjustments for gestational age (GA) and potential confounders, outcomes of children whose mothers had fewer years of education at the time of delivery and children whose mother advanced in education between birth and 10 years were examined.ResultsChildren of mothers in the lowest education stratum at birth were significantly more likely to score ≥2 SDs below normative expectation on 17 of 18 tests administered. Children of mothers who advanced in education (n=199) were at reduced risk for scoring ≥2 SDs on 15 of 18 measures, but this reduction was statistically significant on only 2 of 18 measures.ConclusionAmong EP children, socioeconomic disadvantage at birth, indexed by maternal education, is associated with significantly poorer neurocognitive and academic outcomes at 10 years of age, independently of GA. Maternal educational advancement during the child's first 10 years of life is associated with modestly improved neurocognitive outcomes.

Figure 1.. Box-and-whisker plots of neurocognitive and academic subtests by maternal education category.

Z-scores were adjusted to population norms. Light gray bars indicate ≤ 12 years education, medium gray bars indicate > 12 but < 16 years education, and dark gray bars indicate ≥ 16 years education. The central line in the box indicates the median, and the top and bottom lines indicate the 75^th centile and 25^th centile, respectively. V=Verbal, NV=Nonverbal Reasoning, WM=Working Memory, LC=Listening Comprehension, OE=Oral Expression, WR=Word Reading, PdD=Pseudoword Decoding, NO=Numerical Operations, Sp=Spelling, AA=Auditory Attention, RS=Auditory Response Set, INI=Inhibition Inhibition, INS= Inhibition Switching, AS= Animal Sorting, INN=Inhibition Naming, AW=Arrows, GEO=Geometric Puzzles. Maximum N = 873.

Figure 2.. Top Panel: Odds ratios (95% confidence intervals) of Z-scores ≤ −2 or > −2 but ≤ −1 for neurocognitive subtests associated with maternal education ≤ 12 years and > 12 but < 16 years at the time the child was born.

All models are adjusted for non-white race, maternal IQ (KBIT-2 Z-score ≤ −1), gestational age (23–24 and 35–26 weeks), and birth weight Z-score < −1; and all models account for the correlations between children from the same pregnancy. Bottom Panel: Odds ratios in the bottom panel are adjusted additionally for advance in maternal educational status between the birth of the child and the child’s 10-year assessment. Large black dots indicate ORs significantly > 1.0. Maximum N=873.