Small for gestational age—cognitive performance from infancy to adulthood: an observational study

Abstract

Objective To determine whether cognitive performance from infancy to adulthood is affected by being born small for gestational age (SGA), and if this depends on the SGA reference used. Furthermore, to determine SGA’s effect while considering the effects of very preterm/very low birthweight (VP/VLBW), socio‐economic status (SES) and parent–infant relationship. Design, setting and population A total of 414 participants (197 term‐born, 217 VP/VLBW) of the Bavarian Longitudinal Study. Methods Small for gestational age was classified using neonatal or fetal growth references. SES and the parent–infant relationship were assessed before the infant was 5 months old. Main outcome measures Developmental (DQ) and intelligence (IQ) tests assessed cognitive performance on six occasions, from 5 months to 26 years of age. Results The fetal reference classified more infants as SGA (<10th centile) than the neonatal reference (n = 138, 33% versus n = 75, 18%). Using linear mixed models, SGA was associated with IQ −8 points lower than appropriate for gestational age, regardless of reference used (95% CI −13.66 to −0.64 and 95% CI −13.75 to −1.98). This difference narrowed minimally into adulthood. Being VP/VLBW was associated with IQ −16 (95% CI −21.01 to −10.04) points lower than term‐born participants. Low SES was associated with IQ −14 (95% CI −18.55 to −9.06) points lower than high SES. A poor parent–infant relationship was associated with IQ −10 points lower than those with a good relationship (95% CI −13.91 to −6.47). Conclusions Small for gestational age is associated with lower IQ throughout development, independent of VP/VLBW birth, low SES or poor parent–child relationship. Social factors effects on IQ comparable to those of SGA and should be considered for interventions. Tweetable abstract Small for gestational age is associated with lower cognitive performance from infancy to adulthood.

Developmental Trajectories in Very Preterm Born Children Up to 8 Years: A Longitudinal Cohort Study

“…This indicates the importance of other factors that might influence development over time, for example early childhood interventions such as an extensive physiotherapy program or special education assistance. Moreover, socio-environmental factors such as the quality of the parent-child relationship are important throughout development ( 16 ).…”

“…Currently available outcome data are often limited to cross-sectional measurements in toddlerhood, but longitudinal follow-up of children is important. Early suboptimal functioning may form an important signal for later problems or an indication for early intervention, and impairments may persist over childhood into adolescence and adulthood (11)(12)(13)(14)(15)(16). Moreover, there may be considerable variation in individual trajectories that is not detectable in cross-sectional studies (17).…”

Impact of Home Parenting Environment on Cognitive and Psychomotor Development in Children Under 5 Years Old: A Meta-Analysis

“…Human development is the product of the interaction between certain congenital conditions and acquired developmental environment ( 11 ). During the rapid growth in early childhood, the brain particularly is vulnerable to external factors such as nutritional status, socioeconomic factors, and parent–child relationships ( 1 , 12 ). Such stimuli directly or indirectly have a positive or negative impact on children ( 13 ).…”

Lower hypothalamus subunit volumes link with long-term growth failure after preterm birth: a longitudinal case-control study

“…7, 8 In detail, a neonatal reference was applied for calculation of “birth weight for gestational age z-scores” (referred to as “birth weight z-scores” in our study). We used Voigt’s neonatal population database comprising 2.3 million live and still singleton births in Germany from 1995 to 2000 with a GA from 20 to 43 weeks, 9, 10 allowing for sex-specific weight percentiles to be calculated. For calculation of body weight z-scores at all other ages a reference was applied comprising percentiles of body weight in children and adolescents including 17.147 males and 17.275 females, aged 0-18 years, evaluated from different regional German studies.…”