Background: While many studies have established prematurity (births occurring before 37 weeks of gestation) as a major risk factor for neonatal morbidity and mortality, and poorer cognitive ability, the evidence on poorer cognitive outcomes/school performance in early term births (births occurring at 37–38 weeks gestation) versus that of full term births (39–41 weeks) is inconsistent. This dissertation seeks to add to the existing literature by assessing the relationship between gestational age (specifically early term births) and school performance controlling for the impact of unmeasured qualities of the family environment that may impact this association by using data from siblings.
Methods: This study uses linked birth registry and school records from the Longitudinal Study of Early Development (LSED) data warehouse, and includes children born in New York City between 1994 and 1998 who attended a New York City Public School during the 3rd grade. School performance is measured based on 3rd grade Math and English Language Arts (ELA) standardized test z-scores. Gestational age is based on the obstetric estimate from the birth certificate. Analysis utilizes a hybrid random effects model to allow for simultaneous estimation of within and between sibling group effects of gestational age on ELA and Math z-scores. Models control for various demographic and clinical characteristics previously associated with gestational age and school outcomes.
Results: A total of 31,647 births in 15,432 sibling groups (range 2–4 siblings/group) were included in the analysis. Modeling revealed that a within sibling group difference in gestational age was not associated with a significant difference in ELA z-score (β = –0.003, 95% CI: –0.03, 0.03) nor Math z-score (β = 0.007, 95% CI: –0.02, 0.04). However, several other variables (e.g. birth order, blood lead level, size for gestational age) were associated with significant within sibling group differences in ELA and Math z-scores.
Conclusions: Being born early term (37–38 weeks) versus full term (39–41 weeks) was not associated with standardized test score performance. Among children born at 37 or greater weeks’ gestation, familial, social and environmental factors that have been shown to increase the probability of giving birth before or after 37 weeks are also associated with poorer school outcomes.
|Advisor:||Passannante, Marian R.|
|Commitee:||Kim, Soyeon, Demissie, Kitaw, Mehta, Rahjeev|
|School:||Rutgers The State University of New Jersey, School of Graduate Studies|
|School Location:||United States -- New Jersey|
|Source:||DAI-B 82/1(E), Dissertation Abstracts International|
|Subjects:||Epidemiology, Public health|
|Keywords:||Early term, Gestational age, Multilevel model, School performance|
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