Gestational Age and Cognitive Development in Childhood

Abstract

IMPORTANCE Preterm and early-term births are known risk factors for cognitive impairment, but studies that comprehensively include genetics, prenatal risk, and child-specific factors in high-risk populations are lacking. OBJECTIVE To investigate the long-term cognitive outcomes of children born at various gestational ages, including very preterm (28-31 weeks), moderately preterm (32-33 weeks), late preterm (34-36 weeks), and early term (37-38 weeks), compared with full-term (≥39 weeks), accounting for genetics and other risk factors. DESIGN, SETTING, AND PARTICIPANTS In this prospective, multicenter, longitudinal cross-sectional study, children aged 9 to 10 years were recruited from the Adolescent Brain and Cognitive Development Study between January 1, 2016, and December 31, 2018. Children underwent cognitive assessments using the National Institutes of Health Toolbox, Little Man Task, and Rey Auditory Verbal Learning Test. Polygenic scores for cognitive performance (cogPGS) were generated using results of a genome-wide association study from the genetic variants related to cognitive performance, educational attainment, and mathematical ability. Data analysis was performed from March to June 2024. EXPOSURE Preterm (very preterm, moderately preterm, late preterm) and early-term birth status, with full-term birth status as the reference group. MAIN OUTCOMES AND MEASURES The primary outcome of interest was the composite cognitive score, while secondary outcomes included individual cognitive domain scores. Hierarchical regression models were used to examine associations between gestational age and cognitive outcomes, adjusting for socioeconomic status (SES), cogPGS, prenatal risks, and child-specific factors. RESULTS Among 5946 children included in the study (mean [SD] age, 9.9 [0.6] years; 3083 [51.8%] male), 55 (0.9%) were born very preterm, 110 (1.8%) were born moderately preterm, 454 (7.6%) were born late preterm, 261 (4.4%) were born early term, and 5066 (85.2%) were born full term. The cogPGS was positively associated with the composite cognitive score (β = 0.14; 95% CI, 0.12-0.17; P